The man who has been hailed as “the best state chair in the country” is not a national household name. He’s not even a household name in his own state. But on a recent afternoon in the small village of Grafton, Wisconsin, Ben Wikler might as well have been Bono.
Two dozen middle-aged and retired volunteers stood in line to clutch the hand of the chair of the Wisconsin Democrats. “Thank you for everything you do,” they said, beaming at Wikler as he took a lap through the Ozaukee County party headquarters. “We’re so happy you’re here.” Like proud children before an admiring parent, the volunteers told him how much money they’d raised and how many doors they’d knocked on this summer.
“This is Connie,” someone said, patting a woman’s shoulder. “She just won the school-board race.” “Yay, school board!” Wikler cheered.
He was there to kick off the last day of door knocking for a Wisconsin state-assembly candidate who had very little chance of winning in solid-red Ozaukee County, an exurban district on the shore of Lake Michigan north of Milwaukee. But the point was not to win, it was to lose by less. That afternoon, Wikler managed to deliver a speech with almost the same inspirational zeal as Aragorn at the Black Gate. “This election is a demonstration to ourselves as Democrats and to the country that there is change happening right now,” he told the volunteers—and a reminder to Republicans “that Democrats have not given up on democracy.”
Since becoming chair in 2019, Wikler has brought his party back from virtual irrelevance in Wisconsin. Four years after Donald Trump had demolished the so-called blue wall in the upper Midwest, Wikler’s leadership helped tip Wisconsin—and the entire presidential election—to the Democrats in 2020. Then, earlier this year, the millions of dollars Wikler had raised helped a progressive candidate prevail in the off-cycle state-supreme-court race, which will likely lead to a reworking of Wisconsin’s extremely gerrymandered maps.
Wikler’s talent is getting people to show up. He does this by framing every race as the election of a lifetime. “Resources tend to flow toward the places where they can make a difference or their imagination has been captured,” he told me.
Resources is something of a euphemism; he really means dollars. Thanks to legislation passed by Republicans a few years ago, Wisconsin is one of the few states in which individuals can donate unlimited amounts to political parties, which can, in turn, transfer unlimited funds to candidates.It is Wikler’s particular genius to have turned that weapon of fundraising against the party that made it law.
In the run-up to next year’s presidential election, American eyeballs will once again be on Wikler’s home. “If we could have a Ben Wikler in all 50 states, the Democratic Party would be in better shape,” Jon Favreau, the podcaster and former Obama speechwriter, told me. But people may be getting tired of elections with existential stakes, however much the party spends persuading them to go out and vote. Capturing imaginations once again, especially on behalf of an elderly incumbent with less-than-great approval ratings, could be Wikler’s most formidable challenge yet.
I hitched a ride to the Ozaukee County event with Wikler’s posse in their rented minivan. When I slid open the back door, I found the state party chair buckled into a seat in the middle row, his head grazing the ceiling. The 42-year-old Wikler, who is goateed and tall (6 foot 4), was wearing clear-framed glasses and a denim shirt over denim jeans. He looked like a Brooklyn dad—but Wikler is a dad from Madison, a fact he is very proud of.
I’d hardly sat down before Wikler launched into a 30-minute refresher course, for my benefit, on Wisconsin’s idiosyncratic past. Robert La Follette and the state’s socialist roots. Senator Joe McCarthy. Governor Tommy Thompson’s welfare reform. Then more recent history: Scott Walker’s ascension to the governor’s mansion in 2011, and Republicans’ success in flipping both chambers of the state legislature. Walker’s Act 10 legislation, which eroded the power of public unions. The GOP’s controversial and secretive redistricting project.
“How many times have you delivered that spiel?” I asked when he was done.
He smiled. “There’s actually an extended version.”
Today, Wikler lives in his childhood home on Madison’s west side with his wife, his three kids, and their enormous, excitable Bernese mountain dog. But before moving back to the upper Midwest, Wikler was the Washington, D.C., director of the progressive organization MoveOn, for which he led protests against Republican attempts to overturn the Affordable Care Act. Prior to that, Wikler hosted a politics podcast called The Good Fight after a spell as a researcher and producer for Al Franken. The former senator from Minnesota remains a close friend. “He’s just brilliant—really funny and a really good writer,” Franken told me of Wikler last month, over the phone. “He has the full package, and that’s hard to get in a state chairman.” (The title of Franken’s 2003 book, Lies and the Lying Liars Who Tell Them, was Wikler’s idea, Franken said.)
Then, in 2016, Trump hurtled through the blue wall, winning Wisconsin’s Electoral College votes for the Republicans for the first time since Ronald Reagan in 1984. Which is why Wikler ultimately decided to move back home and help revive his party’s fortunes.
As chair, Wikler is known for posting climactic Twitter threads about Wisconsin elections that go viral. He’s constantly giving interviews to convey the urgency of races up- and down-ballot. The central strategy of his chairmanship, Wikler told me, “has been to buy a bigger siren, and put it as high up as we possibly can.”
Most state parties in America have somewhere around half a dozen full-time paid staff members, but Wikler has expanded his staff from 30 to 70.He has a comprehensive digital operation, an in-house research group, and a full-time staff of youth organizers.
Since 2019, Wikler has used his connections in national politics to raise more than $110 million, an astoundingly high amount for a state party. His team’s most successful money-gathering endeavor was getting celebrities such as Robin Wright and Julia Louis-Dreyfus to care about the Badger State: In September 2020, the Wisconsin Democrats hosted a Zoom table reading of the 1987 film The Princess Bride that reunited most of the original cast. The event attracted more than 100,000 viewers and raised $4.25 million. So they did it twice more, with the casts of The West Wing and Veep.
Wisconsin could have gone the way of neighboring Iowa, which has turned sharply to the right in these past six years. In the Badger State, the trend toward Democrats began in 2018, when many voters revolted against Trump. But thanks in large part to the machine that Wikler has built, the party has continued to win by bigger and bigger margins in the state’s metropolitan areas in the past few cycles, and it’s losing by smaller margins in the Republican-leaning suburbs of Milwaukee. Although Democrats nationally have been hemorrhaging voters in rural areas, they’ve managed to at least stop the bleeding in rural Wisconsin, Craig Gilbert, the retired Washington bureau chief for the Milwaukee Journal Sentinel, told me.
Statewide elections have proved to be the most rewarding battlegrounds for Democrats. In Wisconsin, Biden beat Trump in 2020 by 20,000 votes, and last year Democratic Governor Tony Evers narrowly won reelection. The only major disappointment was Mandela Barnes’s loss to the incumbent Republican senator, Ron Johnson. But just this past spring, Wisconsinites elected Janet Protasiewicz to the state supreme court in a race that broke turnout records and attracted donations from George Soros, Steven Spielberg, and Illinois Governor J. B. Pritzker.
Wikler’s legacy as a Democratic leader will be the nationalization of the state party’s donor base—something he’s achieved by arguing that Wisconsin is at the epicenter of America’s political battle. Whether that’s good for democracy is another matter.
The wealthy Democrats from California or Illinois who’ve done much of the donating are not ideal stand-ins for regular Wisconsinites. “Elections shouldn’t be a tug-of-war between a handful of billionaires on the right and a handful of billionaires on the left,” Matthew Rothschild, the former executive director of the Wisconsin Democracy Campaign, told me. “But Ben didn’t make the playing field. Republicans in Wisconsin made the playing field. The U.S. Supreme Court made the playing field.”
If Wikler’s strategy is to make politics in Wisconsin national, he is also committed to hyperlocal campaigning: Democrats should have a presence everywhere, Wikler believes. Which is why the van drove another two hours west from Grafton to Baraboo for an annual agricultural-equipment expo.
The state party’s Rural Caucus had set up a tent between the crop-spraying-drone display and a demonstration area for grinding forest products. Wikler gave a pep talk to some of his members before striding over to the Sauk County Republicans’ tent. “Hi, I’m the Democratic Party chair,” he said, extending his hand toward a trio of 60-something men chatting in the shade. For a few minutes, the four men went back and forth, a little awkwardly, about the successes and failures of the former Governor Walker and whether any of them were particularly excited about a second nomination of Trump. (They weren’t.) It was all pleasant enough.
Then, as Wikler turned to leave, one of the men took him aside. “I gotta tell you something,” he said, in a low voice. “I spoke with a gentleman over at your tent this morning, and I have never met a finer man or had a more reasonable conversation.” Wikler beamed. “As a party chair, that’s a delight to hear,” he replied.
We left Baraboo in the late afternoon for a volunteer picnic in Middleton, a leafy Madison suburb along Lake Mendota. The gathering was held in a lush backyard, full of unruly flowering shrubs and the kind of wacky animal lawn ornaments that seem to announce, A Democrat lives here!
The yard was full of gray-haired volunteers from different neighborhood door-knocking teams. “I don’t think we could have done anything without Ben,” JoAnna Richard, the host of the event, told me. “His leadership has been key: his connections, and how we fundraise and organize year-round.” A few minutes later, Wikler was giving his third and final motivational speech of the day, thanking people for their work over the past few years. We’re “building something bigger than any of us,” he told them. “You’re at the heart of that project, in a place that is the most key furnace for democracy—the key engine, the center of the web.”
Republicans are working hard for a rebound in Wisconsin. Later this month, they’ll host the first debate of the GOP presidential primary in Milwaukee, and the Republican National Convention will be held in the same city next summer. That national attention will be good for the state party, which has recently under-raised Democrats.
“They’ve been very good at getting Hollywood money,” Brian Schimming, the state GOP chair, told me by phone, with what sounded like a mix of shade and envy. “It’s hard to compete with” the Democrats’ celebrities and wealthy out-of-state donors, he said. “I need to nationalize Wisconsin a bit more.”
This time around, Republicans are certainly going to be more focused on fundraising. “Ben would be kidding himself if he thinks he or his successor can always win the money race,” Rothschild told me. But money is not the race that ultimately matters.
“I’d rather have my problem than the problem Ben has, which is an extraordinarily unpopular sitting incumbent,” Schimming told me. “Our folks are really fired up about this race.”
Wikler, in fact, does seem a little nervous. He worries about a low-turnout election—and that people aren’t taking seriously enough the very real possibility of a second Trump presidency. “In 2020, people were ready to do anything to beat Trump. I had people retiring early and moving to Wisconsin to volunteer,” he told me in the car. “None of that’s happening right now.”
Every recent presidential election in Wisconsin has been decided on a razor-thin margin, and Wikler’s job is to engage more than just the highly educated, high-income activist types. He’ll need to stitch together a delicate coalition and get them all to fill out a ballot: young people in Dane County; Black voters in Milwaukee; moderates in the suburbs and the small cities around Green Bay. The hurdles are already high, and Biden doesn’t exactly get many people’s blood pumping. “I’ve been concerned about that since 2020,” Favreau said. “It’s easy to see a scenario where a couple people say, ‘[Biden’s] too old. I’m going back to Trump.’” It’s even easier to see a situation in which some Wisconsinites, weary of it all, simply don’t vote.
In JoAnna Richard’s backyard in Middleton, Wikler was winding up his pep talk, a little breathlessly. They’d be working “throughout this year, and into next spring in the local elections, and into next fall in 2024,” he said. “And then we’ll continue six months after that in the 2025 local elections! And the next state-supreme-court race—”
A few people audibly sighed at this point, likely in anticipation of another two exhausting years door knocking and phone banking and envelope licking in defense of democracy. A man near me shouted, “We’re tired!” But that moment of wavering enthusiasm lasted only a fraction of a second before the whole group began to laugh.
Sure, they’re tired. But for Wikler, they’ll show up.
In Phoenix, a high of 108 degrees Fahrenheit now somehow counts as a respite. On Monday, America’s hottest major city ended its ominous streak of 31 straight days in which temperatures crested past 110. The toll of this heat—a monthly average of 102.7 degrees in July—has been brutal. One woman was admitted to a hospital’s burn unit after she fell on the pavement outside her home, and towering saguaros have dropped arms and collapsed. Over the past month, hospitals filling up with burn and heat-stroke victims have reached capacities not seen since the height of the pandemic.
“Why would anyone live in Phoenix?” You might ask that question to the many hundreds of thousands of new residents who have made the Arizona metropolis America’s fastest-growing city. Last year, Maricopa County, where Phoenix sits, gained more residents than any other county in the United States—just as it did in 2021, 2019, 2018, and 2017.
At its core, the question makes a mystery of something that isn’t a mystery at all. For many people, living in Phoenix makes perfect sense. Pleasant temperatures most of the year, relatively inexpensive housing, and a steady increase in economic opportunities have drawn people for 80 years, turning the city from a small desert outpost of 65,000 into a sprawling metro area of more than 5 million. Along the way, a series of innovations has made the heat seem like a temporary inconvenience rather than an existential threat for many residents. Perhaps not even a heat wave like this one will change anything.
My first morning in Phoenix, more than 20 years ago, the sun broke the horizon two miles up a trail in South Mountain Park, one of the largest municipal parks in the United States. I had arrived the previous night from Michigan, leaving behind the late-March dreariness that passes for spring in the Midwest for several months of research that would become my book, Power Lines. As the sun turned the mountain golden and I stripped down to short sleeves for the first time in months, I realized the Valley of the Sun’s charms.
Outside the summer months, the quality of life in Phoenix is really quite high—a fact that city boosters have promoted stretching back to before World War II. They traded the desiccated “Salt River Valley” for the welcoming “Valley of the Sun.” Efforts to downplay the dangers of Phoenix’s climate go back even further. In 1895, when Phoenix was home to a few thousand people, a local newspaper reported that it had been proved “by figures and facts” that the heat is “all a joke,” because the “sensible temperature” that people experienced was far less severe than what the thermometers recorded. “But it’s a dry heat” has a long history, one in which generations of prospective newcomers have been taught to perceive Phoenix’s climate as more beneficial than oppressive.
Most people surely move to Phoenix not because of the weather, but because of the housing. The Valley of the Sun’s ongoing commitment to new housing development continues to keep housing prices well below those of neighboring California, drawing many emigrants priced out of the Golden State. Subdivisions have popped up in irrigated farm fields seemingly overnight. In 1955, as the home builder John F. Long was constructing Maryvale, then on Phoenix’s western edge, he quickly turned a cantaloupe farm into seven model homes. Five years later, more than 22,000 people lived in the neighborhood; now more than 200,000 do. Even today, the speed of construction can create confusion, as residents puzzle over the location of Heartland Ranch or Copper Falls or other new subdivisions that include most of the 250,000 homes built since 2010.
Even in the summer, you might not always notice just how harsh of a terrain Phoenix can be. Developers engage in a struggle to secure water rights, tapping groundwater aquifers, drawing water from the Colorado River brought to the city by aqueduct, and purchasing water from local farmers. Air-conditioning is the lifeblood of Phoenix, as much a part of the city as the subway system is in New York. In 1961, Herbert Leggett, a Phoenix banker, spoke of his normal summer day to The Saturday Evening Post: “I awake in my air-conditioned home in the morning … I dress and get into my air-conditioned automobile and drive to the air-conditioned garage in the basement of this building. I work in an air-conditioned office, eat in an air-conditioned restaurant, and perhaps go to an air-conditioned theater.”
In the kind of air-conditioned bubbles Leggett described, it is actually possible for people like me, who work indoors, to forget the heat and oppression of Phoenix’s summer—that is, until we have to scurry across a parking lot or cross concrete plazas between buildings. Starting in late April, when high temperatures regularly hit over 90, many residents fire up their AC, using it until October, when highs once again drop into the 80s. At the height of summer, Phoenix becomes virtually an indoor city during the day. Remote car starters become valuable amenities for taking the edge off the heat. Runners wake before dawn to exercise, and dogs are banned from hiking trails in city parks on triple-digit days. With air-conditioning, the benefits of Phoenix outweigh the drawbacks for many residents.
But this lifestyle comes with a cost. Electricity consumption has soared in Phoenix, almost doubling in the average home from 1970 to today. At the height of its operation, Four Corners Power Plant, only one of five such coal-fired power plants built north of Phoenix to help power the region’s growth, emitted 16 million tons of carbon annually, equivalent to the annual emissions of more than 3.4 million cars. Even today, with most coal-fired generation retired, Phoenix relies heavily on carbon-emitting natural gas for its electricity. Both the past and present of Phoenix’s energy worsens the very heat its residents are trying to escape.
Air-conditioning protects most people, but especially as the heat intensifies, those without it are left incredibly vulnerable. Elderly women living alone, many of whom struggle to maintain and pay for air-conditioning, are particularly susceptible, accounting for the majority of indoor heat-related deaths. Unhoused people, whose population in Phoenix has increased by 70 percent in the past six years, suffer tremendously and make up much of the death toll. One unhoused man recently compared sitting in his wheelchair to “sitting down on hot coals.”
This heat wave will end, but there will be another. Still, the horror stories of life in 115 degrees is hardly guaranteed to blunt Phoenix’s explosive growth. There are currently building permits for 80,000 new homes in the Phoenix metro area that have not yet commenced construction—homes that will require more water, more AC, and more energy.
But in a sense, nothing about Phoenix is unusual at all. The movement from air-conditioned space to air-conditioned space that Leggett described—and the massive energy use that makes it all run—is now typical in a country where nearly 90 percent of homes use air-conditioning. Clothing companies such as Land’s End advertise summer sweaters that “will come to your rescue while you’re working hard for those eight hours in your office, which might feel like an icebox at times.” And heat has claimed lives in “temperate” cities such as Omaha, Seattle, and Boston. Indeed, one 2020 study concluded that the Northeast had the highest rate of excess deaths attributable to heat.
“Why would anyone live in Phoenix?” serves as nothing more than a defensive mechanism. It makes peculiar the choices that huge numbers of Americans have made, often under economic duress—choices to move to the warm climates of the Sun Belt, to move where housing is affordable, to ignore where energy comes from and the inequalities it creates, and, above all, to downplay the threats of climate change. In that way, Phoenix isn’t the exception. It’s the norm.
As recently as the 1990s, Jodi Stookey, a nutrition consultant based in California, remembers hydration research being a very lonely field. The health chatter was all about fat and carbs; children routinely subsisted on a single pouch of Capri Sun a day. Even athletes were discouraged from sipping on fields and race tracks, lest the excess liquid slow them down. “I can’t tell you how many people told me I was stupid,” Stookey told me, for being one of water’s few advocates.
But around the turn of the millennium, hydration became an American fixation. Celebrities touted water’s benefits in magazines; branded bottles overran supermarket shelves. Academic research on hydration underwent a mini-boom. After ages of being persistently parched, we were suddenly all drinking, drinking, drinking, because we felt like we should. It was an aquatic about-face—and it didn’t make total scientific sense.
The importance of hydration, in the abstract, is indisputable. Water keeps our organs chugging and our muscles agile; it helps distribute nutrients through the body and maintains our inner thermostat. Take it away, and cells inevitably die. But the concrete specifics of adequate water intake are still, in large part, a mess. For hydration, “there are no clear numbers, or a threshold you have to maintain,” says Yasuki Sekiguchi, a sports-performance scientist at Texas Tech University. Experts don’t agree on how much water people need, or the best ways to tell when someone should drink; they differ on how to measure hydration, which beverages are adequately hydrating, and how much importance to attribute to thirst. They have yet to reach quorum on what hydration—a process that’s sustained life since its primordial inception—fundamentally is. The murkiness has left the field of hydration research, still relatively young and relatively small, rife with “vicious camps against each other,” says Tamara Hew-Butler, an exercise physiologist at Wayne State University.
Forget, for instance, one of water’s most persistent myths: the oft-repeated advice to down eight 8-ounce glasses of water each day. No one can say for certain, but one theory is that the idea sprouted from a misinterpretation of a nutrition document from the 1940s, which stated that 2.5 liters of water a day (that is, approximately 10 8-ounce glasses) was “a suitable allowance for adults” in “most instances.” The guidance also noted, in the very same paragraph, “Most of this quantity is contained in prepared foods.” But the bigger issue is this: Probably no single number for water intake will ever suffice—not for a population of people with varying weights, genetics, diets, and activity levels, living in varying climates. Even within an individual, what’s best will change through a lifetime. The answer to How much water should I be drinking? is invariably Uh, it really depends.
Today’s hydration zeitgeist seems to hold that no amount of water is too much. The market teems with intake-tracking smartphone apps and time-stamped bottles that cheer drinkers toward hydration goals as high as a gallon a day—a quota astronomical enough to be stressful, even dangerous, should people flood their bodies all at once. But America’s hydration hype machine “has established a narrative that we are all walking around dehydrated, and need to drink more,” Hew-Butler told me. It’s no wonder that some people have reported legitimate anxiety over falling short on water intake.
No single source sold America on water. But a 2021 episode of the podcast Decoder Ringpoints to Gatorade as one of the first companies to pitch dehydration as a health problem—while simultaneously offering a cure. The company’s sports drinks were originally billed as thirst-quenchers, designed to stave off performance dips. But by the 1980s, Decoder Ring reported, the Gatorade Sports Science Institute was churning out data that supported the benefits of drinking before the mouth got parched. A decade later, the American College of Sports Medicine was recommending that athletes consume “the maximal amount” of water they could stand to keep down.
Around the same time, during the fitness craze of the ’70s and ’80s, water was acquiring another identity: the enlightened socialite’s clean drink of choice. When European companies such as Perrier and Evian brought their bottled water to North America, they found a market among those wanting a high-end, calorie- and sweetener-free alternative to sodas, alcohol, and juice. Water “had this healthy, good-for-you halo,” says Michael Bellas, the chair and CEO of the Beverage Marketing Corporation. “There were no negatives.” In 2016, water became the U.S.’s leading bottled beverage, a title it has maintained since.
As water’s market share grew, so did its mythos. Companies hocked the illusion that their products could make people not just healthier but “sexier and more popular,” Peter Gleick, the author of The Three Ages of Water, told me. Hydration was so clearly vital to life that truth-adjacent ideas about its benefits, many of them pushed by prominent people, were easy to buy. Even concerns over single-use plastic bottles could not slow water’s roll: In response, the world cooked up eco-friendly Yetis, HydroFlasks, and Nalgenes, and made those trendy, too.
It’s not that water isn’t healthy. There’s just no evidence to show that guzzling tons of water can fix all our ailments. For people prone to kidney stones and UTIs, drinking more has been shown to cut down on risks; as a swap for sugary beverages, it can also help with weight loss. But for a variety of other issues—such as heart disease, metabolic issues, and cancer—the data is often “really mixed,” Hew-Butler told me. Although researchers have sometimes found evidence that dehydration may raise certain conditions’ risks, that doesn’t automatically imply the inverse—that extra water intake then lowers risk from a typical baseline. At very rare extremes, overdoing it on water can kill us, too.
The connections between hydration and health are shaky enough that health authorities have been reluctant to push a strict recommended daily allowance, like the ones that exist for various vitamins. Instead, the National Academy of Medicine proposes a tentative “adequate intake”: 3.7 liters of total water intake for men, and 2.7 for women (both including hydration from food). Recently, Abigail Colburn, a physiology researcher at Yale, and her colleagues ran an analysis that concluded those figures were sound. Still, the numbers came from population surveys, published in the early aughts, of the amounts that Americans were already drinking—a reflection of how things were, but not necessarily how they should be. And they represent medians within a huge range. Over the years, multiple studies have documented people living, by all appearances healthfully, on daily water budgets that span less than a liter to four, five, or six—sometimes more.
If researchers don’t agree on how much water is good, they also differ on how little water is bad: the point at which dehydration starts to become a problem—or how long people can linger at that threshold without raising long-term health risks.
A bit of water loss should be completely fine. Fluid status is, by design, “a constantly changing state,” Colburn told me. When the body doesn’t take in enough water to recoup the liquid it’s lost—as it naturally does throughout the day, via sweat, urine, and breath—the brain releases a hormone called vasopressin that prompts the kidneys to hold onto fluid. The urine gets darker and less voluminous; eventually, blood-salt levels rise, and the mouth and throat ache with thirst. The goal is to get the body to excrete less water out and take more in so we don’t wring our vital tissues dry. Life forms have evolved to tread carefully down this cascade of steps, and the flexibility is built in—much like a rubber band that snaps back after being stretched and released.
But some researchers have started to worry about repeatedly asking the body to compensate for less than optimal hydration—stretching the band over and over again. The issue isn’t chronic dehydration, Colburn told me, but a subtler precursor state called underhydration, which occurs after a lack of water intake has prompted the body to conserve but before the appearance of signals such as thirst. It’s not clear how worrying teetering on that precipice is. In the same way a rubber band is “designed to stretch,” our fluid balance is built to bounce back, says Evan Johnson, a hydration expert at the University of Wyoming. Over time, though, wear and tear could add up, and resilience could drop.
Tracking those outcomes gets even more complicated when researchers try to quantify how dehydrated individual people are—another thing that experts can’t agree on. “We really don’t have a gold standard for measuring the all-encompassing term of hydration,” Johnson told me, especially one that’s both simple and cheap, and can account for body water’s constant flux. Which leaves scientists with imperfect proxies. Broadly speaking, there’s a urine camp and a blood camp, Stookey told me. Those in the pee camp tend to be hydration conservatives. A change in urine color or volume, they argue, is an early sign—well in advance of thirst—of impending dehydration. The blood-camp crew is more laissez-faire. Diet, medications, and supplements can all alter the shade of urine, making it a fickle clue; Hew-Butler for instance, defines true dehydration as what happens when the plasma’s gotten saltier than usual, to the point where cells have started to shrink—a sign that retaining water is no longer sufficient, and that the body needs to drink.
Which camp researchers fall into influenceshow bad they think America’s hydration problem is. “When you draw blood, most people are within a normal range if they’re not thirsty,” Hew-Butler told me. But Stookey, who’s firmly in the pee camp, contends that a majority of Americans are “walking around dehydrated” and should be drinking far more. Colburn, too, would rather err on the side of heeding urine’s warning signs. By the time thirst kicks in, “you’re already in a dangerous zone,” she told me.
There can be a middle ground. Sekiguchi, of Texas Tech, told me that for most young, healthy people who are spending plenty of time in the air-conditioned indoors—as so many Americans do—it’s probably fine to just drink when thirsty. (That advice works less well for older people, because the sensation of thirst tends to dull with age.) When specific circumstances shift—a stint of heavy exercise, a week of toasty days—people can take notice, and adjust accordingly.
But guidelines for typical water intake, under typical conditions, are quickly going out the window as heat waves get more frequent and intense. When temperatures skyrocket and humidity makes otherwise-cooling sweat stick stubbornly on skin, our bodies need more water to keep cool and functional, beyond what thirst alone might dictate. Part of the problem is that thirst vanishes more quickly than the body rehydrates, Sekiguchi told me, which means that people who drink until they think they’re sated tend to replace only a fraction of the fluids that they’ve lost.
“We’re never going to be able to tell people an exact number,” Colburn told me, for how much to drink. But in reality, many of the healthy people most worried about fine-tuning their hydration to a perfect level are probably among those that least need to fret. The dangers of water tend to happen not in those middle grounds, but at its extremes—especially when failing infrastructure hampers access to water, or contamination makes it undrinkable. Many of the populations that are most vulnerable to dehydration’s effects also happen to be the same groups that probably aren’t getting enough to drink, Johnson told me. While bottled-water markets boom, plenty of pockets of the U.S. still lack consistent access to safe, reliable water from the tap. And the situation is even worse in many places abroad. Perhaps nothing reminds us of water’s power like dramatic deficit: Water, simply, is what keeps us alive.
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Outside the door, I heard a flurry of thudding that reverberated back through the floor. I looked at my friend, then stepped in behind her. The room was damp and stuffy, despite a fan droning loudly in the corner. Six people were dispersed across the floor, weaving to their own rhythms. I was 18 and hadn’t been to a gym more than twice in my life; this was my first boxing class.
Though I was the least fit person in the room, the coach put me through all the drills: shadowboxing in front of the mirror (fine), punching a bag (cathartic), light sparring (rough). The coach struck my nose, my forehead, my jaw, my abdomen as he reminded me to keep my hands up and to keep moving. My legs were screaming; even a gentle tap on the nose stung. (It didn’t help that mine’s been broken since I was 7.) I realized that I liked martial arts anyway.
I wasn’t trying to be an amateur fighter, but I wanted to keep getting stronger and quicker. In this boxing class held at my college gym, and at the gyms I found to train in over summers, sparring was a given. The whole point of training was to get better at landing punches (and eluding them) in the ring. I liked to feel myself improving concretely every time I stepped back in to face a real opponent. But after graduating, I discovered that the experience I’d had that first day, an immediate induction into boxing by light sparring, was almost impossible to find.
Over the past several years, the popularity of “fitboxing” classes, which involve intense cardio, strength training, and ab workouts, has skyrocketed. These classes might look a lot like boxing, but they have a key difference: For the grand finale, you get to punch … a bag. Many of these gyms are entirely “noncontact,” and the few that do let you spar tend to charge extra for it. I asked Bryan Corrigan, my coach that first day, what he sees as the value of sparring—why had he started me on it the very first time I’d boxed? “It’s the whole mind game behind boxing and the science of it,” he told me. Yes, getting hit can be scary, but you learn to keep your calm and be strategic in the face of it. Without sparring, “that gets lost.”
For a long time, boxing gyms were, by nature, fighting gyms: You couldn’t find one without a ring. “In the beginning, we only had professional players and amateur fighters,” Bruce Silverglade, the owner of Gleason’s Gym, in Brooklyn, New York, told me. Many gyms were in low-income areas, and many of the people who fought in them were new immigrants or members of minority groups. Some viewed the sport as “a positive alternative to the streets.”
By the time “fitboxing” started to gain ground, that landscape had shifted. Many professional boxing matches had moved to pay-per-view TV, some fans had come to question the sport’s inherent brutality, and others were gravitating toward MMA fights. Professional fights were harder to find in New York and other storied boxing cities; those shows had moved largely to Las Vegas. Many free programs such as Cops and Kids, which made boxing accessible and provided a pathway for promising fighters from underserved neighborhoods, had also shrunk or shut down altogether. People inside and outside the sport were contending with boxing’s violence, and the brain damage that often resulted.
Meanwhile, fitness classes everywhere were exploding: barre, hot yoga, spinning. Fitboxing soon joined the ranks, and enough white-collar professionals were interested to start a sea change: Michael Hughes, the head trainer at Church Street Boxing, in Manhattan, New York, dates this shift to about 2012. Boutique boxing gyms sprang up to cater to this new clientele; many old-school fighting gyms had to revamp their offerings too. “Today, probably 85 percent of my members are businessmen and women that are just here for conditioning workouts,” Silverglade said.
And most of these newer boxers just weren’t interested in sparring, gym owners told me. As a result, now even many more traditional boxing gyms either don’t offer sparring or separate it out from their regular classes. Joey DeMalavez, the owner of Joltin’ Jabs, in Conshohocken, Pennsylvania, explained that sparring is simply not profitable, especially when gym owners have to contend with increasing rents and high insurance costs. “There’s just not enough people that want to get in there and do that,” DeMalavez told me. “To offer sparring into a regular boxing class will scare a lot more people than it’ll help.” What people really want is the experience of boxing without the possibility of getting hit.
The fear concerning safety is real, and it makes sense. Katalin Rodriguez Ogren, the owner of Pow! Gym Chicago, acknowledges the tension. “An old-school boxing gym doesn’t necessarily mean it’s a safe training environment,” she told me in an email. While these gyms will give you what Rodriguez Ogren calls an “authentic” experience, many “don’t understand injury prevention, or have the education to provide safe training classes,” she said. That’s not to say gyms can’t be both safe and authentic to boxing. With sparring (as opposed to actual fighting), the point is not to hurt someone or knock anyone out; it’s to hone accuracy and reflex. You take knocks where your defense is weak, and there is always a risk of accidents, much as in any sport, but the shots are not full power. Being hit and being hurt are different.
There’s nothing wrong with wanting a boxing-inspired workout—all of the boxing coaches I spoke with agreed. It has some very real fitness benefits: It’s good cardio and can build strength and coordination. But fitboxing is not growing in popularity alongside boxing; it’s overtaking boxing. The few authentic boxing gyms I was able to find in Manhattan and Brooklyn can cost more than $100 a month to join. And boxing without sparring is a fundamentally different activity. “I kind of look at it like, Zumba is super fun and I love Zumba, but I’m not going to go to a Zumba class if I actually want to learn how to salsa dance,” Rodriguez Ogren said.
The risk of getting hit gives you direct, instant feedback about how much better you’re getting—and an extra boost of confidence and reward when you find that you are. “In order to keep you safe, you rely on your skill,” Peter Olusoga, a senior psychology lecturer at Sheffield Hallam University who has a background in sports and exercise psychology, told me. “The confidence boost that you get from seeing yourself improving and feeling more competent is really beneficial.” Although simply rehearsing boxing moves, as in fitboxing, can give you a taste, sparring enhances that feeling. Actually trying to hit another person, and keep yourself from being hit, represents a higher level of difficulty and intimacy with your sparring partners.
When I asked people in the boxing world what they consider the inherent value of sparring, many spoke to the discipline gained, or the visceral lessons it offers in dealing with adversity. But for me, it’s even more basic. A boxing-inspired workout is a great way to get in shape; sparring is a mind game. No matter how much I do it, I’ll still get hit, but I can now hold my own in the ring (mostly). I may never want to fight, but sparring is more than a workout—it’s a form of problem-solving that’s equal parts mental and physical. If you’re interested in boxing, I suggest slipping into the ring and actually trying it out.
Alexis Misko’s health has improved enough that, once a month, she can leave her house for a few hours. First, she needs to build up her energy by lying in a dark room for the better part of two days, doing little more than listening to audiobooks. Then she needs a driver, a quiet destination where she can lie down, and days of rest to recover afterward. The brief outdoor joy “never quite feels like enough,” she told me, but it’s so much more than what she managed in her first year of long COVID, when she couldn’t sit upright for more than an hour or stand for more than 10 minutes. Now, at least, she can watch TV on the same day she takes a shower.
In her previous life, she pulled all-nighters in graduate school and rough shifts at her hospital as an occupational therapist; she went for long runs and sagged after long flights. None of that compares with what she has endured since getting COVID-19 almost three years ago. The fatigue she now feels is “like a complete depletion of the essence of who you are, of your life force,” she told me in an email.
Fatigue is among the mostcommon and mostdisabling of long COVID’s symptoms, and a signature of similar chronic illnesses such as myalgic encephalomyelitis (also known as chronic fatigue syndrome or ME/CFS). But in these diseases, fatigue is so distinct from everyday weariness that most of the people I have talked with were unprepared for how severe, multifaceted, and persistent it can be.
For a start, this fatigue isn’t really a single symptom; it has many faces. It can weigh the body down: Lisa Geiszler likens it to “wearing a lead exoskeleton on a planet with extremely high gravity, while being riddled with severe arthritis.” It can rev the body up: Many fatigued people feel “wired and tired,” paradoxically in fight-or-flight mode despite being utterly depleted. It can be cognitive: Thoughts become sluggish, incoherent, and sometimes painful—like “there’s steel wool stuck in my frontal lobe,” Gwynn Dujardin, a literary historian with ME, told me.
Fatigue turns the most mundane of tasks into an “agonizing cost-benefit analysis,” Misko said. If you do laundry, how long will you need to rest to later make a meal? If you drink water, will you be able to reach the toilet? Only a quarter of long-haulers have symptoms that severely limit their daily activities, but even those with “moderate” cases are profoundly limited. Julia Moore Vogel, a program director at Scripps Research, still works, but washing her hair, she told me, leaves her as exhausted as the long-distance runs she used to do.
And though normal fatigue is temporary and amenable to agency—even after a marathon, you can will yourself into a shower, and you’ll feel better after sleeping—rest often fails to cure the fatigue of long COVID or ME/CFS. “I wake up fatigued,” Letícia Soares, who has long COVID, told me.
Between long COVID, ME/CFS, and other energy-limiting chronic illnesses, millions of people in the U.S. alone experience debilitating fatigue. But American society tends to equate inactivity with immorality, and productivity with worth. Faced with a condition that simply doesn’t allow people to move—even one whose deficits can be measured and explained—many doctors and loved ones default to disbelief. When Soares tells others about her illness, they usually say, “Oh yeah, I’m tired too.” When she was bedbound for days, people told her, “I need a weekend like that.” Soares’s problems are very real, and although researchers have started to figure out why so many people like her are suffering, they don’t yet know how to stop it.
Fatigue creates a background hum of disability, but it can be punctuated by worse percussive episodes that strip long-haulers of even the small amounts of energy they normally have.
Daria Oller is a physiotherapist and athletic trainer, so when she got COVID in March 2020, she naturally tried exercising her way to better health. And she couldn’t understand why, after just short runs, her fatigue, brain fog, chest pain, and other symptoms would flare up dramatically—to the point where she could barely move or speak. These crashes contradicted everything she had learned during her training. Only after talking with physiotherapists with ME/CFS did she realize that this phenomenon has a name: post-exertional malaise.
Post-exertional malaise, or PEM, is the defining trait of ME/CFS and a common feature of long COVID. It is often portrayed as an extreme form of fatigue, but it is more correctly understood as a physiological state in which all existing symptoms burn more fiercely and new ones ignite. Beyond fatigue, people who get PEM might also feel intense radiant pain, an inflammatory burning feeling, or gastrointestinal and cognitive problems: “You feel poisoned, flu-ish, concussed,” Misko said. And where fatigue usually sets in right after exertion, PEM might strike hours or days later, and with disproportionate ferocity. Even gentle physical or mental effort might lay people out for days, weeks, months. Visiting a doctor can precipitate a crash, and so can filling out applications for disability benefits—or sensing bright lights and loud sounds, regulating body temperature on hot days, or coping with stress. And if in fatigue your batteries feel drained, in PEM they’re missing entirely. It’s the annihilation of possibility: Most people experience the desperation of being unable to move only in nightmares, Dujardin told me. “PEM is like that, but much more painful.”
Medical professionals generally don’t learn about PEM during their training. Many people doubt its existence because it is so unlike anything that healthy people endure. Mary Dimmock told me that she understood what it meant only when she saw her son, Matthew, who has ME/CFS, crash in front of her eyes. “He just melted,” Dimmock said. But most people never see such damage because PEM hides those in the midst of it from public view. And because it usually occurs after a delay, people who experience PEM might appear well to friends and colleagues who then don’t witness the exorbitant price they later pay.
That price is both real and measurable. In cardiopulmonary exercise tests, or CPETs, patients use treadmills or exercise bikes while doctors record their oxygen consumption, blood pressure, and heart rate. Betsy Keller, an exercise physiologist at Ithaca College, told me that most people can repeat their performance if retested one day later, even if they have heart disease or are deconditioned by inactivity. People who get PEM cannot. Their results are so different the second time around that when Keller first tested someone with ME/CFS in 2003, “I told my colleagues that our equipment was out of calibration,” she said. But she and others have seen the same pattern in hundreds of ME/CFS and long-COVID patients—“objective findings that can’t be explained by anything psychological,” David Systrom, a pulmonologist at Brigham and Women’s Hospital, told me. “Many patients are told it’s all in their head, but this belies that in spades.” Still, many insurers refuse to pay for a second test, and many patients cannot do two CPETs (or even one) without seriously risking their health. And “20 years later, I still have physicians who refute and ignore the objective data,” Keller said. (Some long-COVID studies have ignored PEM entirely, or bundled it together with fatigue.)
Oller thinks this dismissal arises because PEM inverts the dogma that exercise is good for you—an adage that, for most other illnesses, is correct. “It’s not easy to change what you’ve been doing your whole career, even when I tell someone that they might be harming their patients,” she said. Indeed, many long-haulers get worse because they don’t get enough rest in their first weeks of illness, or try to exercise through their symptoms on doctors’ orders.
People with PEM are also frequently misdiagnosed. They’re told that they’re deconditioned from being too sedentary, when their inactivity is the result of frequent crashes, not the cause. They’re told that they’re depressed and unmotivated, when they are usually desperate to move and either physically incapable of doing so or using restraint to avoid crashing. Oller is part of a support group of 1,500 endurance athletes with long COVID who are well used to running, swimming, and biking through pain and tiredness. “Why would we all just stop?” she asked.
Some patients with energy-limiting illnesses argue that the names of their diseases and symptoms make them easier to discredit. Fatigue invites people to minimize severe depletion as everyday tiredness. Chronic fatigue syndrome collapses a wide-ranging disabling condition into a single symptom that is easy to trivialize. These complaints are valid, but the problem runs deeper than any name.
Dujardin, the English professor who is (very slowly) writing a cultural history of fatigue, thinks that our concept of it has been impoverished by centuries of reductionism. As the study of medicine slowly fractured into anatomical specialties, it lost an overarching sense of the systems that contribute to human energy, or its absence. The concept of energy was (and still is) central to animistic philosophies, and though once core to the Western world, too, it is now culturally associated with quackery and pseudoscience. “There are vials of ‘energy boosters’ by every cash register in the U.S.,” Dujardin said, but when the NIH convened a conference on the biology of fatigue in 2021, “specialists kept observing that no standard definition exists for fatigue, and everyone was working from different ideas of human energy.” These terms have become so unhelpfully unspecific that our concept of “fatigue” can encompass a wide array of states including PEM and idleness, and can be heavily influenced by social forces—in particular the desire to exploit the energy of others.
As the historian Emily K. Abel notes in Sick and Tired: An Intimate History of Fatigue, many studies of everyday fatigue at the turn of the 20th century focused on the weariness of manual laborers, and were done to find ways to make those workers more productive. During this period, fatigue was recast from a physiological limit that employers must work around into a psychological failure that individuals must work against. “Present-day society stigmatizes those who don’t Push through; keep at it; show grit,” Dujardin said, and for the sin of subverting those norms, long-haulers “are not just disbelieved but treated openly with contempt.” Fatigue is “profoundly anti-capitalistic,” Jaime Seltzer, the director of scientific and medical outreach at the advocacy group MEAction, told me.
Energy-limiting illnesses also disproportionately affect women, who have long been portrayed as prone to idleness. Dujardin notes that in Western epics, women such as Circe and Dido were perceived harshly for averting questing heroes such as Odysseus and Aeneas with the temptation of rest. Later, the onset of industrialization turned women instead into emblems of homebound idleness while men labored in public. As shirking work became a moral failure, it also remained a feminine one.
These attitudes were evident in the ways two successive U.S. presidents dealt with COVID. Donald Trump, who always evinced a caricature of masculine strength and chastised rivals for being “low energy,” framed his recovery from the coronavirus as an act of domination. Joe Biden was less bombastic, but he still conspicuously assured the public that he was working through his COVID infection while his administration prioritized policies that got people back to work. Neither man spoke of the possibility of disabling fatigue or the need for rest.
Medicine, too, absorbs society’s stigmas around fatigue, even in selecting those who get to join its ranks. Its famously grueling training programs exclude (among others) most people with energy-limiting illnesses, while valorizing the ability to function when severely depleted. This, together with the tendency to psychologize women’s pain, helps to explain why so many long-haulers—even those with medical qualifications, like Misko and Oller—are treated so badly by the professionals they see for care. When Dujardin first sought medical help for her ME/CFS symptoms, the same doctor who had treated her well for a decade suddenly became stiff and suspicious, she told me, reduced all of her detailed descriptions to “tiredness,” and left the room without offering diagnosis or treatment. There is so much cultural pressure to never stop that many people can’t accept that their patients or peers might be biologically forced to do so.
No grand unified theory explains everything about long COVID and ME/CFS, but neither arethese diseases total mysteries. In fact, plenty of evidence exists for at least two pathways that explain why people with these conditions could be so limited in energy.
First, most people with energy-limiting chronic illnesses have problems with their autonomic nervous system, which governs heartbeat, breathing, sleep, hormone release, and other bodily functions that we don’t consciously control. When this systemis disrupted—a condition called “dysautonomia”—hormones such as adrenaline might be released at inappropriate moments, leading to the wired-but-tired feeling. People might suddenly feel sleepy, as if they’re shutting down. Blood vessels might not expand in moments of need, depriving active muscles and organs of oxygen and fuel; those organs might include the brain, leading to cognitive dysfunction such as brain fog.
Second, many people with long COVID and ME/CFS have problems with generating energy. When viruses invade the body, the immune system counterattacks, triggering a state of inflammation. Both infection and inflammation can damage the mitochondria—the bean-shaped batteries that power our cells. Malfunctioning mitochondria produce violent chemicals called “reactive oxygen species” (ROS) that inflict even more cellular damage. Inflammation also triggers a metabolic switch toward fast but inefficient ways of making energy, depleting cells of fuel and riddling them with lactic acid. These changes collectively explain the pervasive, dead-battery flavor of fatigue, as “the body struggles to generate energy,” Bindu Paul, a pharmacologist and neuroscientist at Johns Hopkins, told me. They might also explain the burning, poisoned feelings that patients experience, as their cells fill with lactic acid and ROS.
These two pathways—autonomic and metabolic—might also account for PEM. Normally, the autonomic nervous system smoothly dials up to an intense fight-and-flight mode and down to a calmer rest-and-digest one. But “in dysautonomia, the dial becomes a switch,” David Putrino, a neuroscientist and rehabilitation specialist at Mount Sinai, told me. “You go from sitting to standing and your body thinks: Oh, are we going hunting? You stop, and your body shuts down.” The exhaustion of these dramatic, unstable flip-flops is made worse by the ongoing metabolic maelstrom. Damaged mitochondria, destructive ROS, inefficient metabolism, and chronic inflammation all compound one another in a vicious cycle that, if it becomes sufficiently intense, could manifest as a PEM crash. “No one is absolutely certain about what causes PEM,” Seltzer told me, but it makes sense that “you have this big metabolic shift and your nervous system can’t get back on an even keel.” And if people push through, deepening the metabolic demands on a body that already can’t meet them, the cycle can spin even faster, “leading to progressive disability,” Putrino said.
Other factors might also be at play. Compared with healthy people, those with long COVID and ME/CFS have differences in the size, structure, or function of brainregionsincluding the thalamus, which relays motor signals and regulates consciousness, and the basal ganglia, which controls movement and has been implicated in fatigue. Long-haulers also have problems with blood vessels, red blood cells, and clotting, all of which might further staunch their flows of blood, oxygen, and nutrients. “I’ve tested so many of these people over the years, and we see over and over again that when the systems start to fail, they all fail in the same way,” Keller said. Together, these woes explain why long COVID and ME/CFS have such bewilderingly varied symptoms. That diversity fuels disbelief—howcould one disease cause all of this?—but it’s exactly what you’d expect if things as fundamental as metabolism go awry.
Long-haulers might not know the biochemical specifics of their symptoms, but they are uncannily good at capturing those underpinnings through metaphor. People experiencing autonomic blood-flow problems might complain about feeling “drained,” and that’s literally happening: In POTS, a form of dysautonomia, blood pools in the lower body when people stand. People experiencing metabolic problems often use dead-battery analogies, and indeed their cellular batteries—the mitochondria—are being damaged: “It really feels like something is going wrong at the cellular level,” Oller told me. Attentive doctors can find important clues about the basis of their patients’ illness hiding amid descriptions that are often billed as “exaggerated or melodramatic,” Dujardin said.
Some COVID long-haulers do recover. But several studies have found that, so far, most don’tfully return to their previous baseline, and many who become severely ill stay that way. This pool of persistently sick people is now mired in the same neglect that has long plagued those who suffer from illnesses such as ME/CFS. Research into such conditions are grossly underfunded, so no cures exist. Very few doctors in the U.S. know how to treat these conditions, and many are nearing retirement, so patients struggle to find care. Long-COVID clinics exist but vary in quality: Some know nothing about other energy-limiting illnesses, and still prescribe potentially harmful and officially discouraged treatments such as exercise. Clinicians who better understand these illnesses know that caution is crucial. When Putrino works with long-haulers to recondition their autonomic nervous system, he always starts as gently as possible to avoid triggering PEM. Such work “isn’t easy and isn’t fast,” he said, and it usually means stabilizing people instead of curing them.
Stability can be life-changing, especially when it involves changes that patients can keep up at home. Over-the-counter supplements such as coenzyme Q10, which is used by mitochondria to generate energy and is depleted in ME/CFS patients, can reduce fatigue. Anti-inflammatory medications such as low-dose naltrexone may have some promise. Sleep hygiene may not cure fatigue, but certainly makes it less debilitating. Dietary changes can help, but the right ones might be counterintuitive: High-fiber foods take more energy to digest, and some long-haulers get PEM episodes after eating meals that seem healthy. And the most important part of this portfolio is “pacing”—a strategy for carefully keeping your activity levels beneath the threshold that causes debilitating crashes.
Pacing is more challenging than it sounds. Practitioners can’t rely on fixed routines; instead, they must learn to gauge their fluctuating energy levels in real time, while becoming acutely aware of their PEM triggers. Some turn to wearable technology such as heart-rate monitors, and more than 30,000 are testing a patient-designed app called Visible to help spot patterns in their illness. Such data are useful, but the difference between rest and PEM might be just 10 or 20 extra heartbeats a minute—a narrow crevice into which long-haulers must squeeze their life. Doing so can be frustrating, because pacing isn’t a recovery tactic; it’s mostly a way of not getting worse, which makes its value harder to appreciate. Its physical benefits come at mental costs: Walks, workouts, socializing, and “all the things I’d do for mental health before were huge energy sinks,” Vogel told me. And without financial stability or social support, many long-haulers must work, parent, and care for themselves even knowing that they’ll suffer later. “It’s impossible not to overdo it, because life is life,” Vogel said.
“Our society is not set up for pacing,” Oller added. Long-haulers must resist the enormous cultural pressure to prove their worth by pushing as hard as they can. They must tolerate being chastised for trying to avert a crash, and being disbelieved if they fail. “One of the most insulting things people can say is ‘Fight your illness,’” Misko said. That would be much easier for her. “It takes so much self-control and strength to do less, to be less, to shrink your life down to one or two small things from which you try to extract joy in order to survive.” For her and many others, rest has become both a medical necessity and a radical act of defiance—one that, in itself, is exhausting.
The heat—miserable and oppressive—is not abating. Today, a third of Americans are under a heat alert as temperatures keep breaking records: Phoenix has hit 110 degrees Fahrenheit for two weeks straight, while this weekend Death Valley in California could surpass the all-time high of 130 degrees.
Even less extreme heat than that can be dangerous. Recently, in Texas, Louisiana, part of Arizona, and Florida, there have been reports of deaths from heat, and many more hospitalizations. The toll of a heat wave is not always clear in the moment: A new report suggests that last summer’s historic heat wave in Europe killed more than 60,000 people.
Ideally, you’d stay in the air-conditioned indoors as much as possible. That’s not an option for everyone. The other thing to do is stay hydrated. The importance of getting enough fluid is hard to overstate—and often underappreciated: Last month, the Texas state legislature banned local governments from mandating water breaks for construction workers. In the heat, hydration “impacts everything,” Stavros Kavouras, the director of the Hydration Science Lab at Arizona State University, in Phoenix, told me. And with temperatures continuing to rise, it’s essential to get it right.
Serious dehydration is really, really bad for you. Your blood volume decreases, which makes your heart work less effectively. “Your ability to thermoregulate declines,” Kavouras told me, “so your body temperature is getting higher and higher.” You might feel weak or dizzy. Your heart rate rises; it gets harder to focus. The worst-case scenario is heatstroke, when your body stops being able to cool itself—a potentially fatal medical emergency.
In extreme temperatures, heat injuries can happen quicker than you might think. Given that the human body is mostly water, you might assume that there is some to spare, but inconveniently, this is not the case. “If you lose even 10 percent of [the water] your body has, you are entering the zone of serious clinical dehydration,” Kavouras said. “And if you look at optimal health, even losing just 1 percent of your body weight impacts your ability to function.” There are two basic ways your body cools itself when it gets hot. One is to send more blood to the skin, which releases heat from the core of your body, and is the reason you turn red when you’re overheated. The other is to sweat. It evaporates off your body, and in the process, your body loses excess heat. You can’t cool yourself as effectively if you’re not properly hydrated. At the same time, one of your main cooling mechanisms is actively dehydrating, which means the goal is not just to be hydrated, but to stay that way.
What that takes depends on many factors rather than a single universal rule, but in general, the danger zone is “high humidity with anything above 90 degrees,” Kavouras said, at which point, “it’s actually dangerous” just to be outside. The more active you are in the heat, and the hotter and more humid it is, the greater the risk—and the more important proper hydration becomes. The standard water target in the U.S. during non-heat-wave times is 3.7 liters a day for men and 2.7 liters for women. When it’s very, very hot out, you need more. Even if you spend most of the day in the bliss of AC, you are almost certainly leaving the house at some point.
Instead of trying to figure out what that precise amount should be, Kavouras recommends you focus on two things instead. “No. 1, keep water close to you. If you have water close to you, or whatever healthy beverage, you’ll end up drinking more, just because it’s closer,” he said. And second: Keep an eye on how often you pee—pale urine, six to seven times a day, or every two to three hours, is good. You want it to be “basically like a Chablis, a Riesling, Pinot Grigio, or champagne-colored,” John Higgins, a sports cardiologist at McGovern Medical School at UTHealth, in Houston, told me. “If you notice the urine is getting darker, like a Chardonnay- or Sauvignon Blanc–type of thing, that generally means you are dehydrated.”
Certain groups are especially at risk. Older adults are more prone to dehydration, as are young children, people who are pregnant, and people taking certain medications—blood-pressure medications, for example. None of this requires you to take in extra fluids per se, just that you need to be even more careful that you’re getting enough.
As for what to drink, as a go-to beverage, straight water is hard to beat. Water with fruit slices floating in it has the benefit of feeling like something from a luxury hotel. Carbonated water is also good—you might not be able to drink quite as much of it, which is a potential drawback, but “there is no mechanism in your GI system that will make sparkling water less effective at hydrating you,” Kavouras said. You probably want to avoid downing giant buckets of coffee—caffeine is a diuretic in large quantities and Higgins warns against sugary drinks for the same reason. (A daily iced coffee is fine.) If you’re doing hours of heavy sweating, then you might work in some (less sugary) sports drinks. But for the majority of people, water remains the ideal. Food can also be a fluid source: “Make sure you’re eating a diet that’s rich in vegetables and fruits that have water content,” William Adams, the director of the University of North Carolina at Greensboro’s Hydration, Environment and Thermal (H.E.A.T) Stress Lab, advised. Alcohol, which causes you to lose fluid, is definitively unhelpful.
There are lots of water myths out there. Can you go too hard? Technically, it’s possible to over-hydrate, causing an electrolyte imbalance, but all three experts agreed that for most people, this isn’t really a concern. You can find arguments for drinking hot drinks in the summer—the idea being that they increase the amount you sweat, thereby promoting cooling. But Kavouras is emphatic that you’re better off with cold drinks, which cool your body, he said. In the moments before a race, marathon runners will sometimes take it one step further, slurping ice slurries to lower their body temperature. For good old-fashioned drinking water, about 50 degrees Fahrenheit is best—roughly the temperature of cool water from the tap.
One final key to staying hydrated: Start early. A lot of people, Higgins said, are lightly dehydrated all the time, heat wave or not. “So particularly when you first wake up in the morning, typically you are in a dehydrated state.” Accordingly, he recommends that people drink about a standard water bottle’s worth—roughly 17 ounces—as soon as they wake up. The other thing people forget about, he said, is what happens when they come back inside after enduring the outdoors. “You keep sweating,” he pointed out. In other words: hydrate, and then keep hydrating.
As crucial as hydration is, it is not a miracle. “It doesn’t mean that you can say, ‘I hydrate well, so I’ll go out for a run in the 120-degree weather, and I’ll be fine because I’m drinking a lot,’” Kavouras said. “It doesn’t work this way.” Still, it is a simple but effective tool. As heat waves like this one become even more frequent, many more people will need to learn how to become attuned to their hydration. And perhaps adequate water can be a perverse sort of comfort: You can’t control the unrelenting heat, but you likely can control your water intake. In a heat wave, it helps to have a glass-half-full attitude—and an emptied glass of water.
This story is part of the Atlantic Planet series supported by HHMI’s Science and Educational Media Group.
In 2016, I gave up Diet Coke. This was no small adjustment. I was born and raised in suburban Atlanta, home to the Coca-Cola Company’s global headquarters, and I had never lived in a home without Diet Coke stocked in the refrigerator at all times. Every morning in high school, I’d slam one with breakfast, and then I’d make sure to shove some quarters (a simpler time) in my back pocket to use in the school’s vending machines. When I moved into my freshman college dorm, the first thing I did was stock my mini fridge with cans. A few years later, my then-boyfriend swathed two 12-packs in wrapping paper and put them under his Christmas tree. It was a joke, but it wasn’t.
You’d think quitting would have been agonizing. To my surprise, it was easy. For years, I’d heard anecdotes about people who forsook diet drinks and felt their health improve seemingly overnight—better sleep, better skin, better energy. I’d also heard whispers about the larger suspected dangers of fake sweeteners. Yet I’d loved my DCs too much to be swayed. Then I tried my first can of unsweetened seltzer at a friend’s apartment. After years of turning my nose up at the thought of LaCroix, I realized that much of what I enjoyed about Diet Coke was its frigidity and fizz. That was enough. I switched to seltzer on the spot, prepared to join the smug converted and receive whatever health benefits were sure to accrue to me for my good behavior.
Except they never came. Seven years later, I feel no better than I ever did drinking four or five cans of the stuff a day. I still stick to seltzer anyway—because, you know, who knows?—and I’ve mostly forgotten that Diet Coke exists. But the diet sodas had not, as it turns out, been preventing me from getting great sleep or calming my rosacea or feeling, I don’t know, zesty. Besides the caffeine, they appeared to make no difference in how good or bad I felt at all.
Yesterday, Reuters reported that the WHO’s International Agency for Research on Cancer will soon declare aspartame, the sweetener used in Diet Coke and many other no-calorie sodas, as “possibly carcinogenic to humans.” I probably should have felt vindicated. I may not feel better now, but many years down the road (knock on wood), I’ll be better off. I’d bet on the right horse! Instead, I felt nothing so much as irritation. Over the past few decades, a growing number of foods and behaviors have become the regular subject of vague, ever-changing health warnings—fake sweeteners, real sugar, wine, butter, milk (dairy and non), carbohydrates, coffee, fat, chocolate, eggs, meat, veganism, vegetarianism, weightlifting, drinking a lot of water, and scores of others. The more warnings there are, the less actionable any particular one of them feels. What, exactly, is anyone supposed to do with any of this information, except feel bad about the things they enjoy?
It’s worth reviewing what is actually known or suspected about diet sodas and health. The lion’s share of research on this topic happens in what are known as observational studies—scientists track consumption and record health outcomes, looking for commonalities and trends linking behavior and effects. These studies can’t tell you if the behavior caused the outcome, but they can establish an association that’s worth investigating further. Regular, sustained diet-soda consumption has been linked to weight gain, Type 2 diabetes, and increased risk of stroke, among other things—understandably troublesome correlations for people worried about their health. But there’s a huge complicating factor in understanding what that means: For decades, advertisements recommended that people who were already worried about—or already had—some of those same health concerns substitute diet drinks for those with real sugar, and many such people still make those substitutions in order to adhere to low-carb diets or even out their blood sugar. As a result, little evidence suggests that diet soda is solely responsible for any of those issues—health is a highly complicated, multifactorial phenomenon in almost every aspect—but many experts still recommend limiting your consumption of diet soda as a reasonable precaution.
A representative for the IARC would neither confirm nor deny the nature of the WHO’s pending announcement on aspartame, which will be released on July 14. For the sake of argument, let’s assume that Reuters’s reporting is correct: In two weeks, the organization will update the sweetener’s designation to indicate that it’s “possibly carcinogenic.” To regular people, those words—especially in the context of a health organization’s public bulletins—would seem to imply significant suspicion of real danger. The evidence may not yet all be in place, but surely there’s enough reason to believe that the threat is real, that there’s cause to spook the general public.
Except, as my colleague Ed Yong wrote in 2015, when the IARC made a similar announcement about the carcinogenic potential of meat, that’s not what the classification means at all. The IARC chops risk up into four categories: carcinogenic (Group 1), probably carcinogenic (Group 2A), possibly carcinogenic (Group 2B), and unclassified (Group 3). Those categories do one very specific thing: They describe how definitive the agency believes the evidence is for any level of increased risk, even a very tiny one. The category in which aspartame may soon find itself, 2B, makes no grand claims about carcinogenicity. “In practice, 2B becomes a giant dumping ground for all the risk factors that IARC has considered, and could neither confirm nor fully discount as carcinogens. Which is to say: most things,” Yong wrote. “It’s a bloated category, essentially one big epidemiological shruggie.”
The categories are not at all intended to communicate the degree of the risk involved—just how sure or unsure the organization is that there’s a risk associated with a thing or substance at all. And association can mean a lot of things. Hypothetically, regular consumption of food that may quadruple your risk of a highly deadly cancer would fall in the same category as something that may increase your risk of a cancer with a 95 percent survival rate by just a few percentage points, as long as the IARC felt similarly confident in the evidence for both of those effects.
These designations about carcinogenicity are just one example of how health information can arrive to the general public in ways that are functionally useless, even if well intentioned. Earlier this year, the WHO advised against all use of artificial sweeteners. At first, that might sound dire. But the actual substance of the warning was about the limited evidence that those sweeteners aid in weight loss, not any new evidence about their unique ability to harm your health in some way. (The warning did nod to the links between long-term use of artificial sweeteners and increased risks of cardiovascular disease, Type 2 diabetes, and premature death, but as the WHO noted at the time, these are understood as murky correlations, not part of an alarming breakthrough discovery.)
The same release quotes the WHO’s director for nutrition and food safety advising that, for long-term weight control, people need to find ways beyond artificial sweeteners to reduce their consumption of real sugar—in essence, it’s not a health alert about any particular chemical, but about dessert as a concept. How much of any sweetener would you need to cut out of your diet in order to limit any risks it may pose? The release, on its own, doesn’t specify. Consider a birthday crudités platter instead of a cake, just to be sure. (Is that celery non-GMO? Organic? Just checking.)
The media, surely, deserve our fair share of blame for how quickly and how far these oversimplified ideas spread. Many people are very worried about the food they eat—perhaps because they have received so many conflicting indicators over the years about how that food affects their bodies—and flock to news that something has been deemed beneficial or dangerous. At best, the research that many such stories cite is rarely definitive, and at worst, it’s so poorly designed or otherwise flawed that it’s flatly incapable of producing useful information.
Taken in aggregate, this morass of poor communication and confusing information has the very real potential to exhaust people’s ability to identify and respond to actual risk, or to confuse them into nihilism. The solution-free finger-wagging, so often about the exact things that many people experience as the little joys in everyday life, doesn’t help. When everything is an ambiguously urgent health risk, it very quickly begins to feel like nothing is. I still drink a few Diet Cokes a year, and I maintain that there’s no better beverage to pair with pizza. We’re all going to die someday.
Just lost my oldest cat tootsie today bros. Some people say they’re just animals ,but they come into your life and bring you love and happiness that they become apart of your family. She was a great cat and i just wanted to show you guys a picture of her. She will be missed. Thanks.
Police at the crash scene near Te Papa Museum in Wellington. Photo / Ethan Griffiths
Two people are in hospital, one in a critical condition, and two others have been arrested after a serious crash in Wellington early on Sunday morning.
Police were called to Cable St about 1.15am after a report of a car hitting two pedestrians.
The car then fled the scene, which is across the street from Te Papa Museum.
Car fled the scene after hitting and injuring two people. Photo / Ethan Griffiths
The two injured pedestrians were transported to hospital – one in a serious condition, and one critical.
About two years ago, one of my psychiatry patients was giving me particular trouble. He had depression, and despite his usual chattiness, I just couldn’t find a way to engage him on our Zoom calls. He seemed to be avoiding eye contact and stayed quiet, giving only short answers to my questions. I worried he would drop out of treatment, so I suggested that we do something I rarely do with patients: go for a walk.
We met at a park on a brisk fall day and sat on a bench when we were done. Among the few people nearby was a group of workers, who were cleaning the grounds, chatting loudly, and obviously having fun. As I tried to ask my patient about his studies, he kept breaking eye contact with me to look at the workers. Just as we were finishing, he became tearful and said that he felt very lonely. It was the most he’d opened up to me in many months, and I was relieved. Perhaps the sight of these convivial young men was a reminder of his painful isolation that he simply couldn’t ignore. Or perhaps the act of walking together had finally made him comfortable enough to open up. Either way, it never would have happened on Zoom or in my office.
My experience with my patient runs contrary to the American fixation on attention. At work, we are lauded for displaying unbroken focus on the task at hand, while some companies punish employees for taking too many breaks away from their computer. With friends, we are expected to be active and engaged listeners, something that demands nearly constant awareness. Being hyper-focused on what people are saying and trying hard not to break your attention might seem like a way to fast-forward a friendship and make meaningful connections. But in fact, that level of intensity can make you feel less connected to other people. If you really want to nurture a relationship, shared distraction might be more powerful.
If you’ve ever defused an awkward social situation with unrelated small talk or an icebreaker game, you’re already familiar with the social benefits of distraction. Indeed, a handful of studies, while not investigating distraction per se, have suggested that engaging in a shared distracting activity, such as physical exercise, can enhance feelings of social connectedness and pleasure. This is in stark contrast to the alienating, alone-together experience of people who each engage in their own distracting activity, such as staring at their smartphone.
Although the mechanism by which distraction might increase a feeling of social connectedness is unclear, there are some plausible explanations. Engaging in physical activity, even one as gentle as walking, has been associated with a substantial increase in creative, divergent, and associative thinking—perhaps because moving takes our focus away from ourselves. Creative thinking, in turn, has the potential to move the conversation along in unpredictable ways, perhaps activating the neural reward pathways that rejoice in novelty and thereby making us delight more in one another’s presence. And moving isn’t strictly necessary for the creative benefits of distraction to occur: A 2022 study published in Nature found that just taking note of one’s environment can enhance creative thinking.
That study also found that pairs working together virtually were less likely to notice their surroundings; instead, they spent more time looking directly at each other’s images. This is decidedly not good for conversation. Staring at a social partner’s face is cognitively and emotionally exhausting, and can be a sign of a domineering nature. Just as you’ve probably experienced the social benefits of distraction, you’ve also probably noticed the social drawbacks of too much intensity. Years ago, hundreds of thousands of people, myself included, went to the Museum of Modern Art to see the Serbian conceptual artist Marina Abramović’s classic performance piece, in which she sat at a small wooden table, staring silently and impassively for several minutes at the face of any visitor who sat across from her. The encounters were uncomfortable at best, and grueling at worst. By removing nearly all ambient stimulation and props, Abramović had underscored their crucial importance.
The discomfort of extended eye contact helps explain why having natural-seeming, friendship-enforcing interactions over platforms like Zoom and FaceTime can be so difficult: They largely remove the rich world of distractions and force us to stare at the face of our social partner. But for most of us, some degree of virtual connection is unavoidable. For example, a recent Pew Research Center survey estimated that more than 30 percent of employed American adults continue to work largely by Zoom, and even more on a hybrid schedule. But we can still leverage the social advantages of distraction even when we can’t physically be with friends and loved ones.
One idea is simply to turn off your camera, and thereby remove the option of staring intently into each other’s pixelated eyes. During the height of the pandemic, I taught my residents by Zoom and became very frustrated when they switched off their video. I thought they were zoning out, but perhaps they were stretching or pacing about their apartment, getting a small dose of distraction and making their Zoom experience richer. The reason it felt annoying to me was because it was one-sided; maybe we would have had a better, more creative dialogue if we had all gone off camera together. At the other extreme, try leaving your video on and picking a conversation-starting background, or taking your conversation partner on a virtual tour of your surroundings, or playing a game together. If your friend spaces out, don’t take offense as I did. Ask them what they just saw or imagined and let the conversation flow.
When you have the luxury of face-to-face contact, skip the staring contest and get out in the world together. You’ll be surprised at the places that can nurture conversation: a lively bar, a challenging fitness class, the sidelines of a riotous parade. Shouting over the noise can be a bonding experience. But be sure you don’t pick something that’s too distracting—otherwise you’ll each be in your own bubble of experience. That happened to me a few years ago, zip-lining with my husband in the Catskill Mountains. It was fun, but ultimately an exercise of being alone together. We debriefed later.
There’s a time and place for intense, focused conversation, if not intense, focused eye contact. If your friend comes to you in a crisis, or your partner is in the middle of confessing their love, they probably won’t appreciate you pointing out the guy with his pet scarlet macaw passing by (yes, I’ve had the pleasure of seeing this a few times in New York City). But mostly, we stand to benefit when we allow a little bit of the world to intrude.
Late last night, New Yorkers were served a public-health recommendation with a huge helping of déjà vu: “If you are an older adult or have heart or breathing problems and need to be outside,” city officials said in a statement, “wear a high-quality mask (e.g. N95 or KN95).”
It was, in one sense, very familiar advice—and also very much not. This time, the threat isn’t viral, or infectious at all. Instead, masks are being urged as a precaution against the thick, choking plumes of smoke from Canada, where wildfires have been igniting for weeks. The latest swaths of the United States to come into the crosshairs are the Midwest, Ohio Valley, Northeast, and Mid-Atlantic.
The situation is, in a word, bad. Yesterday, New Haven, Connecticut, logged its worst air-quality reading on record; in parts of New York and Pennsylvania, some towns have been shrouded in pollutants at levels the Environmental Protection Agency deems “hazardous”—the more severe designation on its list. It is, to put it lightly, an absolutely terrible time to go outside. And for those who “have to go outdoors,” says Linsey Marr, an environmental engineer at Virginia Tech, “I’d strongly recommend wearing a mask.”
The masking advice might understandably spark some whiplash. For the majority of Americans, face coverings are still most saliently a COVID thing—a protective covering meant to be worn when engaging in risky gatherings indoors. Now, though, we’re having to flip the masking script: Right now, it’s outdoor air that we most want to guard our airways against. In more ways than one, the best masking practices in this moment will require snubbing some of our basest COVID-fighting instincts.
The COVID masking mindset can, to be fair, still be helpful to game out the risks at play. Viral outbreaks and wildfires both introduce dangerous particles into the eyes and the airway; both can be blocked with the right barriers. The difference is the source: Pathogens travel primarily aboard people, making crowds and crummy indoor airflow some of the biggest risks; fires and their smoky, ashy by-products, meanwhile, can get stoked and moved about by the very outdoor winds we welcome during viral outbreaks. Conflagrations clog the air with all sorts of pollutants—among them, carbon monoxide, which can poison people by starving them of oxygen, and a class of chemicals called polycyclic aromatic hydrocarbons that’s been linked to increased cancer risk. But the primary perils are the fine-particulate-matter components of soot, ash, and dust, fine enough to be borne over great distances until they reach an unsuspecting face.
Once breathed in, these particles, which the EPA tracks by a metric known as PM2.5, can deposit deep in the airway and possibly even infiltrate the blood. The flecks irritate the moist membranes that line the nose, mouth, lungs, and eyes; they spark bouts of inflammation, triggering itching and irritation. Chronic exposure to them has been linked to heart and lung issues, and the risks are especially high for individuals with chronic medical conditions—burdens that concentrate among people of color and the poor—as well as for older adults and children.
But N95s and many other high-quality masks have their roots in environmental health; they were designed specifically to filter out microscopic particulate matter that travels through the air. And they’re astoundingly good at their job. Jose-Luis Jimenez, an aerosol scientist at the University of Colorado at Boulder, recently put their performance to the test with an N95 strapped to his own face. Using an industry-standard test, he measured the particulate matter outside the mask, then checked how much made it through the device and into the space around his nose and mouth. Percentage-wise, he told me, “it removes 99.99 … I didn’t measure how many nines; it was working so well.” On broader scales, too, the protective math plays out: Well-fitting masks can curb smoke-related hospitalizations; studies back up their importance as a firefighting mainstay.
The key, Jimenez told me, is choosing the right mask and getting it flush against your face. Experts in the field even get professionally fit-tested to avoid contamination infiltrating through any gaps. Surgical masks, cloth masks, or any other loose accessories that aren’t specifically designed to filter out tiny particles just won’t do the trick, though they’re still better than not covering up at all. (If that sounds familiar, it should; viral or smoky, “masks don’t care what the particle is,” Marr told me. “They care about the size.”)
N95 masks aren’t perfect protectives either. They don’t shield the eyes, and they aren’t great at staving off carbon monoxide and the other gaseous pollutants that wildfires emit. (That’s for a reason: Allowing gas through masks is how we continue to breathe while wearing them.) But gases are volatile and quickly dissipate; for Americans hundreds or even thousands of miles from the source of the smoke, “it’s going to be the particulate matter that is most concerning to us,” Marr told me. Even in the parts of New York and Pennsylvania where PM2.5 has rocketed up to dangerous levels, the carbon-monoxide stats have remained low.
Considering how dicey the discourse over masking has gotten, masking advice won’t necessarily be embraced by all. Less than a month after the official end of the United States’ COVID public-health emergency, people are fatigued by face coverings and other mitigations. And we’re fast entering the stretch of the year when having synthetic polymer fabrics strapped across your face can get downright miserable, especially in the humidity of northeastern heat. But when it comes to avoiding the harms of wildfire smoke, experts generally consider masks a second-line defense. The first priority is trying to minimize any exposure at all—which, for now, means staying indoors with the doors and windows tightly shut, especially for people at highest risk. Paula Olsiewski, an environmental-health researcher at the Johns Hopkins Center for Health Security, also recommends running whatever air filters might be available; air conditioners, portable air cleaners, and DIY air filters all help.
It’s also a good time, experts told me, to be mindful of the differences between filtration and ventilation, or increasing flow to turn over stale air. Both are crucial, sustainable interventions against respiratory viruses. But in the context of wildfires, excellent ventilation could actually increase harm, Jimenez told me, by allowing in excess smoke. For right now, stale indoor air—a classic COVID foe—is a smoke-avoider’s ally. The masks come in for anyone who must go outside in a part of the country where the air quality is bad—say, above an index of 150 or so.
The move might feel especially counterintuitive for people who have long since stopped masking against COVID—or even ones who still do, simply because the rules don’t mesh. Through the flip-flopping guidance of mask everywhere to mask until you’re vaccinated to actually, mask after you’re vaccinated too to mask only indoors, Americans never hit much of a stable rhythm with the practice. The inertia may be especially powerful on the East Coast, which has largely been spared from the scourge of wildfires that’s constantly plaguing the West. (That puts the U.S. well behind other countries, especially in East Asia, where masking against viruses and pollutants indoors and out has long been commonplace; even in California, N95 and HEPA shortages aren’t anything new.)
That said, our COVID-centric view on masking was always going to get a wake-up call. Wildfires—and viral outbreaks, for that matter—are expected to become more common going forward, even in regions that haven’t historically experienced them. And for all their weariness with COVID, Americans now have far more awareness of and, in many cases, access to masks than they did just a few years ago. The wildfires aren’t good news, but maybe a mask-friendly response to them can be. Smoke does, from a public-health perspective, have one thing going for it, Olsiewski told me: It is visible and ominous in ways that a microscopic virus is not. “People can see that their air is not clean,” she told me. It’ll take more than ash and haze to break through the divisiveness around masks. But a threat this obvious might at least forge a tiny crack.
This story is part of the Atlantic Planet series supported by the HHMI Department of Science Education.
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For as long as I have been feeding myself—which, for the record, is several decades now—I have been feeding myself fast. I bite big, in rapid succession; my chews are hasty and few. In the time it takes others to get through a third of their meal, mine is already gone. You could reasonably call my approach to eating pneumatic, reminiscent of a suction-feeding fish or a Roomba run amok.
Where my vacuuming mouth goes, advice to constrain it follows. Internet writers have declared slowness akin to slimness; self-described “foodies” lament that there’s “nothing worse” than watching a guest inhale a painstakingly prepared meal. There are even children’s songs that warn against the perils of eating too fast. My family and friends—most of whom have long since learned to avoid “splitting” entrees with me—often comment on my speed. “Slow down,” one of my aunts fretted at a recent meal. “Don’t you know that eating fast is bad for you?”
I do, or at least I have heard. Over the decades, a multitudeofstudieshavefound that people who eat faster are more likely to consume more calories and carry more weight; they’re also more likely to have high blood pressure and diabetes. “The data are very robust,” says Kathleen Melanson of the University of Rhode Island; the evidence holds up when researchers look across geographies, genders, and age. The findings have even prompted researchers to conduct eating-speed interventions, and design devices—vibrating forks and wearable tech—that they hope will slow diners down.
But the widespread mantra of go slower probably isn’t as definitive or universal as it at first seems. Fast eaters like me aren’t necessarily doomed to metabolic misfortune; many of us can probably safely and happily keep hoovering our meals. Most studies examining eating speed rely on population-level observations taken at single points in time, rather than extended clinical trials that track people assigned to eat fast or slow; they can speak to associations between pace and certain aspects of health, but not to cause and effect. And not all of them actually agree on whetherprotracted eating boosts satisfaction or leads people to eat less. Even among experts, “there is no consensus about the benefits of eating slow,” says Tany E. Garcidueñas-Fimbres, a nutrition researcher at Universitat Rovira i Virgili, in Spain, who has studiedeating rates.
The idea that eating too fast could raise certain health risks absolutely does make sense. The key, experts told me, is the potential mismatch between the rate at which we consume nutrients and the rate at which we perceive and process them. Our brain doesn’t register fullness until it’s received a series of cues from the digestive tract: chewing in the mouth, swallowing down the throat; distension in the stomach, transit into the small intestine. Flood the gastrointestinal tract with a ton of food at once, and those signals might struggle to keep pace—making it easier to wolf down more food than the gut is asking for. Fast eating may also inundate the blood with sugar, risking insulin resistance—a common precursor to diabetes, says Michio Shimabukuro, a metabolism researcher at Fukushima Medical University, in Japan.
The big asterisk here is that a lot of these ideas are still theoretical, says Janine Higgins, a pediatric endocrinologist at the University of Colorado Anschutz Medical Campus, who’s studied eating pace. Research that merely demonstrates an association between fast eating and higher food intake cannot prove which observation led to the other, if there’s a causal link at all. Some other factor—stress, an underlying medical condition, even diet composition—could be driving both. “The good science is just completely lacking,” says Susan Roberts, a nutrition researcher at Tufts University.
Scientists don’t even have universal definitions of what “slow” or “fast” eating is, or how to measure it. Studies over the years have used total meal time, chew speed, and other metrics—but all have their drawbacks. Articles sometimes point to a cutoff of 20 minutes per meal, claiming that’s how long the body takes to feel full. But Matthew Hayes, a nutritional neuroscientist at the University of Pennsylvania, criticized that as an oversimplification: Satisfaction signals start trickling into the brain almost immediately when we eat, and fullness thresholds vary among people and circumstances. Studies that ask volunteers to rate their own speeds have issues too: People often compare themselves with friends and family, who won’t represent the population at large. Eating rate can also fluctuate over a lifetime or even a day, depending on hunger, stress, time constraints, the pace of present company, even the tempo of background music.
In an evolutionary sense, all of us humans eat absurdly fast. We eat “orders of magnitude quicker” than our primate relatives, just over one hour a day compared with their almost 12, says Adam van Casteren, a feeding ecologist at the University of Manchester, in England. That’s thanks largely to how we treat our food: Fire, tools such as knives, and, more recently, chemical processing have softened nature’s raw ingredients, liberating us from “the prison of mastication,” as van Casteren puts it. Modern Western diets have taken that pattern to an extreme. They’re chock-full of ultra-processed foods, so soft and sugar- and fat-laden that they can be gulped down with nary a chew—which could be one of the factors that drive faster eating and chronic metabolic ills.
In plenty of circumstances, slowing down will come with perks, not least because it could curb the risk of choking or excess gas. It could also temper blood-sugar spikes in people with diets heavy in processed foods—which whiz through the digestive tract, Roberts told me, though the healthier move would probably be eating fewer of those foods to begin with. And some studies focused on people with high BMI, including Melanson’s, have shown that eating slower can aid weight loss. But, she cautioned, those results won’t necessarily apply to everyone.
The main impact of leisurely eating may not even be about chewing rates or bite size per se, but about helping people eat more mindfully. “A lot of us are distracted when we eat,” says Fatima Cody Stanford, an obesity-medicine physician at Massachusetts General Hospital. “And so we are missing our hunger and satiety cues.” In countries such as the United States, people also have to wrestle with the immense pressure “to be done with lunch really fast,” Herman Pontzer, an anthropologist at Duke University, told me. Couple that with the fast foods we tend to reach for, and maybe it’s no shock that people don’t feel satisfied as they scarf down their meals.
The point here isn’t to demonize slow eating; in the grand scheme of things, it seems a pretty healthful thing to do. At the same time, that doesn’t mean that “eat slow” should be a blanket command. For people already eating a lot of high-fiber foods—which the body naturally processes ploddingly—Roberts doesn’t think sluggish chewing has much to add. The extolling of slow eating is, at best, “a half truth,” Hayes told me, that’s become easy to exploit.
I do feel self-conscious when I’m the first person at the table to finish by a mile, and I don’t enjoy the stares and the comments about my “big appetite.” Certain super-slow eaters might get teased for making others wait, but they’re generally not getting chastised for ruining their health. When I asked experts if it was harmful to eat too slowly, several of them told me they’d never even considered it—and that the answer was probably no.
Still, for the most part, I’m happy to be the Usain Bolt of chewing. My hot foods stay hot, and my cold foods stay cold. I’ve intermittently tried slow eating over the years, deploying some of the usual tricks: smaller utensils, tinier bites, crunchier foods. I even, once, tried to count my chews. The biggest difference I felt, though, wasn’t fullness or more satisfaction; I just kind of hated the way that my mushy food lingered in my mouth.
Maybe if I’d stuck with slow eating, I would have lost some gassiness, choking risk, or weight—but also, I think, some joy. There’s something to speed-eating that can be plain old fun, akin to the rush of zooming down an empty highway in a red sports car. If I have just an hour-ish (or, knowing me, less) of eating each day, I’d prefer to relish every brisk, indecorous bite.
For as long as I can remember, I have been that friend—the one who, from May to November, gets invited to every outdoor soiree. It’s not because I make the best desserts, even though I do. It’s because, with me around, the shoes can come off and the DEET can stay sheathed: No one else need fear for their blood when the mosquitoes are all busy biting me.
Explanations abound for why people like me just can’t stop getting nipped—blood type, diet, the particular funk of the acids that emanate from our skin. Mosquitoes are nothing if not expert sniffers, evolving over millennia to detect the body’s many emissions, including the carbon dioxide we exhale and the heat we radiate.
But to focus only on a mosquito’s hankering for flesh is to leave a whole chapter of the pests’ scent-seeking saga “largely overlooked,” Clément Vinauger, a chemical ecologist at Virginia Tech, told me. Mosquitoes are omnivores, tuned to sniff out blood and plants. And nowadays, most humans, especially those in the Western world, tend to smell a bit like both, thanks to all the floral, citrusy lotions and potions that so many of us slather atop our musky flesh.
That medley of scents, Vinauger and his colleagues have discovered, may be an underappreciated part of what makes people like me smell so darn good to pests. The findings are from a small study with just five volunteers, four brands of soap, and one mosquito species, and still need to be confirmed outside the lab. But they’re a reminder that, as good or as bad as some of us might inherently smell to a mosquito, the insects experience us as dietarily diverse smorgasbords—not just as our animal selves.
Researchers have also long known that “everything we use on our skin will affect mosquitoes’ behavior or attraction toward us,” says Ali Afify, a mosquito researcher at Drexel University. That includes extracts from plants—among them, chemicals such as citronella and limonene, which have both been found to repel the bloodsucking insects in at least some contexts. Something about encountering floral and faunal cues together seems to bamboozle mosquitoes, as if they’re “seeing an organism that doesn’t exist,” says Baldwyn Torto, a chemical ecologist and mosquito expert at the International Centre of Insect Physiology and Ecology. After all, female mosquitoes, the only ones that bite, spend their lives toggling between seeking nectar and hunting for blood, but never both at the same time. That’s part of why Vinauger initially figured that soap might deter mosquitoes from flying in for a sip.
The story ended up being a bit more complicated. The researchers, led by Morgen VanderGiessen and Anaïs Tallon, collected chemicals from their volunteers’ arms—one scrubbed with soap, the other left aromatically bare—and offered them to the mosquitoes. One body wash, a coconut-and-vanilla-scented number made by Native, seemed to make a subset of people less appetizing, probably in part, Vinauger told me, because mosquitoes and other insects are not into coconut. (Duly noted.) But two other cleansers, made by Dove and Simple Truth, bumped up the attractiveness of several of their volunteers—even though all of the soaps in the study contained plenty of limonene. (None of the manufacturers of the body washes used in the study responded to a request for comment.)
No single product was a universal attractant or repellent, which probably says more about us than it does about body wash. A bevy of lifestyle choices and environmental influences can tweak an individual’s unique odor profile; even identical twins, Torto told me, won’t smell the same to a mosquito on the prowl. Soaped up or no, some people will remain stubbornly magnetic to mosquitoes; others will continue to disgust them. This makes it “hard to say, ‘Hey, this soap will make you really attractive’ or ‘That soap will keep mosquitoes completely away from you,’” says Seyed Mahmood Nikbakht Zadeh, a chemical ecologist and medical entomologist at CSU San Bernardino, who wasn’t involved in the study. Plus, soap is hardly the only scented product that people use: Whatever enticing ingredients your body wash might contain, Tallon told me, could easily be counteracted by the contents of your lotion or deodorant.
The point of the study isn’t to demonize or extol any particular products—especially considering how few soaps were tested and how many factors dictate each individual’s odor profile. The five volunteers in the study can’t possibly capture the entire range of human-soap interactions, though the researchers hope to expand their findings with a lot of follow-up. “I wouldn’t want the public to be alarmed about what type of soap they’re using,” Torto told me.
But just knowing that personal-care products can alter a person’s appeal could kick-start more research. Scientists could design better baits to lure skeeters away from us, or develop a new generation of repellents using gentle, plant-based ingredients that are already found in our soaps. “DEET is really efficient, but it’s a chemical that melts plastic,” Vinauger told me. “Could we do better?”
The researchers behind the study are already trying. After analyzing the specific chemicals in each of the soaps they tested, they blended some of the most alluring and aversive substances into two new concoctions—a flowery, fruity attractant and a nuttier repellent—and offered them to the insects. The repellent was “as strong as applying DEET on your skin,” Vinauger told me, “but it’s all coming from those soap chemicals.”
What’s not yet clear, though, is how long those powers of repulsion last. Most people don’t manage more than a daily scrub; meanwhile, “the odors coming out of your pores are continuously coming out, so in the long run, those might win out,” says Maria Elena De Obaldia, a neurogeneticist who previously studied mosquito attraction at Rockefeller University. And it’s a lot less practical to ask someone to shower every few hours than to simply reapply bug spray.
I’m certainly not ready to blame my mosquito magnetism on my body wash (which, for what it’s worth, contains a lot of “coconut-based cleanser”) or anything else in my hygiene repertoire. Part of the problem is undoubtedly just me—the tastiest of human meat sticks. But the next time I shop for anything scented, I’ll at least know that whatever wafts out of that product won’t just be for me. Some pest somewhere is always catching a stray whiff.
More than three years ago, the coronavirus pandemic officially became an emergency, and much of the world froze in place while politicians and public-health advisers tried to figure out what on Earth to do. Now the emergency is officially over—the World Health Organization declared so on Friday, and the Biden administration will do the same later this week.
Not every lesson has to be a cautionary tale, however, and the end of the COVID-19 emergency may be, if nothing else, a chance to consider which pandemic policies, decisions, and ideas actually worked out for the best. Put another way: In the face of so much suffering, what went right?
To find out, we called up more than a dozen people who have spent the past several years in the thick of pandemic decision making, and asked: When the next pandemic comes, which concrete action would you repeat in exactly the same way?
What they told us is by no means a comprehensive playbook for handling a future public-health crisis. But they did lay out 23 specific tactics—and five big themes—that have kept the past few years from being even worse.
Good information makes everything else possible.
Start immediate briefings for the public. At the beginning of March 2020, within days of New York City detecting its first case of COVID-19, Governor Andrew Cuomo and Mayor Bill de Blasio began giving daily or near-daily coronavirus press briefings, many of which included health experts along with elected officials. These briefings gave the public a consistent, reliable narrative to follow during the earliest, most uncertain days of the pandemic, and put science at the forefront of the discourse, Jay Varma, a professor of population health at Cornell University and a former adviser to de Blasio, told us.
Let everyone see the information you have. In Medway, Massachusetts, for instance, the public-school system set up a data dashboard and released daily testing results. This allowed the entire affected community to see the impact of COVID in schools, Armand Pires, the superintendent of Medway Public Schools, told us.
Be clear that some data streams are better than others. During the first year of the pandemic, COVID-hospitalization rates were more consistent and reliable than, say, case counts and testing data, which varied with testing shortages and holidays, Erin Kissane, the managing editor of the COVID Tracking Project, told us.The project, which grew out of The Atlantic’s reporting on testing data, tracked COVID cases, hospitalizations, and deaths. CTP made a point of explaining where the data came from, what their flaws and shortcomings were, and why they were messy, instead of worrying about how people might react to this kind of information.
Act quickly on the data. At the University of Illinois Urbana-Champaign, testing made a difference, because the administration acted quickly after cases started rising faster than predicted when students returned in fall of 2020, Rebecca Lee Smith, a UIUC epidemiologist, told us. The university instituted a “stay at home” order, and cases went down—and remained down. Even after the order ended, students and staff continued to be tested every four days so that anyone with COVID could be identified and isolated quickly.
And use it to target the places that may need the most attention. In California, a social-vulnerability index helped pinpoint areas to focus vaccine campaigns on, Brad Pollock, UC Davis’s Rolkin Chair in Public-Health Sciences and the leader of Healthy Davis Together, told us. In this instance, that meant places with migrant farmworkers and unhoused people, but this kind of precision public health could also work for other populations.
Engage with skeptics. Rather than ignore misinformation or pick a fight with the people promoting it, Nirav Shah, the former director of Maine’s CDC, decided to hear them out, going on a local call-in radio show with hosts known to be skeptical of vaccines.
A pandemic requires thinking at scale.
Do pooled testing as early as possible. Medway’s public-school district used this technique, which combines samples from multiple people into one tube and then tests them all at once, to help reopen elementary schools in early 2021, said Pires, the Medway superintendent. Pooled testing made it possible to test large groups of people relatively quickly and cheaply.
Choose technology that scales up quickly. Pfizer chose to use mRNA-vaccine tech in part because traditional vaccines are scaled up in stainless-steel vats, Jim Cafone, Pfizer’s senior vice president for global supply chain, told us. If the goal is to vaccinate billions of patients, “there’s not enough stainless steel in the world to do what you need to do,” he said. By contrast, mRNA is manufactured using lipid nanoparticle pumps, many more of which can fit into much less physical space.
Take advantage of existing resources. UC Davis repurposed genomic tools normally used for agriculture for COVID testing, and was able to perform 10,000 tests a day, Pollock, the UC Davis professor, told us.
Use the Defense Production Act. This Cold War–era law, which allows the U.S. to force companies to prioritize orders from the government, is widely used in the defense sector. During the pandemic, the federal government invoked the DPA to break logjams in vaccine manufacturing, Chad Bown, a fellow at the Peterson Institute for International Economics who tracked the vaccine supply chain, told us. For example, suppliers of equipment used in pharmaceutical manufacturing were compelled to prioritize COVID-vaccine makers, and fill-and-finish facilities were compelled to bottle COVID vaccines first—ensuring that the vaccines the U.S. government had purchased would be delivered quickly.
Vaccines need to work for everyone.
Recruit diverse populations for clinical trials. Late-stage studies on new drugs and vaccines have a long history of underrepresenting people from marginalized backgrounds, including people of color. That trend, as researchers have repeatedly pointed out, runs two risks: overlooking differences in effectiveness that might not appear until after a product has been administered en masse, and worsening the distrust built up after decades of medical racism and outright abuse. The COVID-vaccine trials didn’t do a perfect job of enrolling participants that fully represent the diversity of America, but they did better than many prior Phase 3 clinical trials despite having to rapidly enroll 30,000 to 40,000 adults, Grace Lee, the chair of CDC’s Advisory Committee on Immunization Practices, told us. That meant the trials were able to provide promising evidence that the shots were safe and effective across populations—and, potentially, convince wider swaths of the public that the shots worked for people like them.
Try out multiple vaccines. No one can say for sure which vaccines might work or what problems each might run into. So drug companies tested several candidates at once in Phase I trials, Annaliesa Anderson, the chief scientific officer for vaccine research and development at Pfizer, told us; similarly, Operation Warp Speed placed big bets on six different options, Bown, the Peterson Institute fellow, pointed out.
Be ready to vet vaccine safety—fast. The rarest COVID-vaccine side effects weren’t picked up in clinical trials. But the United States’ multipronged vaccine-safety surveillance program was sensitive and speedy enough that within months of the shots’ debut, researchers found a clotting issue linked to Johnson & Johnson, and a myocarditis risk associated with Pfizer’s and Moderna’s mRNA shots. They were also able to confidently weigh those risks against the immunizations’ many benefits. With these data in hand, the CDC and its advisory groups were able to throw their weight behind the new vaccines without reservations, said Lee, the ACIP chair.
Make the rollout simple. When Maine was determining eligibility for the first round of COVID-19 vaccines, the state prioritized health-care workers and then green-lighted residents based solely on age—one of the most straightforward eligibility criteria in the country. Shah, the former head of Maine’s CDC, told us that he and other local officials credit the easy-to-follow system with Maine’s sky-high immunization rates, which have consistently ranked the state among the nation’s most vaccinated regions.
Create vaccine pop-ups. For many older adults and people with limited mobility, getting vaccinated was largely a logistical challenge. Setting up temporary clinics where they lived—at senior centers or low-income housing, as in East Boston, for instance—helped ensure that transportation would not be an obstacle for them, said Josh Barocas, an infectious-diseases doctor at the University of Colorado School of Medicine.
Give out boosters while people still want them. When boosters were first broadly authorized and recommended in the fall of 2021, there was a mad rush to immunization lines. In Maine, Shah said, local officials discovered that pharmacies were so low on staff and supplies that they were canceling appointments or turning people away. In response, the state’s CDC set up a massive vaccination center in Augusta. Within days, they’d given out thousands of shots, including both boosters and the newly authorized pediatric shots.
Also, spend money.
Basic research spending matters. The COVID vaccines wouldn’t have been ready for the public nearly as quickly without a number of existing advances in immunology, Anthony Fauci, the former head of the National Institute of Allergy and Infectious Diseases, told us. Scientists had known for years that mRNA had immense potential as a delivery platform for vaccines, but before SARS-CoV-2 appeared, they hadn’t had quite the means or urgency to move the shots to market. And research into vaccines against other viruses, such as RSV and MERS, had already offered hints about the sorts of genetic modifications that might be needed to stabilize the coronavirus’s spike protein into a form that would marshal a strong, lasting immune response.
Pour money into making vaccines before knowing they work. Manufacturing millions of doses of a vaccine candidate that might ultimately prove useless wouldn’t usually be a wise business decision. But Operation Warp Speed’s massive subsidies helped persuade manufacturers to begin making and stockpiling doses early on, Bown said. OWS also made additional investments to ensure that the U.S. had enough syringes and factories to bottle vaccines. So when the vaccines were given the green light, tens of millions of doses were almost immediately available.
Invest in worker safety. The entertainment industry poured a massive amount of funds into getting COVID mitigations—testing, masking, ventilation, sick leave—off the ground so that it could resume work earlier than many other sectors. That showed what mitigation tools can accomplish if companies are willing to put funds toward them, Saskia Popescu, an infection-prevention expert in Arizona affiliated with George Mason University, told us.
Lastly, consider the context.
Rely on local relationships. To distribute vaccines to nursing homes, West Virginia initially eschewed the federal pharmacy program with CVS and Walgreens, Clay Marsh, West Virginia’s COVID czar, told us. Instead, the state partnered with local, family-run pharmacies that already provided these nursing homes with medication and flu vaccines. This approach might not have worked everywhere, but it worked for West Virginia.
Don’t shy away from public-private partnerships. In Davis, California, a hotelier provided empty units for quarantine housing, Pollock said. In New York City, the robotics firm Opentrons helped NYU scale up testing capacity; the resulting partnership, called the Pandemic Response Lab, quickly slashed wait times for results, Varma, the former de Blasio adviser, said.
Create spaces for vulnerable people to get help. People experiencing homelessness, individuals with substance-abuse disorders, and survivors of domestic violence require care tailored to their needs. In Boston, for example, a hospital recuperation unit built specifically for homeless people with COVID who were unable to self-isolate helped bring down hospitalizations in the community overall, Barocas said.
Frame the pandemic response as a social movement. Involve not just public-health officials but also schools, religious groups, political leaders, and other sectors. For example, Matt Willis, the public-health officer for Marin County, California, told us, his county formed larger “community response teams” that agreed on and disseminated unified messages.
In October of 1858, John Stuart Mill and his wife, Harriet, were traveling near Avignon, France. She developed a cough, which seemed like just a minor inconvenience, until it got worse. Soon Harriet was racked with pain, not able to sleep or even lie down. Mill frantically wrote to a doctor in Nice, begging him to come see her. Three days later her condition had worsened further, and Mill telegraphed his forebodings to his stepdaughter. Harriet died in their hotel room on November 3.
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Mill sat alone with her body in their room for a day. He was despondent over the loss of his marriage: “For seven and a half years that blessing was mine. For seven and a half years only!”
Later that same month, he sent a manuscript to his publisher, which opened with a lavish dedication to Harriet. He subsequently wrote that she had been more than his muse; she had been his co-author. The book was, he said, “more directly and literally our joint production than anything else which bears my name, for there was not a sentence of it that was not several times gone through by us together.” The book’s “whole mode of thinking,” he continued, “was emphatically hers.”
The book was called On Liberty. It is one of the founding documents of our liberal world order. Individuals, the Mills argued, have the right to be the architect of their own life, to choose whom to marry, where to live, what to believe, what to say. The state has no right to impinge on a citizen’s individual freedom of choice, provided that the person isn’t harming anyone else.
A society organized along these lines, the Mills hoped, would produce a rich variety of creative and daring individuals. You wouldn’t have to agree with my mode of life, and I wouldn’t have to agree with yours, but we would give each other the space to live our fullest life. Individual autonomy and freedom of choice would be the rocks upon which we built flourishing nations.
The liberalism that the Mills championed is what we enjoy today as we walk down the street and greet a great variety of social types. It’s what we enjoy when we get on the internet and throw ourselves into the messy clash of ideas. It is this liberalism that we defend when we back the Ukrainians in their fight against Russian tyranny, when we stand up to authoritarians on the right and the left, to those who would impose speech codes, ban books, and subvert elections.
After he sent in the manuscript, Mill bought a house overlooking the cemetery where Harriet was buried, filled it with furniture from the room in which she’d died, and visited every year for the rest of his life. It’s a sad scene to imagine—him gazing down at her grave from the window—but the couple left us an intellectual legacy that has guided humanity another step forward in civilization’s advance.
Many good ideas turn bad when taken to their extreme. And that’s true of liberalism. The freedom of choice that liberals celebrate can be turned into a rigid free-market ideology that enables the rich to concentrate economic power while the vulnerable are abandoned. The wild and creative modes of self-expression that liberals adore can turn into a narcissistic culture in which people worship themselves and neglect their neighbors.
These versions of liberalism provoke people to become anti-liberal, to argue that liberalism itself is spiritually empty and too individualistic. They contend that it leads to social breakdown and undermines what is sacred about life. We find ourselves surrounded by such anti-liberals today.
I’d like to walk with you through one battlefield in the current crisis of liberalism, to show you how liberalism is now threatened by an extreme version of itself, and how we might recover a better, more humane liberalism—something closer to what the Mills had in mind in the first place.
In 2016, the Canadian government legalized medical assistance in dying. The program, called MAID, was founded on good Millian grounds. The Canadian Supreme Court concluded that laws preventing assisted suicide stifled individual rights. If people have the right to be the architect of their life, shouldn’t they have the right to control their death? Shouldn’t they have the right to spare themselves needless suffering and indignity at the end of life?
As originally conceived, the MAID program was reasonably well defined. Doctors and nurses would give lethal injections or fatal medications only to patients who met certain criteria, including all of the following: the patient had a serious illness or disability; the patient was in an “advanced state” of decline that could not be reversed; the patient was experiencing unbearable physical or mental suffering; the patient was at the point where natural death had become “reasonably foreseeable.”
To critics who worried that before long, people who were depressed, stressed, or just poor and overwhelmed would also be provided assistance to die, authorities were reassuring: The new law wouldn’t endanger those who are psychologically vulnerable and not near death. Citing studies from jurisdictions elsewhere in the world with similar laws, Prime Minister Justin Trudeau declared that this “simply isn’t something that ends up happening.”
But the program has worked out rather differently. Before long, the range of who qualifies for assisted suicide was expanded. In 2021, the criterion that natural death must be “reasonably foreseeable” was lifted. A steady stream of stories began to appear in the media, describing how the state was granting access to assisted suicide to people who arguably didn’t fit the original criteria.
If you are having thoughts of suicide, please know that you are not alone. If you’re in danger of acting on suicidal thoughts, call 911. For support and resources, call the National Suicide Prevention Lifeline at 988 or text 741741 for the Crisis Text Line.
For example, the Associated Press reported on the case of Alan Nichols. Nichols had lost his hearing in childhood, and had suffered a stroke, but for the most part was able to live independently. In June 2019, at age 61, he was hospitalized out of concern that he might be suicidal. He urged his brother Gary to “bust him out” of the facility as soon as possible. But within a month, he applied for a physician-assisted death, citing hearing loss as his only medical condition. A nurse practitioner also described Nichols’s vision loss, frailty, history of seizures, and general “failure to thrive.” The hospital told the AP that his request for a lethal injection was valid, and his life was ended. “Alan was basically put to death,” his brother told the AP.
In The New Atlantis, Alexander Raikin described the case of Rosina Kamis, who had fibromyalgia and chronic leukemia, along with other mental and physical illnesses. She presented these symptoms to the MAID assessors and her death was approved. Meanwhile, she wrote in a note evidently meant for those to whom she had granted power of attorney: “Please keep all this secret while I am still alive because … the suffering I experience is mental suffering, not physical. I think if more people cared about me, I might be able to handle the suffering caused by my physical illnesses alone.” She was put to death on September 26, 2021, via a lethal injection, at the age of 41.
In The Free Press, Rupa Subramanya reported on the case of a 23-year-old man named Kiano Vafaeian, who was depressed and unemployed, and also had diabetes and had lost vision in one eye. His death was approved and scheduled for September 22, 2022. The doctor who was to perform the procedure emailed Vafaeian clear and antiseptic instructions: “Please arrive at 8:30 am. I will ask for the nurse at 8:45 am and I will start the procedure at around 9:00 am. Procedure will be completed a few minutes after it starts.” Vafaeian could bring a dog with him, as long as someone would be present to take care of it.
About two weeks before the appointment, Vafaeian’s 46-year-old mother, Margaret Marsilla, telephoned the doctor who was scheduled to kill her son. She recorded the call and shared it with The Free Press. Posing as a woman named Joann, she told the doctor that she wanted to die by Christmas. Reciting basic MAID criteria, the doctor told her that she needed to be over 18, have an insurance card, and be experiencing “suffering that cannot be remediated or treated in some way that’s acceptable to you.” The doctor said he could conduct his assessment via Zoom or WhatsApp. Marsilla posted on social media about the situation. Eventually, the doctor texted Marsilla, saying that he would not follow through with her son’s death.
Personally, I don’t have great moral qualms about assisted suicide for people who are suffering intensely in the face of imminent death. These cases are horrible for individuals and families. What’s important here is that the MAID program has spilled beyond its original bounds so quickly.
When people who were suffering applied to the MAID program and said, “I choose to die,” Canadian society apparently had no shared set of morals that would justify saying no. If individual autonomy is the highest value, then when somebody comes to you and declares, “It’s my body. I can do what I want with it,” whether they are near death or not, painfully ill or not, doesn’t really matter. Autonomy rules.
Within just a few years, the number of Canadians dying by physician-assisted suicide ballooned (the overwhelming majority of them by lethal injection). In 2021, that figure was more than 10,000, one in 30 of all Canadian deaths. The great majority of people dying this way were elderly and near death, but those who seek assisted suicide tend to get it. In 2021, only 4 percent of those who filed written applications were deemed ineligible.
If autonomy is your highest value, these trends are not tragic; they’re welcome. Death is no longer the involuntary, degrading end of life; it can be a glorious act of self-expression. In late 2022, the Canadian fashion retailer La Maison Simons released a branding video that paid tribute to the assisted suicide of a 37-year-old woman afflicted with Ehlers-Danlos syndrome, which affects the body’s connective tissue. The video, titled “All Is Beauty,” was released the day after the woman’s death. In a series of lush images of her on tourist-destination beaches and at a dinner party, the video portrayed her death as “the most beautiful exit”—a sort of rich, Instagram-ready consumer experience that you might get from a five-star resort.
Back in 2016, critics of the MAID law saw this coming. They warned that soon enough, people in anguish and near death wouldn’t be the only ones given assistance to die. That warning turned out to be understated. Within a few years, Canada went from being a country that had banned assisted suicide to being one of the loosest regimes in the world.
Some people leading pathos-filled lives have begun to see assisted suicide as a release from their misery. Michael Fraser, though not terminally ill at age 55, had become unable to walk and suffered from an array of medical problems—liver disease and incontinence, as well as mental-health issues after what he described as prolonged sexual abuse as a child. His monthly check from the Ontario Disability Support Program was barely enough to live on. “Some of the struggles he talked to me about was this feeling of not being worthy,” the doctor who gave Fraser a lethal injection on July 2, 2022, told the Toronto Star. “There’s a social aspect to poverty, a hierarchy, that affected his psyche. He told me that it did.”
Vartika Sharma
As assisted suicide has become an established part of Canadian society, the complex moral issues surrounding the end of life have drifted out of sight. Decisions tend to be made within a bureaucratic context, where utilitarian considerations can come to dominate the foreground. Or as the president of the Quebec College of Physicians, which regulates medical practice in the province, put it, assisted suicide “is not a political or moral or religious issue. It is a medical issue.” A materialist cost-benefit analysis, for some people, crowds out affirmations that life is sacred, and socioeconomic burdens weigh heavily in the balance.
Tyler Dunlop is a physically healthy 37-year-old man who suffers from schizoaffective disorder and PTSD, and has no job or home or social contact. “When I read about medically assisted dying,” he told a local news website earlier this year, “I thought, well, logistically, I really don’t have a future.” Knowing that “I’m not going anywhere,” as he put it, he has started the process for approval under MAID. The New Atlantis published slides from a Canadian Association of MAID Assessors and Providers seminar, in which a retired care coordinator noted that a couple of patients had cited poverty or housing uncertainty, rather than their medical condition, as their main reason for seeking death.
Health-care costs also sometimes come into play. According to the Associated Press, Roger Foley, a patient at a hospital in Ontario who has a degenerative brain disorder, was disturbed enough by how often the staff talked about assisted dying that he began recording their conversations. The hospital’s director of ethics informed Foley that if he were to stay in the hospital, it would cost Foley “north of $1,500 a day.” Foley replied that he felt he was being coerced into death. “Roger, this is not my show,” the ethicist replied. “I told you my piece of this was to talk to you about if you had an interest in assisted dying.” (The hospital network told The Atlantic that it could not comment on specific patients for privacy reasons and added that its health-care teams do not discuss assisted dying unless patients express interest in it.)
These trends have not shocked Canadian lawmakers into tightening the controls on who gets approved for MAID, or dramatically ramping up programs that would provide medical and community-based help for patients whose desperation might be addressed in other ways. On the contrary, eligibility may expand soon. On February 15, a parliamentary committee released a set of recommendations that would further broaden MAID eligibility, including to “mature minors” whose death is “reasonably foreseeable.” The influential activist group Dying With Dignity Canada recommends that “mature minors” be defined as “at least 12 years of age and capable of making decisions with respect to their health.” Canada is scheduled to move in 2024 to officially extend MAID eligibility to those whose only illness is a mental disorder.
The frame of debate is shifting. The core question is no longer “Should the state help those who are suffering at the end of life die?” The lines between assisted suicide for medical reasons, as defined by the original MAID criteria, and straight-up suicide are blurring. The moral quandary is essentially this: If you see someone rushing toward a bridge and planning to jump off, should you try to stop them? Or should you figure that plunging into the water is their decision to make—and give them a helpful shove?
I don’t mean to pick on Canada, the land of my birth. Lord knows that, in many ways, Canada has a much healthier social and political culture—less bitter and contentious—than the United States does. I’m using the devolution of the MAID program to illustrate a key feature of modern liberalism—namely, that it comes in different flavors. The flavor that is embedded in the MAID program, and is prevalent across Western societies, is what you might call autonomy-based liberalism.
Autonomy-based liberalism starts with one core conviction: I possess myself. I am a piece of property that I own. Because I possess property rights to myself, I can dispose of my property as I see fit. My life is a project that I am creating, and nobody else has the right to tell me how to build or dispose of my one and only life.
The purpose of my life, in this version of liberalism, is to be happy—to live a life in which my pleasures, however I define them, exceed my pains. If I determine that my suffering outweighs my joys, and that things will never get better, then my life isn’t working. I have a right to end it, and the state has no right to prevent me from doing so; indeed, it ought to enable my right to end my life with dignity. If you start with autonomy-based liberalism, MAID is where you wind up.
But there is another version of liberalism. Let’s call this gifts-based liberalism. It starts with a different core conviction: I am a receiver of gifts. I am part of a long procession of humanity. I have received many gifts from those who came before me, including the gift of life itself. The essential activity of life is not the pursuit of individual happiness. The essential activity of life is to realize the gifts I’ve been given by my ancestors, and to pass them along, suitably improved, to those who will come after.
Gifts-based liberals, like autonomy-based liberals, savor individual choice—but our individual choices take place within the framework of the gifts we have received, and the responsibilities to others that those gifts entail. (This understanding of choice, I should note, steers a gifts-based liberal away from both poles in the American abortion debate, endorsing neither a pure abortion-rights stance rooted in bodily autonomy, nor a blanket ban that ignores individual circumstances and pays no heed to a social consensus.) In our lives, we are citizens and family members, not just individuals and property owners. We have obligations to our neighbors as well as to those who will come after us. Many of those obligations turn out to be the sources of our greatest joy. A healthy society builds arrangements and passes laws that make it easier to fulfill the obligations that come with our gifts. A diseased society passes laws that make it easier to abandon them.
I’m going to try to convince you that gifts-based liberalism is better than autonomy-based liberalism, that it rests on a more accurate set of assumptions about what human life is actually like, and that it leads to humane modes of living and healthier societies.
Let me start with four truths that gifts-based liberalism embraces and autonomy-based liberalism subverts:
You didn’t create your life. From the moment of your birth, life was given to you, not earned. You came out bursting with the gift of being alive. As you aged, your community taught you to celebrate the prodigality of life—the birds in their thousands of varieties, the deliciousness of the different cheeses, the delightful miracle of each human face. Something within us makes us desperately yearn for longer life for our friends and loved ones, because life itself is an intrinsic good.
The celebration of life’s sacredness is so deeply woven into our minds, and so central to our civilization, that we don’t think about it much until confronted with shocking examples of when the celebration is rejected. For example, in the early 2000s, a German man named Armin Meiwes put an ad online inquiring whether anybody would like to be killed and eaten. A man came by and gave his consent. First, Meiwes cut off the man’s penis, and the two men attempted to eat it together. Then Meiwes killed and butchered him; by the time of his arrest, he had consumed more than 40 pounds of his flesh. Everything was done with the full consent of both participants, but the extreme nature of the case forced the German court system not only to sentence Meiwes to life in prison, but to face an underappreciated yet core pillar of our civilization: You don’t have the right to insult life itself. You don’t have the right to turn yourself or other people into objects to be carved up and consumed. Life is sacred. Humanity is a higher value than choice.
You didn’t create your dignity. No insignificant person has ever been born, and no insignificant day has ever been lived. Each of us has infinite dignity, merely by being alive. We can do nothing to add to that basic dignity. Getting into Harvard doesn’t make you more important than others, nor does earning billions of dollars. At the level of our intrinsic dignity, all humans are radically equal. The equal dignity of all life is, for instance, the pillar of the civil-rights movement.
Once MAID administrators began making decisions about the life or death of each applicant based on the quality of their life, they introduced a mode of thinking that suggests that some lives can be more readily extinguished than others—that some lives have more or less value than others. A human being who is enfeebled, disabled, depressed, dwindling in their capacities is not treated the same way as someone who is healthier and happier.
When such a shift occurs, human dignity is no longer regarded as an infinite gift; it is a possession that other humans can appraise, and in some cases erase. Once the equal and infinite dignity of all human life is compromised, everything is up for grabs. Suddenly debates arise over which lives are worth living. Suddenly you have a couple of doctors at the Quebec College of Physicians pushing the envelope even further, suggesting that babies with severe deformations and limited chances of survival be eligible for medically assisted death. Suddenly people who are ill or infirm are implicitly encouraged to feel guilty for wanting to live. Human dignity, once inherent in life itself, is measured by what a person can contribute, what level of happiness she is deemed capable of enjoying, how much she costs.
You don’t control your mind. “From its earliest beginning,” Francis Fukuyama writes, “modern liberalism was strongly associated with a distinctive cognitive mode, that of modern natural science.” In liberal societies, people are supposed to collect data, weigh costs and benefits, and make decisions rationally. Autonomy-based liberalism, with its glorification of individual choice, leans heavily on this conception of human nature.
Gifts-based liberals know that no purely rational thinker has ever existed. They know that no one has ever really thought for themselves. The very language you think with was handed down as a gift from those who came before. We are each nodes in a network through which information flows and is refracted. The information that is stored in our genes comes from eons ago; the information that we call religion and civilization comes from thousands of years ago; the information that we call culture comes from distant generations; the information that we call education or family background comes from decades ago. All of it flows through us in deep rivers that are partly conscious and partly unconscious, forming our assumptions and shaping our choices in ways that we, as individuals, often can’t fathom.
Gifts-based liberals understand how interdependent human thinking is. When one kid in high school dies by suicide, that sometimes sets off a contagion, and other kids in that school take their own life. Similarly, when a nation normalizes medically assisted suicide, and makes it a more acceptable option, then more people may choose suicide. A 2022 study in the Journal of Ethics in Mental Health found that in four jurisdictions—Switzerland, Luxembourg, the Netherlands, and Belgium—where assisted dying is legal, “there have been very steep rises in suicide,” including both assisted and unassisted suicide. The physician who assists one person to die may be influencing not just that suicide but the suicides of people he will never see.
Gifts-based liberals understand the limitations of individual reason, and have a deep awareness of human fallibility. Gifts-based liberals treasure having so many diverse points of view, because as individuals, we are usually wrong to some degree, and often to a very large degree. We need to think together, over time, in order to stumble toward the truth. Intellectual autonomy is a dangerous exaggeration.
Gifts-based liberals understand that at many times in life, we’re just not thinking straight—especially when we are sick, in pain, anxious, or depressed. My friend the Washington Post columnist Michael Gerson, who died of cancer last year, once said, “Depression is a malfunction of the instrument we use to determine reality.” When he was depressed, lying voices took up residence there, spewing out falsehoods he could scarcely see around: You are a burden to your friends; you have no future; no one would miss you if you died. This is not an autonomous, rational mind. This is a mind that has gone to war with its host.
In these extreme cases, human fallibility is not just foolish; it is potentially fatal. To cope with those cases, societies in a gifts-based world erect guardrails, usually instantiated in law. In effect the community is saying: No, suicide is out of bounds. It’s not for you to decide. You don’t have the freedom to end your freedom. You don’t have the right to make a choice you will never be able to revisit. Banish the question from your mind, because the answer is a simple no. Individual autonomy is not our ultimate value. Life and belonging are. We are responsible for one another.
You did not create your deepest bonds. Liberal institutions are healthiest when they are built on arrangements that precede choice. You didn’t choose the family you were born into, the ethnic heritage you were born into, the culture you were born into, the nation you were born into. As you age, you have more choices over how you engage with these things, and many people forge chosen families to supplant their biological ones. But you never fully escape the way these unchosen bonds have formed you, and you remain defined through life by the obligations they impose upon you.
Autonomy-based liberals see society as a series of social contracts—arrangements people make for their mutual benefit. But a mother’s love for her infant daughter is not a contract. Gifts-based liberals see society as resting on a bedrock of covenants. Rabbi Jonathan Sacks once captured the difference this way: “A contract is a transaction. A covenant is a relationship. Or to put it slightly differently: a contract is about interests. A covenant is about identity. It is about you and me coming together to form an ‘us.’ ”
A society constructed on gifts-based liberalism does everything it can to strengthen the bedrock layer of covenants. The MAID program, by contrast, actively subverts them. It has led a mother to plead with a doctor not to end her son’s life. It has left a man enraged, feeling that he and his other family members were shut out of the process that led to the killing of his brother. The state, seeing people only as autonomous individuals, didn’t adequately recognize family bonds.
Families have traditionally been built around mutual burdens. As children, we are burdens on our families; in adulthood, especially in hard times, we can be burdens on one another; and in old age we may be burdens once again. When these bonds have become attenuated or broken in Western cultures, many people re-create webs of obligation in chosen families. There, too, it is the burdening that makes the bonds secure.
I recently had a conversation with a Canadian friend who told me that he and his three siblings had not been particularly close as adults. Then their aging dad grew gravely ill. His care became a burden they all shared, and that shared burden brought them closer. Their father died but their closeness remains. Their father bestowed many gifts upon his children, but the final one was the gift of being a burden on his family.
Autonomy-based liberalism imposes unrealistic expectations. Each individual is supposed to define their own values, their own choices. Each individual, in the words of Supreme Court Justice Anthony Kennedy in Planned Parenthood v. Casey, is left to come up with their own “concept of existence, of meaning, of the universe, of the mystery of human life.” If your name is Aristotle, maybe you can do that; most of us can’t. Most of us are left in a moral vacuum, a world in which the meaning of life is unclear, unconnected to any moral horizon outside the self.
Autonomy-based liberalism cuts people off from all the forces that formed them, stretching back centuries, and from all the centuries stretching into the future. Autonomy-based liberalism leaves people alone. Its emphasis on individual sovereignty inevitably erodes the bonds between people. Autonomy-based liberalism induces even progressives to live out the sentence notoriously associated with Margaret Thatcher: “There is no such thing as society.” Nearly 200 years ago, Alexis de Tocqueville feared that this state of affairs not only makes
men forget their ancestors, but also clouds their view of their descendants and isolates them from their contemporaries. Each man is forever thrown back upon himself alone and there is a danger that he may be shut up in the solitude of his own heart.
As Émile Durkheim pointed out in 1897, this is pretty much a perfect recipe for suicide. We now live in societies in which more and more people are deciding that death is better than life. In short, autonomy-based liberalism produces the kind of isolated, adrift people who are prone to suicide—and then provides them with a state-assisted solution to the problem it created in the first place.
Gifts-based liberalism, by contrast, gives you membership in a procession that stretches back to your ancestors. It connects you to those who migrated to this place or that, married this person or that, raised their children in this way or that. What you are is an expression of history.
This long procession, though filled with struggles and hardship, has made life sweeter for us. Human beings once lived in societies in which slavery was a foundational fact of life, beheadings and animal torture were popular entertainments, raping and pillaging were routine. But gradually, with many setbacks, we’ve built a culture in which people are more likely to abhor cruelty, a culture that has as an ideal the notion that all people deserve fair treatment, not just our kind of people.
This is progress. Thanks to this procession, each generation doesn’t have to make the big decisions of life standing on naked ground. We have been bequeathed sets of values, institutions, cultural traditions that embody the accumulated wisdom of our kind. The purpose of life, in a gifts-based world, is to participate in this procession, to keep the march of progress going along its fitful course. We may give with our creativity, with our talents, with our care, but many of the gifts people transmit derive from deeper sources.
A few years ago, the historian Wilfred McClay wrote an essay about his mother, a mathematician, in The Hedgehog Review. One day he mentioned to her that H. L. Mencken had suffered a stroke late in life that left him unable to read or write and nearly unable to speak. His mother coolly remarked that if such a fate ever befell her, he should not prolong her life. Without a certain quality of life, she observed, there’s no point in living.
A couple of years later, she suffered a near-fatal stroke that left her unable to speak. She cried the most intense sobs of grief McClay had ever heard. It might have appeared that her life was no longer worth living. But, McClay observed, “something closer to the opposite was true. An inner development took place that made her a far deeper, warmer, more affectionate, more grateful, and more generous person than I had ever known her to be.”
Eventually McClay’s mother moved in with his family. “It wasn’t always easy, of course, and while I won’t dwell on the details, I won’t pretend that it wasn’t a strain. But there are so many memories of those years that we treasure—above all, the day-in-and-day-out experience of my mother’s unbowed spirit, which inspired and awed us all.”
She and her family devised ways to communicate, through gestures, intonations, and the few words she still possessed. She could convey her emotions by clapping and through song. “Most surprisingly, my mother proved to be a superb grandmother to my two children, whom she loved without reservation, and who loved her the same way in return.” McClay noted that her grandkids saw past her disability. They could not have known how they made life worth living for her, but being around her was a joy. After she died, McClay writes that “it took a long time to adjust to the silence in the house.” He concluded, “Aging is not a problem to be solved, my mother taught us. It is a meaning to be lived out.”
Sometimes the old and the infirm, those who have been wounded by life and whose choices have been constrained, reveal what is most important in life. Sometimes those whose choices have been limited can demonstrate that, by focusing on others and not on oneself, life is defined not by the options available to us but by the strength of our commitments.
If autonomy-based liberals believe that society works best when it opens up individual options, gifts-based liberals believe that society works best when it creates ecologies of care that help people address difficulties all along the path of life. Autonomy-based liberalism is entrenching an apparatus that ends life. Gifts-based liberalism believes in providing varieties of palliative care to those near death and buttressing doctors as they forge trusting relationships with their patients. These support structures sometimes inhibit choices by declaring certain actions beyond the pale. Doctors are there for healing, at all times and under all pressures. Patients can trust the doctor because they know the doctor serves life. Doctors can know that, exhausted and confused though they might be while attending to a patient, their default orientation will be to continue the struggle to save life and not to end life.
John Stuart and Harriet Taylor Mill believed in individual autonomy. But they also believed that a just society has a vision not only of freedom but also of goodness, of right and wrong. Humans, John Stuart Mill wrote, “are under a moral obligation to seek the improvement of our moral character.” He continued, “The test of what is right in politics is not the will of the people, but the good of the people.” He understood that the moral obligations we take on in life—to family, friends, and nation, to the past and the future—properly put a brake on individual freedom of action. And he believed that they point us toward the fulfillment of our nature.
The good of humanity is not some abstraction—it’s grounded in the succession of intimates and institutions that we inherit, and that we reform, improve, and pass on. When a fellow member of the procession is in despair, is suffering, is thinking about ending their life, we don’t provide a syringe. We say: The world has not stopped asking things of you. You still have gifts to give, merely by living among us. Your life still sends ripples outward, in ways you do and do not see. Don’t go. We know you need us. We still need you.
This article appears in the June 2023 print edition with the headline “The Canadian Way of Death.” When you buy a book using a link on this page, we receive a commission. Thank you for supporting The Atlantic.
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