Tag: recent years

A Teen Gender-Care Debate Is Spreading Across Europe

As Republicans across the U.S. intensify their efforts to legislate against transgender rights, they are finding aid and comfort in an unlikely place: Western Europe, where governments and medical authorities in at least five countries that once led the way on gender-affirming treatments for children and adolescents are now reversing course, arguing that the science undergirding these treatments is unproven, and their benefits unclear.

The about-face by these countries concerns the so-called Dutch protocol, which has for at least a decade been viewed by many clinicians as the gold-standard approach to care for children and teenagers with gender dysphoria. Kids on the protocol are given medical and mental-health assessments; some go on to take medicines that block their natural puberty and, when they’re older, receive cross-sex hormones and eventually surgery. But in Finland, Sweden, France, Norway, and the U.K., scientists and public-health officials are warning that, for some young people, these interventions may do more harm than good.

European health authorities are not reversing themselves on broader issues of trans rights, particularly for adults. But this turn against the Dutch protocol has inflamed activists and politicians in the United States. Republicans who have worked to ban its recommended treatments claim that the shifts in Europe prove they’re right. Their opponents argue that any doubts at all about the protocol, raised in any country whatsoever, are simply out of step with settled science: They point to broad endorsements by the American Medical Association, the American Psychiatric Association, and the American Academy of Pediatrics, among other groups; and they assert that when it comes to the lifesaving nature of gender-affirming care, “doctors agree.”

But doctors do not agree, particularly in Europe, where no treatments have been banned but a genuine debate is unfurling in this field. In Finland, for example, new treatment guidelines put out in 2020 advised against the use of puberty-blocking drugs and other medical interventions as a first line of care for teens with adolescent-onset dysphoria. Sweden’s National Board of Health and Welfare followed suit in 2022, announcing that such treatments should be given only under exceptional circumstances or in a research context. Shortly after that, the National Academy of Medicine in France recommended la plus grande réserve in the use of puberty blockers. Just last month, a national investigatory board in Norway expressed concerns about the treatment. And the U.K.’s only national gender clinic for children, the Tavistock, has been ordered to close its doors after a government-commissioned report found, among other problems, that its Dutch-protocol-based approach to treatment lacked sufficient evidence.

These changes in Europe have so far been fairly localized: Health authorities in many countries on the continent—among them Austria, Denmark, Germany, Italy, and Spain—have neither subjected the Dutch approach to formal scrutiny nor advised against its use. Yet questions about the protocol seem to be spreading. At the end of March, for example, a Belgian TV report described a 42-fold increase in patients at a leading gender clinic in Ghent and raised questions about the right approach to care. Doubts about the protocol have even come to the country that invented it, at the Center of Expertise on Gender Dysphoria in Amsterdam. “Until I began noticing the developments in other EU countries and started reading the scientific literature myself, I too thought that the Dutch gender care was very careful and evidence-based,” Jilles Smids, a postdoctoral researcher in medical ethics at Erasmus University in the Netherlands, told me via email. “But now I don’t think that any more.”

Kirsten Visser, a Netherlands-based advocate and consultant for parents of trans teens, says her own son, Sietse, started receiving “definitely lifesaving” care at the Amsterdam center in 2012, at the age of 11. Around the time that Sietse showed up at the clinic, the Dutch protocol was becoming established internationally, largely through the work of a child and adolescent psychiatrist there named Annelou de Vries.

After completing a Ph.D. on gender dysphoria in Dutch adolescents, de Vries published two seminal papers with the clinical psychologist Peggy Cohen-Kettenis and other colleagues, in 2011 and 2014. The former looked at the psychological effects of puberty suppression on 70 young people over a period of two years, on average; the latter tracked outcomes for 55 of those people who had gone on to receive gender-reassignment surgery, over an average of six years. Taken together, the studies found that the teens showed fewer symptoms of depression after having their puberty suppressed, as well as a decrease in behavioral and emotional problems; and that the ones who went on to take gender-affirming hormones and have surgery grew into “well-functioning young adults.” De Vries’s expertise has since been widely recognized within the field: She served as a co-lead on the revision of the adolescent section of care guidelines recently published by the World Professional Association for Transgender Health, and is now president-elect of the European equivalent, EPATH.

But in the years after her two studies were released, research done in other European countries led to concerns about their relevance. In 2015, for example, Finnish researchers described a phenomenon that “called for clinical attention,” as they put it: More children were reporting gender dysphoria, and a greater proportion of them had been assigned female at birth. The fact that three-quarters of those Finnish teens had been diagnosed with separate and severe psychiatric conditions appeared to be at odds with the data from the Netherlands, the paper argued. The Dutch studies had found that just one-third of adolescents with gender dysphoria experienced other psychiatric issues, suggesting they were in far better mental health.

In Sweden, too, clinicians grew alarmed by the sudden increase in the number of teenagers seeking gender care. Mikael Landén, a professor of psychiatry at the University of Gothenburg, told me that this population has increased 17-fold since 2010. One explanation for that change—that more open-minded attitudes around gender have emboldened kids to seek the help they need—just doesn’t ring true to him. He’d studied those views in his early work, he said, and found that, on the whole, Swedish attitudes toward transgender people have been very positive for a long time.

When the government asked Landén and a group of other scientists to write an evidence-based review of hormone-based treatments for young people, their verdict, after two years of study, was expressed definitively: The original research findings from de Vries were outdated, and do not necessarily apply to the group of teens who have been coming forward in more recent years. The Dutch protocol had been “a valuable contribution,” he told me, and “it was reasonable to start using it” in Sweden. But times had changed, and so had the research literature. In 2021, for instance, a team based at the U.K.’s Tavistock clinic published research showing no detectable improvements in the mental health of youngsters who had been put on puberty blockers and followed for up to three years.

Read: The war on trans kids is totally unconstitutional

De Vries acknowledged some concerns about the research when we spoke in February. “Our early outcomes studies were really from another time and comprised small samples,” she told me, and they looked only at trans youth who had experienced gender dysphoria from childhood. She granted that there is some research to suggest that kids who don’t arrive at the clinic until they’re older are worse off, psychologically, than their younger peers; but she also said her team has run studies including 16-year-olds, and that their findings were “not worrisome.” She agrees that other researchers have not replicated the long-term follow-up research on kids who went through the Dutch protocol, but she pointed out that the short-term benefits of such treatment have indeed been seen in other studies. Research conducted in the U.S., and published earlier this year, found that a group of 315 trans and nonbinary youth were on average less depressed and anxious, and better-functioning, after two years of hormonal treatment.

In the meantime, de Vries and her colleagues have urged clinicians in other countries to do more of their own investigation, in part because the youngsters who receive care at gender clinics in the Netherlands seem to be in comparatively good mental health from the get-go. It’s not yet clear, she told me, that studies of this group will be applicable to youth in other countries. “Every doctor or psychologist who is involved in transgender care should feel the obligation to do a good pre- and post-test,” one of de Vries’s co-authors on the 2011 and 2014 studies said to a Dutch newspaper in 2021. “The rest of the world is blindly adopting our research.”

De Vries is now working on a research project, funded by an $864,000 grant, that will try to answer newly forming doubts about the Dutch protocol. Her proposal for the grant, filed in 2021, described its subject as a “once so welcomed but now sharp[ly] criticized approach.”

That such criticisms are becoming mainstream even in her own country is itself a startling development. After all, the Netherlands has long been at the vanguard of progressive health-care practices. When the Dutch approach to transgender care for adults first started taking shape during the 1970s (many years before the protocol for kids would be established), the country’s politics were dominated by a steadfast opposition to taboos. James Kennedy, an American-born professor of modern Dutch history at Utrecht University, has described this as the country’s “compassionate culture”: In a radical departure from its traditional Christian conservatism, long-standing policies were being spurned; and even touchy subjects such as death and sex were made the subject of broad public-policy debates. Sex work, for example, was widely tolerated, then legalized in 2000. Similarly, the Royal Dutch Medical Association offered formal guidelines for the practice of euthanasia in the 1980s, and a corresponding national law—one of the world’s first—codified the rules in 2002.

Against this backdrop of openness, in which doctors were seen as authoritative figures who were well equipped to decide what was best for their patients, one of the first dedicated clinics for transgender people was established in Amsterdam in 1972. It offered an array of services—blood tests, hormone therapy, and surgeries—to trans adults. According to a recent book by the historian Alex Bakker, Dutch surgeons, some of them inspired by their Christian beliefs, developed techniques that would reduce patients’ psychological suffering. “Helping those in need trumped ‘taboos’ about the sanctity of life or fixed gender roles,” Kennedy told me. The Dutch protocol for treating gender dysphoria in children, as established in the 1990s, reflected a further extension of this philosophy, aiming to smooth adult transitions by intervening early.

Read: Take detransitioners seriously

Nevertheless, in December, a journalist named Jan Kuitenbrouwer and a sociologist named Peter Vasterman published an opinion piece in a leading daily newspaper, NRC, that took aim at the Dutch protocol and its “shaky” scientific foundations, and alluded to the international scrutiny of the past few years. “It is remarkable that the media in our neighboring countries report extensively on this reconsideration,” the article said, “but the Dutch hardly ever do.” Like critics elsewhere, Kuitenbrouwer and Vasterman pointed to the rising numbers of children seeking care, from 60 to 1,600 in the Netherlands across a dozen years, and the unaccounted rise in those assigned female at birth; and they suggested that this new generation of people seeking treatment is not analogous to those included in the studies conducted by de Vries a decade ago. De Vries and some colleagues countered that their more recent research addresses this concern. “Scientific evaluation has always been an integral part of this challenging model of care, where young people make early decisions about medical interventions with lifelong implications,” they wrote in the same newspaper.

Also in December, a clinical psychologist at Radboud University’s gender clinic in Nijmegen named Chris Verhaak told a different Dutch outlet that puberty blockers affect children’s bones, and maybe also their brain development. “It is not nothing,” she said. Verhaak is currently running a government-funded study to understand the source and nature of the increase in the number of patients. (Results are due to be presented to the Dutch House of Representatives this year.) In another interview that month, she said that for up to half of cases, the gains in suppressing puberty are not clear. “I worry about that,” she told the newsweekly De Groene Amsterdammer. “Especially because we also experience enormous pressure to provide these puberty inhibitors as quickly as possible.”

Verhaak’s comments in particular sparked dismay among trans groups, which saw them as promoting destructive narratives about social contagion. Verhaak and her direct collaborators say that they are no longer speaking to the media until their study is released, but Hedi Claahsen, a professor and principal clinician on the Radboud center’s gender team, told me that practitioners are cautious and follow national guidelines. When I asked if her center’s approach differed from the one used in Amsterdam, she told me, “No clinic is exactly the same.” Individual providers, who are working at different institutions, may end up providing care that reflects “a different vision.”

Another, more significant round of criticism arrived at the end of February, when another widely read Dutch newspaper, de Volkskrant, published a 5,000-word article under a headline reading: “The treatment of transgender youth in the Netherlands was praised. Now the criticism of ‘the Dutch approach’ is growing.” The authors spoke with Iris, a 22-year-old woman who spent five years on testosterone and had a double mastectomy that she now regrets; they pointed to a new population of kids assigned female at birth seeking care only in their teens; and they noted reservations about the protocol in Finland and Sweden. “Is the ‘Dutch approach’ still the way to go?” the story asked.

The article prompted debate on Twitter, where Michiel Verkoulen, a health economist working with the government of the Netherlands to address the long-standing problem of ever-expanding waiting lists and their impact on young people’s mental health, accused the Dutch protocol’s critics of ignoring what he described as the elephant in the room. “What to do with the people for whom transgender care is critical?” he asked. “You can put every research aside, keep asking for more, and argue that diagnostics and treatments should be stricter … But the question remains: What then?”

“In the Netherlands there are more and more people saying that gender diversity is woke and it’s nonsense and it’s bullshit,” Visser, the consultant for parents of trans teens, told me. Sam van den Berg, a spokesperson for an Utrecht-based trans-rights organization called Transvisie, argued that this debate does not need to happen. The quality of care for children with gender dysphoria is better in the Netherlands than almost anywhere else, she said. “We don’t feel it’s necessary to change anything.” Indeed, doctors in the Netherlands are still free to provide gender-affirming care as they see fit. The same is true of their colleagues in Finland, Sweden, France, Norway, and the U.K., where new official guidelines and recommendations are not binding. No legal prohibitions have been put in place in Europe, as they have been in more than a dozen U.S. states, where physicians risk losing their medical license or facing criminal sanctions for prescribing certain forms of gender-affirming care.

But the trend toward more conservative application of the Dutch protocol is likely to have real effects in European countries, in terms of which kids get treatment, and of what kind. Louise Frisén, an associate professor at Karolinska Institute and a pediatric psychiatrist at the child and adolescent mental-health clinic in Stockholm, Sweden, told me she worries that under her country’s new guidelines, many of her teenage patients will find it harder to access medical care. The benefits of treatment are clear, she said, and she further claimed that the policy change has caused anguish for some patients who are panicking at the looming prospect of puberty.

As for de Vries, when I spoke with her a few weeks before the article in de Volkskrant was published, she agreed that clinicians should be cautious, but not to the point where treatment becomes inaccessible. Outcomes for those with later-onset dysphoria do need to be investigated further, she acknowledged, but “if we are going to wait ’til the highest-standard medical evidence provides us the answers, we will have to stop altogether.” In that sense, Europe’s brewing disagreement over treatment could turn into paralysis. “That’s what worries me,” she said. “You will always have to work with uncertainties in this field.”

Frieda Klotz

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April 28, 2023
Why Congress Doesn’t Work

Control of the House of Representatives could teeter precariously for years as each party consolidates its dominance over mirror-image demographic strongholds.

That’s the clearest conclusion of a new analysis of the demographic and economic characteristics of all 435 congressional districts, conducted by the Equity Research Institute at the University of Southern California in conjunction with The Atlantic.

Based on census data, the analysis finds that Democrats now hold a commanding edge over the GOP in seats where the share of residents who are nonwhite, the share of white adults with a college degree, or both, are higher than the level in the nation overall. But Republicans hold a lopsided lead in the districts where the share of racial minorities and whites with at least a four-year college degree are both lower than the national level—and that is the largest single bloc of districts in the House.

This demographic divide has produced a near-partisan stalemate, with Republicans in the new Congress holding the same narrow 222-seat majority that Democrats had in the last one. Both sides will struggle to build a much bigger majority without demonstrating more capacity to win seats whose demographic and economic profile has mostly favored the other. “The coalitions are quite stretched to their limits, so there is just not a lot of space for expansion,” says Lee Drutman, a senior fellow in the political-reform program at New America.

The widening chasm between the characteristics of the districts held by each party has left the House not only closely divided, but also deeply divided.

Through the late 20th and early 21st centuries, substantial overlap remained between the kinds of districts each party held. In those years, large numbers of Democrats still represented mostly white, low-income rural and small-town districts with few college graduates, and a cohort of Republicans held well-educated, affluent suburban districts. That overlap didn’t prevent the House from growing more partisan and confrontational, but it did temper that trend, because the small-town “blue dog” Democrats and suburban “gypsy moth” Republicans were often the members open to working across party lines.

Now the parties represent districts more consistently divided along lines of demography, economic status, and geography, which makes finding common ground difficult. The parties’ intensifying separation “is a recipe for polarization,” Manuel Pastor, a sociology professor at USC and the director of the Equity Research Institute, told me.

To understand the social and economic characteristics of the House seats held by each party, Jeffer Giang and Justin Scoggins of the Equity Research Institute analyzed five-year summary results through 2020 from the Census Bureau’s American Community Survey.

The analysis revealed that along every key economic and demographic dimension, the two parties are now sorted to the extreme in the House districts they represent. “These people are coming to Washington not from different districts, but frankly different planets,” says former Representative Steve Israel, who chaired the Democratic Congressional Campaign Committee.

Among the key distinctions:

*More than three-fifths of House Democrats hold districts where the share of the nonwhite population exceeds the national level of 40 percent. Four-fifths of House Republicans hold districts in which the minority share of the population is below the national level.

*Nearly three-fourths of House Democrats represent districts where the share of white adults with a college degree exceeds the national level of 36 percent. More than three-fourths of Republicans hold districts where the share of white college graduates trails the national level.

*Just over three-fifths of House Democrats hold districts where the share of immigrants exceeds the national level of 14 percent; well over four-fifths of House Republicans hold districts with fewer immigrants than average.

*Perhaps most strikingly, three-fifths of Democrats now hold districts where the median income exceeds the national level of nearly $65,000; more than two-thirds of Republicans hold districts where the median income falls beneath the national level.

Sorting congressional districts by racial diversity and education produces the “four quadrants of Congress”: districts with high levels of racial diversity and white education (“hi-hi” districts), districts with high levels of racial diversity and low levels of white education (“hi-lo districts”), districts with low levels of diversity and high levels of white education (“lo-hi districts”), and districts with low levels of diversity and white education (“lo-lo districts”). (The analysis focuses on the education level among whites, and not the entire population, because education is a more significant difference in the political behavior of white voters than of minority groups.)

Read: The GOP’s control of congress is only getting stronger

Looking at the House through that lens shows that the GOP has become enormously dependent on one type of seat: the “lo-lo” districts revolving around white voters without a college degree. Republicans hold 142 districts in that category (making up nearly two-thirds of the party’s House seats), compared with just 21 for Democrats.

The intense Republican reliance on this single type of mostly white, blue-collar district helps explain why the energy in the party over recent years has shifted from the small-government arguments that drove the GOP in the Reagan era toward the unremitting culture-war focus pursued by Donald Trump and Florida Governor Ron DeSantis. Many of the most militantly conservative House Republicans represent these “lo-lo” districts—a list that includes Marjorie Taylor Greene of Georgia, Lauren Boebert of Colorado, Matt Gaetz of Florida, Ralph Norman of South Carolina, and Scott Perry of Pennsylvania.

“The right accuses the left of identity politics, when the analysis of this data suggests that identity politics has become the core of the Republican Party,” Pastor told me.

House Democrats are not nearly as reliant on seats from any one of the four quadrants. Apart from the lo-lo districts, they lead the GOP in the other three groupings. Democrats hold a narrow 37–30 lead over Republicans in the seats with high levels of diversity and few white college graduates (the “hi-lo” districts). These seats include many prominent Democrats representing predominantly minority areas, including Jim Clyburn of South Carolina, Terri Sewell of Alabama, and Ruben Gallego of Arizona. At the same time, these districts have been a source of growth for Republicans: The current Democratic lead of seven seats is way down from the party’s 28-seat advantage in 2009.

Democrats hold a more comfortable 57–35 edge in the “lo-hi” districts with fewer minorities and a higher share of white adults with college degrees than average. These are the mostly white-collar districts represented by leading suburban Democrats, many of them moderates, such as Angie Craig of Minnesota, Seth Moulton of Massachusetts, Sharice Davids of Kansas, and Mikie Sherrill of New Jersey. A large share of the House Republicans considered more moderate also represent districts in this bloc.

The core of Democratic strength in the House is the “hi-hi” districts that combine elevated levels of both racial minorities and college-educated whites. Democrats hold 98 of the 113 House seats in this category. Many of the party’s most visible members represent seats fitting this description, including former Speaker Nancy Pelosi; the current House Democratic leader, Hakeem Jeffries; former House Intelligence Committee chair Adam Schiff; and Alexandria Ocasio-Cortez. These are also the strongholds for Democrats representing what Pastor calls the places where “diversity is increasing the most”: inner suburbs in major metropolitan areas. Among the members representing those sorts of constituencies are Lucy McBath of Georgia, Abigail Spanberger of Virginia, and Ro Khanna and Zoe Lofgren of California.

Though Democrats are not as dependent on any single quadrant as Republicans are on the low-diversity, low-education districts, each party over the past decade has been forced to retreat into its demographic citadel. As Drutman notes, that’s the result of a succession of wave elections that has culled many of the members from each side who had earlier survived in districts demographically and economically trending toward the other.

The first victims were the so-called blue-dog Democrats, who had held on to “lo-lo” districts long after they flipped to mostly backing Republican presidential candidates. Those Democrats from rural and small-town areas, many of them in the South, had started declining in the ’90s. Still, as late as 2009, during the first Congress of Barack Obama’s presidency, Republicans held only 20 more seats than Democrats did in the “lo-lo” quadrant. Democrats from those districts composed almost as large a share of the total party caucus in that Congress as did members from the “hi-hi” districts.

But the 2010 Tea Party landslide virtually exterminated the blue dogs. After that election, the GOP edge in the lo-lo districts exploded to 90 seats; it reached 125 seats after redistricting and further GOP gains in the 2014 election. Today the districts low in diversity and white-education levels account for just one in 10 of all House Democratic seats, and the “hi-hi” seats make up nearly half. The seats low in diversity and high in white education (about one-fourth) and those high in diversity and low in white education (about one-sixth), provide the remainder.

For House Republicans, losses in the 2018 midterms represented the demographic bookend to their blue-collar, small-town gains in 2010. In 2018, Democrats, powered by white-collar antipathy toward Trump, swept away a long list of House Republicans who had held on to well-educated suburban districts that had been trending away from the GOP at the presidential level since Bill Clinton’s era.

Today, districts with a higher share of white college graduates than the nation overall account for less than one-fourth of all GOP seats, down from one-third in 2009. The heavily blue-collar “lo-lo” districts have grown from just over half of the GOP conference in 2009 to their current level of nearly two-thirds. (The share of Republicans in seats with more minorities and fewer white college graduates than average has remained constant since 2009, at about one in seven.)

Each party is pushing an economic agenda that collides with the immediate economic interests of a large portion of its voters. “The party leadership has not caught up with the coalitions,” says former Representative Tom Davis, who served as chair of the National Republican Congressional Committee.

For years, some progressives have feared that Democrats would back away from a populist economic agenda if the party grew more reliant on affluent voters. That shift has certainly occurred, with Democrats now holding 128 of the 198 House districts where the median income exceeds the national level. But the party has continued to advocate for a redistributionist economic agenda that seeks higher taxes on upper-income adults to fund expanded social programs for working-class families, as proposed in President Joe Biden’s latest budget. The one concession to the new coalition reality is that Democrats now seek to exempt from higher taxes families earning up to $400,000—a level that earlier generations of Democrats probably would have considered much too high.

Republicans face more dissonance between their reconfigured coalition and their agenda. Though the GOP holds 152 of the 237 districts where the median income trails the national level, the party continues to champion big cuts in domestic social programs that benefit low-income families while pushing tax cuts that mostly flow toward the wealthy and corporations. As former Democratic Representative David Price, now a visiting fellow at Duke University’s Sanford School of Public Policy, says, there “is a pretty profound disconnect” between the GOP’s economic agenda and “the economic deprivation and what you would think would be a pretty clear set of needs” of the districts the party represents.

Each of these seeming contradictions underscores how cultural affinity has displaced economic interest as the most powerful glue binding each side’s coalition. Republicans like Davis lament that their party can no longer win culturally liberal suburban voters by warning that Democrats will raise their taxes; Democrats like Price express frustration that their party can’t win culturally conservative rural voters by portraying Republicans as threats to Social Security and Medicare.

The advantage for Republicans in this new alignment is that there are still many more seats where whites exceed their share of the national population than seats with more minorities than average. Likewise, the number of seats with fewer white college graduates than the nation overall exceeds the number with more.

That probably gives Republicans a slight advantage in the struggle for House control over the next few years. Of the 22 House seats that the nonpartisan Cook Political Report currently rates as toss-ups or leaning toward the other party in 2024, for instance, 14 have fewer minorities than average and 12 have fewer white college graduates. “On the wedge issues, a lot of the swing districts look a little bit more like Republican districts than Democratic districts,” says Drutman, whose own recent analysis of House districts used an academic polling project to assess attitudes in all 435 seats.

But as Pastor points out, Republicans are growing more dependent on those heavily white and non-college-educated districts as society overall is growing more diverse and better educated, especially in younger generations. “It’s hard to see how the Republicans can grow their coalition,” Pastor told me, with the militant culture-war messages they are using “to cement their current coalition.”

Davis, the former NRCC chair, also worries that the GOP is relying too much on squeezing bigger margins from shrinking groups. The way out of that trap, he argues, is for Republicans to continue advancing from the beachheads they have established in recent years among more culturally conservative voters of color, especially Latino men.

Read: Are latinos really realigning toward Republicans?

But Republicans may struggle to make sufficient gains with those voters to significantly shift the balance of power in the House: Though the party last year improved among Latinos in Florida, the results in Arizona, Nevada, and even Texas showed the GOP still facing substantial barriers. The Trump-era GOP also continues to face towering resistance in well-educated areas, which limits any potential recovery there: In 2020, Biden, stunningly, carried more than four-fifths of the House districts where the share of college-educated white adults exceeds the national level. Conversely, despite Biden’s emphasis on delivering tangible economic benefits to working families, Democrats still faced enormous deficits with blue-collar white voters in the midterms. With many of its most vulnerable members defending such working-class terrain, Democrats could lose even more of those seats in 2024.

Constrained by these offsetting dynamics, neither party appears well positioned to break into a clear lead in the House. The two sides look more likely to remain trapped in a grinding form of electoral trench warfare in which they control competing bands of districts that are almost equal in number, but utterly antithetical in their demographic, economic, and ideological profile.

Ronald Brownstein

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March 17, 2023
A Troubling Sign for 2024

Updated at 12:43 p.m. ET on March 7, 2023

Twilight offered welcome concealment when we met at the prearranged hour. “I really haven’t gone out anywhere” since well before the election, Bill Gates, the outgoing Republican chair of the Maricopa County board of supervisors, told me in mid-November. He’d agreed to meet for dinner at an outdoor restaurant in the affluent suburb of Scottsdale, Arizona, but when he arrived, he kept his head down and looked around furtively. “Pretty much every night, I just go home, you know, with my wife, and maybe we pick up food, but I’m purposely not going out right now. I don’t necessarily want to be recognized.” He made a point of asking me not to describe his house or his car. Did he carry a gun, or keep one at home? Gates started to answer, then stopped. “I’m not sure if I want that out there,” he said.

As a younger politician, not so long ago, Gates had been pleased and flattered to be spotted in public. Now 51 years old, he never set out to become a combatant in the democracy wars. He shied away from the role when it was first thrust upon him, after the 2020 election, recognizing a threat to his rising career in the GOP. But the fight came to him, like it or not, because the Maricopa County board of supervisors is the election-certification authority for well over half the votes in the state.

When we spoke, Kari Lake was still contesting her loss in Arizona’s gubernatorial election. Months later, she is still anointing herself “the real governor” and saying that election officials who certified her defeat are “crooks” who “need to be locked up.” She reserves special venom for Gates. Speaking to thousands of raucous supporters in Phoenix on December 18, beneath clouds of confetti, Lake denounced “sham elections … run by fraudsters” and singled him out as the figurehead of a corrupt “house of cards.”

“They are daring us to do something about it,” she said. “We’re going to burn it to the ground.” Then she lowered her mic and appeared to mouth, with exaggerated enunciation, “Burn the fucker to the ground.” To uproarious applause, she went on to invoke the Second Amendment and the bloody American Revolution against a tyrant. “I think we’re right there right now, aren’t we?” she said.

All of that may seem a little beside the point from afar, an inconsequential footnote to a 2022 election season that, mercifully, felt more normal than the last one. But Lake shares Donald Trump’s dark gift for channeling the rage of her supporters toward violence that is never quite spoken aloud.

From the January 2021 issue: Barton Gellman on Trump’s next insurrection

In part as a result of her vilification campaign, Gates is stalked on social media, in his inbox and on voicemail, and in public meetings of the board of supervisors. Based on what law enforcement regarded as a credible death threat, Maricopa County Sheriff Paul Penzone removed Gates and his wife from their home in Phoenix on Election Night and dispatched them to a secure location under guard. They knew the drill. “I’ve done it so many times,” Gates recalled. “It’s like, ‘Here we go again.’”

In two successive elections, 2020 and 2022, Gates has had to choose: back his party, or uphold the law. Today, he is a leading defender—in news conferences, in court, and in election oversight—of Arizona’s democratic institutions.

I’d come to Phoenix to try to understand this moment in American politics. November’s midterm election was the first in the country’s history to feature hundreds of candidates running explicitly as election rejectionists. Enough of them were defeated to mark a salutary trend: Swing voters did not seem to favor blatant, self-serving lies about election fraud. That was an encouraging result for democracy, and a balm to many Americans eager for a return to something like political normalcy.

But it was not the whole story. Election deniers won races for secretary of state—the post that oversees election administration—in Alabama, Indiana, South Dakota, and Wyoming. They make up most of the Republican freshman class in Congress. Even some of the losers came very close. Lake’s election-denying ticket mate, Abe Hamadeh, lost the Arizona attorney general’s race by 280 votes.

Of greatest interest to me was the extent to which the narrow losses of MAGA conspiracists gained legitimacy from the words and actions of people like Gates—otherwise low-profile electoral officials, many of them Republican. I wanted to know how he saw the recent election, and what he expected of the next one. The more time I spent with him, and in Arizona, the more uncertain the reprieve of last November appeared.

“I’m politically dead,” Gates told me. It’s what he thinks most of the time, though not always. He toys with thoughts of running again, even running for higher office, but calculates that he has next to no chance of securing his party’s nomination for any office in 2024. If Trump or a successor tries to overturn the vote in January 2025, somebody else will have to be found to push back.

In Maricopa County alone, four of the five supervisors, all of whom have stood shoulder to shoulder in defense of the county’s election machinery, are Republicans. As ultra-MAGA conspiracists continue to dominate the GOP base, what kind of Republicans will be around to safeguard the next election, or the one after that?

Left: Ballot drop box outside the election center in Phoenix, Arizona. Right: “Unborn Lives Matter,” “Trump 2024 Take America Back,” and “Kari Lake for Governor” flags in a residential backyard in Peoria, Arizona. (Adam Riding for The Atlantic)

Something goes wrong in just about every voting cycle, and even when things go right, there are always details that can be made to look suspicious by fabulists intent on breaking public confidence. Sound elections rely on the competence, the fairness, the transparency, and, in recent years, the courage of election workers.

On Election Day 2022, Gates and other county authorities planned to ward off conspiracy theories with a smooth and efficiently functioning vote. The technology gods had other plans.

The first sign of trouble turned up around 6:30 a.m. One polling center reported what looked like a tabulator malfunction. Ballots were printing on demand, and voters were filling them in, but the tabulator spat them out unread. The troubleshooting hotline logged a second call a few minutes later, then a third. Soon, dozens of polling places had tabulation failures. Trouble spots filled the status board at the Maricopa County Tabulation and Election Center, which stood behind a newly built security fence to keep protesters outside.

“And then it’s like, ‘Oh, crap,’” Gates recalled. “This is a widespread issue.” And “we have literally the eyes of the world on this election.” Voter lines backed up and tempers flared. Nobody knew what was wrong. Gates got on the phone with the president of Dominion Voting Systems, which made the tabulators.

Lake and the far-right information ecosystem had promoted the lie that the ballot was rigged long before Election Day. Social media now lit up with claims that election officials had sabotaged their own machines to suppress the vote in Republican neighborhoods. Lake went on television to say, falsely, that her voters were being turned away.

Gates and Stephen Richer, the county recorder, rushed out a video message at 8:52 a.m. Standing in front of a tabulator, Gates said, “We’re trying to fix this problem as quickly as possible, and we also have a redundancy in place. If you can’t put the ballot in the tabulator, then you can simply place it here where you see the number three. This is a secure box where those ballots will be kept for later this evening, where we’ll bring them in here to Central Count to tabulate them.”

It was the sort of rapid public response—factual, practical, and reassuring—that’s become essential since Trump first began poisoning voter confidence with false claims of fraud. But the Lake campaign and its allies nonetheless saw an opportunity to sow doubt and confusion.

“No. DO NOT PUT YOUR BALLOT IN BOX 3 TO BE ‘TABULATED DOWNTOWN,’” Charlie Kirk of Turning Point USA tweeted repeatedly to nearly 2 million followers. Kelli Ward, the Arizona Republican Party chair, posted the same urgent, all-caps advice, adding falsely that “Maricopa County is not turning on their tabulators downtown today!”

Many Lake supporters refused to use the Box 3 option, fearful that their votes would not be counted, and Gates ordered that voters be allowed to try the tabulators as many times as they wanted. The chaos at some polling stations worsened.

The technical error, diagnosed by midmorning, turned out to be that the printers in 43 of the 223 polling places were printing ballots with ink too faint for the tabulators to read. Nobody knew why; the same settings and equipment had worked fine in the August primaries. By early afternoon, technicians had solved the problem by increasing the heat setting on the print fuser.

Lake spread conspiracy theories throughout the day and in the days that followed, as the vote count went on. All Gates and Richer could do was stand in front of cameras, over and over again, answering every question. Box 3, by one or another name, was a standard voting option, employed in most Arizona counties for decades. There were plenty of polling places with short lines. Fewer than 1 percent of ballots were affected by printer issues, and all of them were being counted anyway. A live public video feed showed the tabulation operations, 24 hours a day. No voter had been turned away because of the glitch.

The office of Mark Brnovich, Arizona’s Republican attorney general, amplified Lake’s accusations and warned in a letter against certifying the election results without addressing numerous “concerns regarding Maricopa’s lawful compliance with Arizona election law.” Gates’s lawyer responded that the attorney general’s office had its facts wrong. Gates and his fellow supervisors certified the canvass on November 28. Katie Hobbs, the Democrat, had beaten Lake by 17,117 votes.

Lake filed a lawsuit on December 9, a 70-page complaint filled with florid accusations: sabotaged printers and tabulators, “hundreds of thousands of illegal ballots,” thousands of Republican voters who’d been disenfranchised—all in Maricopa County alone. The judge threw out most of her charges in pretrial rulings. At trial, Lake was unable to supply any persuasive evidence of wrongdoing or identify even one disenfranchised voter or illegal ballot. She lost again in the Court of Appeals on February 16, and now vows to go to the state supreme court. She has raised more than $2.6 million since Election Day, spoke at the Conservative Political Action Conference in Washington, D.C., this past weekend, and seems likely to run for the U.S. Senate next year.

Interior building details of the election center in Phoenix, Arizona (Adam Riding for The Atlantic)

M

ost of the election deniers who lost their races around the country in November conceded defeat, with varying degrees of grace. Pretending to win elections they lost turned out to be harder than Trump made it look. Not many politicians have the former president’s bottomless capacity to live and breathe an alternate reality—or make millions of people care. A pair of Joe Biden speeches on democracy, together with the public hearings of the January 6 committee, had also helped discredit election-fraud charges among independent voters. And right-wing media may have been more cautious about baseless fraud claims after the defamation lawsuits brought against them following their performance in 2020. Lake, a charismatic presence who had honed her television skills as a local news anchor, was one of the few candidates who doubled down on conspiracy talk.

Read: Trumpism has found its leading lady

But the impact of Lake’s performance was not hard to see. More than 1.2 million people voted for Lake in the governor’s race, three-quarters of a million of them in Maricopa. Many, swept up in her reality-distortion field, believed sincerely that the election had been stolen. Scores of them surged into the board of supervisors’ hearing room on November 16, eight days after the election. Gates had scheduled public comments on election procedures. He sat on the dais with the demeanor of a nervous high-school principal, determined to keep rowdy students under control.

“I’m just going to say this right now: We have children watching this,” he told the crowd, improbably. “So please, no profanity.”

Everyone who signed up to speak would have two minutes. No interruptions. “We’re not going to have any outbursts, okay?” he said. The audience laughed, mocking him.

A woman named Raquel stood up.

“Mr. Chairman Bill Gates and Recorder Richer, you both have lost all credibility and any shred of integrity—”

Applause interrupted her. Gates narrowed his eyes.

Raquel accused Gates of founding “a political-action committee to specifically defeat MAGA candidates” and asked how he could fairly run an election. In 2021, amid a spurious “forensic audit” that tried to prove that Trump had won Arizona the previous year, Gates had made a $500 contribution to a PAC formed by Richer, the county recorder, called Pro-Democracy Republicans of Arizona—“The Arizona election wasn’t stolen” was the first line on its website—but he’d had no role in distributing its funds.

Another woman, Kimberly, told the supervisors that she knew they had sabotaged the ballot printers. “As a former programmer myself, I can tell you there’s no such thing as a glitch,” she said. The crowd, stirring, murmured its assent.

Jeff Zink, a MAGA Republican who had just lost his race for U.S. Congress, brought a more direct sense of grievance. The only reason he had not won, he said, was that “an algorithm took place which shows that at no time did I ever gain any ground whatsoever.” He did not explain what he thought an algorithm is. It did not matter: He had the room behind him.

Some witnesses made specific allegations. Many simply flung vitriol. “I’m just disgusted by your behavior,” said Sheila, a retired city worker. “Look at all these people out here who are suffering so badly because of your falsehoods.”

“You are the cancer that is tearing this nation apart,” said Matt, another speaker, to louder and angrier applause.

“Thank you,” Gates replied tightly.

Several speakers invoked higher powers and threatened divine retribution—or, anyway, retribution in God’s name. “Beware, your sins will find you out,” one speaker said in a quavering voice. Another, a hulk of a man named Michael, said that “God knows what you’ve done … I warn you and I caution you, we got a big God in Jesus’s name.”

Another burst of applause amid angry buzzing. Audience members were beginning to rise from their seats. Two sheriff’s deputies made as if to move toward them and then thought better of it. My sense, sitting near the front, was that the gathering was just below full boil. If the crowd got any hotter, two deputies would not be enough.

“You need to resign today. And I pray that God is going to convict your heart and for what you’ve done,” yelled a furious Lake supporter named Lisette.

Gates tried to respond, beginning to speak of the electoral redundancies that ensure that every vote is counted. But the crowd was standing and shouting. He adjourned the meeting and slipped out a side door, stage right. I joined him a few minutes later in his office across the street. I told Gates that it had looked to me as though the crowd had been making up its mind about whether to rush the dais.

“This is not a game,” he said. “This is very serious. And the danger of violence is just right under the surface.”

Gates picked without enthusiasm at a container of plain chicken and steamed carrots that his wife, the county’s associate presiding judge, had cooked for his lunch. “We’re doing this diet right now,” he said, a bit mournfully. “We’re trying to be good.”

He had rejected the option of packing the room with security, he said. “These are challenging times, because you also don’t want to create a police state, you know? And that’s something that we’re balancing.”

Gates has learned to live with a constant stream of abuse. It began long before the 2022 midterms and has not let up since those elections concluded. One persistent correspondent has written to him several times a month since early 2021. One day, he writes, “Hey I hear little bitch Bill Gates is in hiding? Why? Cause you worked extra hard to steal tao elections … or more? Keep hiding rat shit.” Four days later: “You are scum and deserve to be tried for treason.”

A voicemail left for his chief of staff, Zach Schira, twisted with rage: “I really believe that what we used to do to traitors is what we should do today. Give ’em a fucking Alabama necktie, you piece of shit. Fucking traitor, just like your fucking boss, rigging the election for a little bit of dough, you know? Piece of shit.” (The good old boy who left the message was probably aiming for a lynching metaphor, but he had hit on something else.)

In December, Gates woke up one morning and was moved to post on Twitter about the beauty around him: “If you are in @maricopacounty, step outside and look at the sunrise. We are blessed to live here.” The responses, dozens of them, were almost comically savage.

“Hopefully soon you won’t be able to see that beautiful sunrise, bc you’ll be locked up!”

“Treeeeaaasooon.”

“Quick question. Do you happen to know the penalty for treason? Just curious is all.”

There was more, calling him subhuman, soulless, satanic.

Every now and then, something sufficiently threatening crosses Sheriff Penzone’s desk, and he notifies Gates that it is time to sleep somewhere else. On other occasions, the sheriff will post a pair of undercover deputies outside his home. Most of the time, though, Gates walks and drives and puts himself out there in the world all alone.

A residential property in Peoria, Arizona (Adam Riding for The Atlantic)

Gates knows he is far from the only election official under threat. On January 16, police in Albuquerque, New Mexico, arrested a failed Republican political candidate who’d rejected his defeat and allegedly paid gunmen to shoot at the homes of four Democratic officeholders. On January 26, over in Arizona’s Cochise County, the elections director resigned her post after years of abuse, citing an “outrageous and physically and emotionally threatening” working environment.

According to a fall 2022 survey by the nonpartisan Democracy Fund, one in four election officials has experienced threats of violence because of their work. In the largest jurisdictions, that number increases to two out of three.

From the April 2023 issue: Adrienne LaFrance on America’s new anarchy

Gates stays in touch with peers around the country, mostly Republicans, who have stood up against election denial and faced the consequences. They form a little community, like an internet support group, dishing out comfort on bad days and dispatching a friendly word when they see one another in the news.

One member of this informal group is Al Schmidt, who was the sole Republican on the Philadelphia board of elections in the 2020 election and received a deluge of death threats after Trump accused him of being party to corruption. Gates also corresponds with Georgia Secretary of State Brad Raffensperger and his chief operating officer, Gabriel Sterling, both of whom pushed back against Trump’s demands to “find” enough votes to upend Biden’s victory in that state.

“We have done Zoom meetings,” he told me. “We have met in person. We talk on the phone. We text one another. And it’s very helpful because … if you haven’t gone through this, you don’t really understand. And if you have gone through it, you do.”

The simple banter reminds Gates that he has allies, even if far away.

“Yesterday, Trump endorsed an all-in stop the steal candidate for AG so look for me in handcuffs in early 2023. 😊,” Gates said in a text last June to Maggie Toulouse Oliver, the secretary of state of neighboring New Mexico. He was only half-joking: Abe Hamadeh, who nearly went on to win the attorney general’s race, was vowing to prosecute election officials whom he accused of fraud.

“Omg. Well I’ll come bail you out!! ❤️,” Oliver replied.

Chair of the board of supervisors is not even a full-time job in Maricopa, the fourth-largest county in America, with a population of 4.5 million and a $4.5 billion budget. Gates’s day job is associate general counsel for Ping, a large Phoenix-based manufacturer of golf clubs and bags. His position is not undemanding, but election controversies sometimes keep him away from the office for days or weeks at a time. His bosses, he said, “have been very understanding.”

It is hard to convey how little his world resembles the one Gates signed up for when he first ran for county supervisor. He grew up as a self-described “political dork” in Phoenix and chose Drake University, in Des Moines, for college because of its champion mock-trial team and because he wanted to see the Iowa caucuses in person. Jack Kemp, Ronald Reagan, and George H. W. Bush were his political heroes.

In 2009, Gates won an appointment to the Phoenix city council, where he developed a reputation as an urban technocrat. When he ran for county supervisor in 2016, the planks of his platform involved vacant strip malls, water and sewer problems, and garbage pickup. He called himself an “economic-development Republican” who “wants government to get out of the way to allow … free enterprise to flourish.”

Left: A polling-place tabulator and ballot box. Right: Election canvassing books at the election center in Phoenix. (Adam Riding for The Atlantic)

The warehouse section of the election center in Phoenix (Adam Riding for The Atlantic)

Gates did not much like Trump in the 2016 campaign, and voted for John Kasich in the primary. When Trump came to town for a rally, Gates told The Arizona Republic that Trump’s views “do not reflect the majority of Arizonans and the majority of Arizona Republicans.”

Even so, like a lot of reluctant Republicans, Gates voted for Trump over Hillary Clinton that year. “I believed he would nominate judges to the federal bench who would exercise judicial restraint, and that Mike Pence would have a calming influence,” he told me. Now that he represents the election-certification authority, Gates will not say how he voted in 2020.

If 2022 was hard on Gates and his colleagues, 2020 was worse—a fact that can reasonably support either optimism or pessimism for 2024. The presidency was at stake, not the governor’s office, and the aftermath of the election fell upon Gates and his fellow supervisors like a toxic spill. Arizona, and Maricopa County in particular, became a major focus of Trump’s cries of fraud. Angry mobs descended on the election command center and the homes of some of the supervisors, shouting “Stop the steal.” Alex Jones of Infowars and Representative Paul Gosar worked up the crowds. Gates called the scene outside the command center “Lollapalooza for the alt right.” Police put up temporary fencing to protect the ongoing tabulation. Inside, the staff could hear chanting and the reverberation of drums.

The incumbent president, wielding all the authority of his position, mobilized not only the MAGA grassroots but also the GOP establishment in service of his pressure campaign. Trump twice tried to get one of Gates’s colleagues, then-chair Clint Hickman, on the phone. Ward, the state Republican chair, began calling and texting Gates relentlessly as the deadline neared to certify the presidential vote, on November 20. “Here’s Sidney Powell’s phone number,” she said, according to Gates, referring to a Trump lawyer who would become notorious for outlandish claims. “Will you please call her?”

“I’m going, ‘Who’s Sidney Powell?’” Gates told me. “I never returned that call.”

In her text messages, which Gates provided to me, Ward recited multiple alleged anomalies and conspiracy theories. She attributed a baseless allegation about the corrupt design of Dominion software to an unnamed “team of fraud investigators.” She worried that “fellow Repubs are throwing in the towel. Very sad. And unAmerican.” She noted, “You all have the power that none of the rest of us have.”

The texts went on and on, alternately lawyerly, angry, and pleading.

Gates replied in the end with four words: “Thanks for your input.”

Had he felt threatened by all the arm-twisting from the state party chair? I asked.

“Threat is a strong word,” he told me, adding, “I felt pressure. I felt like if I didn’t do what she wanted to do, that there would be political ramifications, certainly.”

Gates grew up in local government and had a politician’s instinct not to make enemies. But if he fulfilled his lawful duty, he would become a pariah in the state GOP and an enemy of the president of the United States. Knowing that—and Ward made sure he knew—was supposed to crush all thoughts of resistance.

“Once you make that vote to certify, you know you’re not coming back from that,” Gates said. “People thought because I was nice over all these years that I was weak.”

Gates and his fellow supervisors voted unanimously, on schedule, to certify the 2020 election. But that didn’t slow the campaign to overturn the results. “Stop the steal” sentiment intensified as the year drew to a close. The Republican-dominated State Senate issued a subpoena for all of the county’s paper ballots and voting machines, planning to hand them over to a MAGA-run outfit called Cyber Ninjas to “audit” the results. Gates and his colleagues refused to comply, believing that would be illegal. They filed a lawsuit to void the subpoena.

Gates was doing last-minute shopping at Walgreens at about 5 p.m. on Christmas Eve when Rudy Giuliani called him. He did not recognize the number and ignored it, but he kept the voicemail, which he played for me.

“I have a few things I’d like to talk over with you,” Giuliani says, after introducing himself. “Maybe we can get this thing fixed up. You know, I really think it’s a shame that Republicans, sort of, we’re both in this kind of situation. And I think there may be a nice way to resolve it for everybody. So give me a call, Bill. I’m on this number, any time, doesn’t matter, okay? Take care. Bye.”

Gates shook his head at the memory.

“Someone who on 9/11 I had great respect for,” he said. “I didn’t return his call.”

In early 2021, state legislators moved to have Gates and his colleagues taken into custody for contempt if they did not hand over the ballots, notwithstanding the pending court case. Gates assured his crying daughters—there are three of them, now all in college—that he would be all right.

“So I actually shot a video on my camera—this was sort of like, you know, a hostage video,” Gates said. “Like, ‘If, you know, if you’re watching this, I’m now in custody,’ kind of explaining why I had done what I did, why I thought we were right.”

For all the sense of menace, there was something liberating about this period, Gates told me, and it was around this time that he began to speak out more often and more forcefully in defense of elections and the people who run them.

“They made allegations that our employees had deleted files, basically committed crimes,” Gates said. “That’s when this board, along with Recorder Richer and other countywide electeds, stood up and said, ‘We’re going to push back now. This is a lie. You’re accusing our folks of committing crimes. We can’t stand by silent.’”

The county court eventually ruled that Maricopa had to turn over the ballots and voting machines, and the Cyber Ninjas circus began. It found no evidence of fraud but stretched on for months, keeping Gates in the news as a foil.

His career, he believed then, was finished. He had no reason to hold back.

“Once you’re dead, there’s nothing they can do to you,” he said. “Right?”

Pedestrians walking along Mill Avenue in Tempe, Arizona (Adam Riding for The Atlantic)

“You know,” Gates told me, “I think this is the most dangerous time for the state of our democracy other than the Civil War.”

By any accounting, the 2020 election was more dangerous than the one last year. Gates knows as well as anyone that it’s too soon to say the worst is behind us. As a presidential nominee, Trump or another candidate could bring a subversive focus and intensity to the party that’s all but impossible during the midterms. More than a third of Republicans are still hard-core Trump supporters, and nearly two-thirds still believe the 2020 election was rigged. The race late last month for chair of the Republican National Committee pitted an incumbent who was all in for Trump against two challengers who competed to be more so.

Yet for all that, and despite what he’s just been through (again), Gates does see hopeful possibilities—possibilities he didn’t see two years ago. Many of the most strident election deniers did lose, he points out. Gripped by MAGA fever, the GOP has now experienced three successive setbacks at the ballot box, in 2018, 2020, and 2022. Some of the party’s elected leaders have distanced themselves from Trump since the midterms, and polls of GOP voters show some softening of support.

If Arizona rejected the extremists who ran for statewide office—Lake and Hamadeh and Mark Finchem, who ran for secretary of state—does that mean a politician like Gates might still have a chance? It’s an important question, because extremists who win primaries won’t always lose local general elections, and in the worst case, it wouldn’t take many extremists in roles like his to throw the country into chaos.

There is no clear answer yet, for Gates or for American democracy. In the biggest picture, the range of plausible outcomes in 2024 is as wide as it has been in living memory.

On January 11, Gates handed over the chair’s gavel to his colleague Clint Hickman. Until next year, when his term expires, Gates will simply be one of five members of the county board.

Recently, he has allowed himself to imagine running for statewide office. Democrats defeated all of the Arizona election deniers in 2022, but perhaps a mainstream Republican could win next time.

“Maybe we can take another shot at this. Maybe we can fight to get candidates who can appeal to the big tent,” he said. “That was the party that I joined.”

Did he really think it could happen as soon as 2024? I asked.

“I don’t know,” he said. “Things change. Two years is a long time in politics.”

This article initially misstated Bill Gates’s job title at Ping.

Barton Gellman

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March 7, 2023
Trump Has Become the Thing He Never Wanted to Be

One thing can be said for the proprietors of the MAGA Mall: They know their brand.

The right-wing-merch retailer’s setup was among the most impressive at this year’s Conservative Political Action Conference—a gargantuan display of apparel and tchotchkes meticulously curated to appeal to every segment of the Donald Trump–loving clientele. There were the MAKE AMERICA GREAT AGAIN hats in “classic” red for those who prefer a timeless look, and the ULTRA MAGA 45 hats for the more trend-conscious. There were T-shirts with Trump as Superman and T-shirts with Trump as the Terminator and—because even the most patriotic T-shirt designers eventually run out of ideas—T-shirts with Trump as the Geico lizard. (You can save 40% off everything by switching to Trump.)

Read: Republicans’ 2024 magical thinking

When I stopped by the booth on Friday afternoon, I noticed a smattering of non-Trump-branded products in the mix and thought I’d spotted a clever angle for a story.

“How’s the Ron DeSantis stuff selling?” I asked two people running the booth.

“Oh, good, another one,” the woman mumbled. “You’re the third one to ask today. You media?”

I nodded, feeling somewhat less certain of my cleverness, and sheepishly confirmed that I was a reporter. She seemed to stifle a sigh. “Not great,” she said, gesturing toward a cap that read MAKE AMERICA FLORIDA: DESANTIS 2024. “It’s about 50 to one Trump.”

As I turned to go, I heard her add, “But, I mean, we have a lot more Trump stuff …”

It was a perfect microcosm for CPAC’s strange vibe in 2023. Billed as the conservative movement’s marquee annual gathering, the conference was once known for its ability to draw together the right’s various factions and force them to compete noisily for supremacy. In the 1990s, Pat Buchanan rallied paleoconservative activists against the Bob Dole wing of the GOP. In the early 2010s, Tea Partiers in Revolutionary-era garb roamed the premises while scruffy libertarians hustled to win the straw poll for Ron Paul. Yes, the speakers would say controversial things, and yes, presidential candidates would give sporadically newsworthy speeches. But more than anything, it was the friction that gave the proceedings their electric, carnivalesque quality—that rare, sometimes frightening sense that anything could happen.

This year, that friction was notably absent. Trump, who jump-started his career as a political celebrity with a speech at CPAC in 2011, has so thoroughly captured the institution that many of the GOP’s other stars didn’t even bother to show up. Everything about the conference—the speakers, the swag, the media personalities broadcasting from outside the ballroom—suggested that it was little more than a three-day MAGA pep rally.

The result: In my decade of covering the event, I’d never seen it more dead.

I wasn’t the only one who noticed. Eddie Scarry, a conservative writer and longtime CPAC attendee, tweeted that the conference had devolved into a parade of “peripheral figures, grifters, and aging Fox News personalities who show up like they’re rock stars. Not to mention, 80% of it remains a tribute to Trump. Who is that still fun for?” Sponsors grumbled to Rolling Stone that turnout had dropped off from past years. My colleague John Hendrickson, who attended on Saturday, wrote that the conference had a “1 a.m. at the party” vibe, and wondered if 2023 would be remembered as “the last gasp of CPAC.”

Read: The martyr at CPAC

The relative dearth of Republican star power this year could be attributed to the scandal surrounding CPAC’s chairman Matt Schlapp, who was recently accused of fondling a male campaign aide against his will. (Schlapp has denied the allegation.) But in an interview with NBC News, one anonymous GOP operative said that top Republicans had already come to view the conference as a chore in recent years. “Someone said to me, ‘We all wanted an excuse not to go, and Schlapp gave it to us,’” the operative said.

The apparent decline in interest isn’t just about CPAC. It speaks to a serious problem for Trump’s 2024 campaign: His shtick has gotten stale. Which makes it awkward that so many party leaders continue to treat him like he’s still the generational political phenomenon who galvanized the right in 2016—the natural center of attention.

Writing last year in National Review, the conservative commentator Michael Brendan Dougherty noted that Trump’s appeal in 2016 resided largely in his image as a disruptive outsider who said shocking, outlandish things. To recapture that magic, Dougherty wrote, “Trump needs to re-create the iconoclastic thrill of supporting him, the empowering sense that he is an instrument for crushing the establishment in both parties.”

Instead, Trump has followed a different trajectory. His CPAC speech on Saturday night, like so many of his recent appearances, felt predictable and devoid of vitality as he rambled past the 90-minute mark in front of a not-quite-full ballroom. Trump, in other words, has become the establishment—and the establishment, by definition, is boring. He might as well attach an exclamation point to his campaign slogan and start asking voters to “please clap.”

Jack Malin, a freshman at Florida Gulf Coast University, traveled to CPAC this year for the first time, with a group of college Republicans. When I asked him what he thought of Trump, Malin talked about the transgressive excitement he felt as a high-school kid following the 2016 election. Trump got him interested in politics. But Malin is not so into Trump anymore. “I would say, as much as people love him, his four years have come and gone,” Malin told me. For 2024, he likes DeSantis, the Florida governor, and so do most of his friends.

As Malin spoke, I glanced past him at a crowd of onlookers that had formed around Donald Trump Jr., who was recording an interview with Steve Bannon. There was a time when these two men were seen—by critics and supporters alike—as dangerous provocateurs. Spellbound fans would hang on their every word; indignant journalists would live-tweet their speeches and interviews. Now their rhetoric about “deconstructing the administrative state” and “draining the swamp” just sounded like white noise. (As Trump and Bannon ranted, I watched some spectators turn their interest toward a baby and mom at the edge of the crowd.)

Read: American Rasputin

Nowhere was the general ennui at CPAC more palpable than in Exhibit Hall D, on the ground floor of the convention center in National Harbor, Maryland. In some ways, the scene was the same as in years past: nicely dressed conservatives perusing rows of booths set up by think tanks, lobbyists, and vendors. There were, as ever, exhibits for niche companies such as The Right Stuff, a dating app for Republicans, and Patriot Mobile, “America’s only Christian conservative wireless provider” (for those tired of relying on godless liberals for Wi-Fi.) The aforementioned MAGA Mall occupied one corner of the room, competing with at least two other booths peddling Trump-branded paraphernalia. And a mock Oval Office—adorned with various photos of Trump—was available for selfies.

But there was something perfunctory and rote about all the ostentatious Trump worship. At one booth, a group called the Conservative Caucus was showing off an oversize scroll topped with the message Thank You for Your Service President Trump! (Followed by a disclaimer in much smaller print: Not an endorsement, just a BIG thank you!)

A friendly guy working the booth, Art Harman, told me proudly about how the scroll contained more than 100,000 signatures and ran 135 feet long when fully unfurled. Once we started talking politics, though, Trump seemed to slip from his mind. When I asked him who he thought of when he pictured the future of conservatism, he answered quickly: DeSantis.

“He’s a more youthful guy. He’s energizing people a lot,” Harman said, going on to extol the Florida governor’s many virtues. He paused for a moment to think. “He’s kind of the only one who comes to mind offhand.”

McKay Coppins

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March 6, 2023
Someday, You Might Be Able to Eat Your Way Out of a Cold

When it comes to treating disease with food, the quackery stretches back far. Through the centuries, raw garlic has been touted as a home treatment for everything from chlamydia to the common cold; Renaissance remedies for the plague included figs soaked in hyssop oil. During the 1918 flu pandemic, Americans wolfed down onions or chugged “fluid beef” gravy to keep the deadly virus at bay.

Even in modern times, the internet abounds with dubious culinary cure-alls: apple-cider vinegar for gonorrhea; orange juice for malaria; mint, milk, and pineapple for tuberculosis. It all has a way of making real science sound like garbage. Research on nutrition and immunity “has been ruined a bit by all the writing out there on Eat this to cure cancer,” Lydia Lynch, an immunologist and a cancer biologist at Harvard, told me.

In recent years, though, plenty of legit studies have confirmed that our diets really can affect our ability to fight off invaders—down to the fine-scale functioning of individual immune cells. Those studies belong to a new subfield of immunology sometimes referred to as immunometabolism. Researchers are still a long way off from being able to confidently recommend specific foods or dietary supplements for colds, flus, STIs, and other infectious illnesses. But someday, knowledge of how nutrients fuel the fight against disease could influence the way that infections are treated in hospitals, in clinics, and maybe at home—not just with antimicrobials and steroids but with dietary supplements, metabolic drugs, or whole foods.

Although major breakthroughs in immunometabolism are just now arriving, the concepts that underlie them have been around for at least as long as the quackery. People have known for millennia that in the hours after we fall ill, our appetite dwindles; our body feels heavy and sluggish; we lose our thirst drive. In the 1980s, the veterinarian Benjamin Hart argued that those changes were a package deal—just some of many sickness behaviors, as he called them, that are evolutionarily hardwired into all sorts of creatures. The goal, Hart told me recently, is to “help the animal stay in one place and conserve energy”—especially as the body devotes a large proportion of its limited resources to igniting microbe-fighting fevers.

The notion of illness-induced anorexia (not to be confused with the eating disorder anorexia nervosa) might seem, at first, like “a bit of a paradox,” says Zuri Sullivan, an immunologist at Harvard. Fighting pathogenic microbes is energetically costly—which makes eating less a very counterintuitive choice. But researchers have long posited that cutting down on calories could serve a strategic purpose: to deprive certain pathogens of essential nutrients. (Because viruses do not eat to acquire energy, this notion is limited to cell-based organisms such as bacteria, fungi, and parasites.) A team led by Miguel Soares, an immunologist at the Instituto Gulbenkian de Ciência, in Portugal, recently showed that this exact scenario might be playing out with malaria. As the parasites burst out of the red blood cells where they replicate, the resulting spray of heme (an oxygen-transporting molecule) prompts the liver to stop making glucose. The halt seems to deprive the parasites of nutrition, weakening them and tempering the infection’s worst effects.

Read: Why science can be so indecisive about nutrition

Cutting down on sugar can be a dangerous race to the bottom: Animals that forgo food while they’re sick are trying to starve out an invader before they themselves run out of energy. Let the glucose boycott stretch on too long, and the dieter might develop dangerously low blood sugar —a common complication of severe malaria—which can turn deadly if untreated. At the same time, though, a paucity of glucose might have beneficial effects on individual tissues and cells during certain immune fights. For example, low-carbohydrate, high-fat ketogenic diets seem to enhance the protective powers of certain types of immune cells in mice, making it tougher for particular pathogens to infiltrate airway tissue.

Those findings are still far from potential human applications. But Andrew Wang, an immunologist and a rheumatologist at Yale, hopes that this sort of research could someday yield better clinical treatments for sepsis, an often fatal condition in which an infection spreads throughout the body, infiltrating the blood. “It’s still not understood exactly what you’re supposed to feed folks with sepsis,” Wang told me. He and his former mentor at Yale, Ruslan Medzhitov, are now running a clinical trial to see whether shifting the balance of carbohydrates and lipids in their diet speeds recovery for people ill with sepsis. If the team is able to suss out clear patterns, doctors might eventually be able to flip the body’s metabolic switches with carefully timed doses of drugs, giving immune cells a bigger edge against their enemies.

But the rules of these food-illness interactions, to the extent that anyone understands them, are devilishly complex. Sepsis can be caused by a whole slew of different pathogens. And context really, really matters. In 2016, Wang, Medzhitov, and their colleagues discovered that feeding mice glucose during infections created starkly different effects depending on the nature of the pathogen driving disease. When the mice were pumped full of glucose while infected with the bacterium Listeria, all of them died—whereas about half of the rodents that were allowed to give in to their infection-induced anorexia lived. Meanwhile, the same sugary menu increased survival rates for mice with the flu.

In this case, the difference doesn’t seem to boil down to what the microbe was eating. Instead, the mice’s diet changed the nature of the immune response they were able to marshal—and how much collateral damage that response was able to inflict on the body, as James Hamblin wrote for The Atlantic at the time. The type of inflammation that mice ignited against Listeria, the team found, could imperil fragile brain cells when the rodents were well fed. But when the mice went off sugar, their starved livers started producing an alternate fuel source called ketone bodies—the same compounds people make when on a ketogenic diet—that helped steel their neurons. Even as the mice fought off their bacterial infections, their brain stayed resilient to the inflammatory burn. The opposite played out when the researchers subbed in influenza, a virus that sparks a different type of inflammation: Glucose pushed brain cells into better shielding themselves against the immune system’s fiery response.

Read: Feed a cold, don’t starve it

There’s not yet one unifying principle to explain these differences. But they are a reminder of an underappreciated aspect of immunity. Surviving disease, after all, isn’t just about purging a pathogen from the body; our tissues also have to guard themselves from shrapnel as immune cells and microbes wage all-out war. It’s now becoming clear, Soares told me, that “metabolic reprogramming is a big component of that protection.” The tactics that thwart a bacterium like Listeria might not also shield us from a virus, a parasite, or a fungus; they may not be ideal during peacetime. Which means our bodies must constantly toggle between metabolic states.

In the same way that the types of infections likely matter, so do the specific types of nutrients: animal fats, plant fats, starches, simple sugars, proteins. Like glucose, fats can be boons in some contexts but detrimental in others, as Lynch has found. In people with obesity or other metabolic conditions, immune cells appear to reconfigure themselves to rely more heavily on fats as they perform their day-to-day functions. They can also be more sluggish when they attack. That’s the case for a class of cells called natural killers: “They still recognize cancer or a virally infected cell and go to it as something that needs to be killed,” Lynch told me. “But they lack the energy to actually kill it.” Timing, too, almost certainly has an effect. The immune defenses that help someone expunge a virus in the first few days of an infection might not be the ones that are ideal later on in the course of disease.

Even starving out bacterial enemies isn’t a surefire strategy. A few years ago, Janelle Ayres, an immunologist at the Salk Institute for Biological Studies, and her colleagues found that when they infected mice with Salmonella and didn’t allow the rodents to eat, the hungry microbes in their guts began to spread outside of the intestines, likely in search of food. The migration ended up killing tons of their tiny mammal hosts. Mice that ate normally, meanwhile, fared far better—though the Salmonella inside of them also had an easier time transmitting to new hosts. The microbes, too, were responding to the metabolic milieu, and trying to adapt. “It would be great if it was as simple as ‘If you have a bacterial infection, reduce glucose,’” Ayres said. “But I think we just don’t know.”

All of this leaves immunometabolism in a somewhat chaotic state. “We don’t have simple recommendations” on how to eat your way to better immunity, Medzhitov told me. And any that eventually emerge will likely have to be tempered by caveats: Factors such as age, sex, infection and vaccination history, underlying medical conditions, and more can all alter people’s immunometabolic needs. After Medzhitov’s 2016 study on glucose and viral infections was published, he recalls being dismayed by a piece from a foreign outlet circulating online claiming that “a scientist from the USA says that during flu, you should eat candy,” he told me with a sigh. “That was bad.”

Read: You can’t “starve” cancer, but you might help treat it with food

But considering how chaotic, individualistic, and messy nutrition is for humans, it shouldn’t be a surprise that the dietary principles governing our individual cells can get pretty complicated too. For now, Medzhitov said, we may be able to follow our instincts. Our bodies, after all, have been navigating this mess for millennia, and have probably picked up some sense of what they need along the way. It may not be a coincidence that during viral infections, “something sweet like honey and tea can really feel good,” Medzhitov said. There may even be some immunological value in downing the sick-day classic, chicken soup: It’s chock-full of fluid and salts, helpful things to ingest when the body’s electrolyte balance has been thrown out of whack by disease.

The science around sickness cravings is far from settled. Still, Sullivan, who trained with Medzhitov, jokes that she now feels better about indulging in Talenti mango sorbet when she’s feeling under the weather with something viral, thanks to her colleagues’ 2016 finds. Maybe the sugar helps her body battle the virus without harming itself; then again, maybe not. For now, she figures it can’t hurt to dig in.

Katherine J. Wu

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February 2, 2023
Are Gas Stoves Doomed?

Somehow, in a few short days, gas stoves have gone from a thing that some people cook with to, depending on your politics, either a child-poisoning death machine or a treasured piece of national patrimony. Suddenly, everyone has an opinion. Gas stoves! Who could have predicted it?

The roots of the present controversy can be traced back to late December, when scientists published a paper arguing that gas stoves are to blame for nearly 13 percent of childhood asthma cases in the U.S. This finding was striking but not really new: The scientific literature establishing the dangers of gas stoves—and the connection to childhood asthma in particular—goes back decades. Then, on Monday, the fracas got well and truly under way, when Richard Trumka Jr., a member of the Consumer Product Safety Commission, said in an interview with Bloomberg News that the commission would consider a full prohibition on gas stoves. “This is a hidden hazard,” he said. “Any option is on the table. Products that can’t be made safe can be banned.”

Just like that, gas stoves became the newest front in America’s ever expanding culture wars. Politicians proceeded to completely lose their minds. Florida Governor Ron DeSantis tweeted a cartoon of two autographed—yes autographed—gas stoves. Representative Jim Jordan of Ohio declared simply: “God. Guns. Gas stoves.” Naturally, Tucker Carlson got involved. “I would counsel mass disobedience in the face of tyranny in this case,” he told a guest on his Fox News show.

No matter that Democrats are more likely to have gas stoves than Republicans, and in fact the only states in which a majority of households use gas stoves—California, Nevada, Illinois, New York, New Jersey—are states that went blue in 2020. Why let a few pesky facts spoil a perfectly good opportunity to own the libs? The Biden administration, for its part, clarified yesterday that it has no intention of banning gas stoves. In the long run, though, this may prove to have been more a stay of execution than a pardon.

Beyond the knee-jerk partisanship, the science of gas stoves is not entirely straightforward. Emily Oster, an economist at Brown University, suggested in her newsletter that the underlying data establishing the connection between gas-stove use and childhood asthma may not be as clear-cut as the new study makes it out to be. And because those data are merely correlational, we can’t draw any straightforward causal conclusions. This doesn’t mean gas stoves are safe, Oster told me, but it complicates the picture. Switching from gas to electric right this minute probably isn’t necessary, she said, but she would make the change if she happened to be redesigning her kitchen.

Whatever the shortcomings of the available data, it’s clear that gas stoves are worse for the climate and fill our homes with pollutants we’re better off not inhaling. Brady Seals, a manager at the Rocky Mountain Institute and a lead author of the new paper, told me that even assuming the maximum amount of uncertainty, her work still suggests that more than 6 percent of childhood asthma cases in the U.S. are associated with gas stoves.

Regardless of the exact science, gas stoves might be in trouble anyway. Statistically, they’re not all that deeply entrenched to begin with: Only about 40 percent of American households have one. Plus, induction stoves—a hyper-efficient option that generates heat using electromagnetism—are on the rise. “We’re not asking people to go back to janky coils,” said Leah Stokes, a political scientist at UC Santa Barbara who has provided testimony on the subject of gas stoves before the U.S. Senate, and who is currently in the process of installing an induction stove in her home.

Rachelle Boucher, a chef who has worked in restaurants, in appliance showrooms, and as a private cook for such celebrity clients as George Lucas and Metallica, swears by induction. She started using it about 15 years ago and has since become a full-time evangelist. (In the past, Boucher has done promotions for electric-stove companies, though she doesn’t anymore.) Induction, she told me, tops gas in just about every way. For one thing, “the speed is remarkable.” An induction stovetop can boil a pot of water in just two minutes, twice as quickly as a gas burner. For another, it allows for far greater precision. When you adjust the heat, the change is nearly instantaneous. “Once you use that speed,” Boucher said, “it’s weird to go back and have everything be so much harder to control.” Induction stoves also emit virtually no excess heat, reducing air-conditioning costs and making it harder to burn yourself. And they’re also easier to clean.

Induction stoves do have minor drawbacks. Because they are flat and use electromagnetism, they aren’t compatible with all cookware, meaning that if you make the switch, you may also have to buy yourself a new wok or kettle. Flambéing and charring will also take a little longer, Boucher told me, but few home cooks are deploying those techniques on a regular basis. In recent years, induction has received the endorsement of some of the world’s top chefs, who have tended to be ardent gas-stove users. Eric Ripert, whose restaurant Le Bernardin has three Michelin stars, switched his home kitchens from gas to induction. “After two days, I was in love,” he told The New York Times last year. At his San Francisco restaurant, Claude Le Tohic, a James Beard Award–winning chef, has made the switch to induction. The celebrity chef and food writer Alison Roman is also a convert: “I have an induction stove by choice AMA,” she tweeted yesterday.

If it’s good enough for them, it’s probably good enough for us. At the moment, induction stoves are more expensive than the alternatives, although their efficiency and the fact that they don’t heat up the kitchen help offset the disparity. So, too, do the rebates included in last year’s Inflation Reduction Act, which should kick in later this year and can amount to as much as $840. The price has been falling in recent years, and as it continues to come down, Stokes told me, she expects induction to overtake gas. A 2022 Consumer Reports survey found that while 3 percent of Americans have induction stoves, nearly 70 might consider going induction the next time they buy new appliances. “I think the same thing’s going to happen for induction stoves” as happened with electric vehicles, Stokes told me. In the end, culture-war considerations will lose out to questions of cost and quality. The better product will win the day, plain and simple.

Still, gas stoves’ foray into the culture wars likely means that at least some Republicans will probably scorn electric stoves now in the same way they have masks over the past few years. And this whole episode does have a distinctly post-pandemic feel to it: the concern about the air we’re breathing, the discussion of what precautions we ought to take, the panic and outrage in response. The new gas-stove controversy feels as though it has been jammed into a partisan framework established—or at least refined—during the pandemic. “I don’t know if this discourse that we’re seeing now could have happened five years ago,” Brady Seals told me. Whatever happens to gas stoves, the public-health culture wars don’t seem to be going anywhere.

Jacob Stern

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January 13, 2023
Nothing Is Working for Kevin McCarthy

At this point in the unending search for a House speaker, Donald Trump’s candidacy is making as much progress as Kevin McCarthy’s.

The former president (and half-hearted 2024 White House applicant) today secured his first vote as the House slogged through its seventh fruitless attempt to elect a leader. The semi-serious effort to elevate Trump, put forward by Representative Matt Gaetz of Florida, came at the expense of McCarthy, the Trump-endorsed Republican leader whose bid hasn’t improved in the past six ballots. McCarthy twice more lost 21 Republicans and fell well short of the 218 votes he needs for a majority.

Today’s votes were notable because they were the first since McCarthy reportedly made an offer to his GOP opponents that seemingly encompassed all of their public demands. The two sides have engaged in intense negotiations over the past day, keeping McCarthy’s candidacy alive and offering perhaps a slim hope that he can win over enough of the holdouts to become speaker. But none of that progress was evident in the tallies this afternoon.

McCarthy’s concessions represented the equivalent of giving away the remaining trinkets in an already ransacked store. He had previously agreed to significantly lower the threshold of members needed to force a vote to remove him as speaker, known as a “motion to vacate.” After setting the minimum at five members, McCarthy gave in to the renegades’ demand that a single member could trigger that vote—restoring the standard conservatives had used in 2015 to push Speaker John Boehner out of office. His allies could argue that with so much opposition to McCarthy already, there was little difference between a threshold of five and one.

David Frum: No tears for Kevin McCarthy

But according to reports, McCarthy went even further. He agreed to give the House Freedom Caucus designated seats on the powerful Rules Committee, a panel traditionally controlled by the speaker that decides whether and under what parameters legislation can come to a vote on the floor. He also reportedly promised to allow members to demand virtually unlimited amendment votes on spending bills; that change could open up a process that in recent years has been centralized by the leadership, but it could also lead to free-for-alls that drag out debates on bills for days or weeks.

The concessions are sure to frustrate McCarthy supporters who believe the wannabe-speaker had already surrendered too much to his opponents. Representative Ann Wagner of Missouri told me that the threshold for the motion to vacate should be a majority of the Republican conference. Lowering it to five, she said, was akin to the speaker having “a knife over your head every day.” Earlier this week, I asked Representative Don Bacon of Nebraska, a McCarthy supporter who has spoken of partnering with Democrats on a consensus pick for speaker, whether he might desert McCarthy if the GOP leader kept empowering his far-right critics. “It depends on what it is,” Bacon told me. “But I think we went too far as it was already.”

McCarthy was betting that Republicans closest to the political center would stick with him if it meant finally ending a leadership crisis now on its third day. And yet, even this most generous offer to his foes was not enough, and none of the 21 holdouts crossed over to McCarthy’s corner.

McCarthy downplayed today’s first vote before it even began, telling reporters, “Nothing is going to change.” For McCarthy, maintaining the status quo might count as progress. His lingering fear is likely that the bottom will fall out among supporters who are growing tired of the stalemate and are looking to alternatives. Representative Ken Buck of Colorado told CNN that Republicans could nominate McCarthy’s lieutenant, Representative Steve Scalise of Louisiana, by the end of the day if a deal wasn’t struck.

McCarthy’s allies had hoped for another delay to buy time for negotiations, perhaps even through the weekend, but Republicans evidently determined they could not muster the voters to adjourn for a third time in 24 hours. The desire for delay revealed a tactical reversal by McCarthy born out of desperation. At the outset of the voting on Tuesday, his stated goal had been to keep lawmakers on the House floor, casting ballot after ballot until either his far-right opponents or possibly the Democrats got tired enough to let him win. But six consecutive defeats, during which McCarthy lost rather than gained support, disabused him of that idea. Beginning yesterday afternoon, McCarthy tried to adjourn the House to give him more time for backroom negotiations, having apparently realized that his repeated public floggings were doing him no good.

David A. Graham: Kevin McCarthy’s predicament is a warning

Democrats reluctantly agreed to adjourn after the sixth vote yesterday afternoon, but when McCarthy allies sought to close down the House again in the evening, the Democrats fought back. The vote to adjourn became something of a circus. McCarthy’s critics on the right splintered, with four of them voting alongside Democrats to keep the House in session and one arch-conservative, Representative Paul Gosar of Arizona, switching his vote at the last minute. With the outcome in doubt, both parties began shoving late-arriving members—some still wearing their winter coats—to the front of the chamber to cast their votes before the House clerk, Cheryl Johnson, gaveled the motion closed. When Johnson shouted the final tally over the din of the House—the motion to adjourn passed, 216–214—McCarthy and his allies cheered. McCarthy had won his first vote in his bid for speaker, one that staved off his next public abasement for at least another day.

Earlier yesterday, the House took three more failed speaker votes that were nearly identical to the three failed votes it took on Tuesday. The lone differences were that the anti-McCarthy GOP faction nominated a new candidate, Representative Byron Donalds of Florida, and McCarthy lost 21 Republican votes instead of the 20 defections he had suffered previously. Representative Victoria Spartz of Indiana switched her vote from McCarthy to “present,” telling reporters after that the party needed to have more conversations about the way forward. “What we’re doing on the floor is wasting everyone’s time,” she said.

Spartz’s protest made little difference. The House met again for more time-wasting this afternoon, and the best that McCarthy could accomplish was not losing any more votes. His candidacy survived a seventh losing ballot, and the House moved quickly on to an eighth and then a ninth (during which Gaetz abandoned his support for Trump and voted for Representative Kevin Hern of Oklahoma instead).

Those votes proceeded no better and no worse for McCarthy, who now seems to be one or two more defections away from a final defeat. He is hanging on for now, but the deadline for him to strike a deal or exit the race is fast approaching.

Russell Berman

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January 5, 2023
Kevin McCarthy’s Reckoning

Republicans today could take control of the House of Representatives, giving them a foothold of power in Washington from which to smother Joe Biden’s agenda and generally make life hell for the president and his family.

Or they might not.

It all depends on whether Representative Kevin McCarthy of California, the GOP House leader, can lock down the final votes he needs to become speaker. As of this morning, McCarthy was short of the 218 required for a majority. He can afford to lose only four Republicans in the party-line vote if all members are present. So far, at least five and potentially more than a dozen far-right lawmakers remain opposed to McCarthy’s candidacy or are withholding their support.

Should McCarthy falter on the first vote, to be taken shortly after the 118th Congress gavels into session at noon, the House would remain in a state of limbo. (Democrats and more than a few Republicans might call it purgatory.) Without a speaker, the House can do nothing. It cannot adopt the rules it will use to operate for the next two years; it cannot debate or pass legislation; it cannot form committees and name chairs; it cannot unleash the torrent of subpoenas that Republicans have vowed to send the Biden administration’s way. Without a speaker, in other words, the GOP has no majority.

So for the moment, the functioning of the legislative branch depends on McCarthy’s ability to wrangle votes. And like any deadlocked negotiation on Capitol Hill, his—and the GOP’s—predicament could be resolved quickly, or it could endure for quite a while. If no candidate receives a majority of votes on the first ballot for speaker this afternoon—the only candidate who has a legitimate chance on that roll call is McCarthy—then the House must keep voting until someone does. McCarthy has said he will not drop out after the first ballot, effectively hoping to wear down his GOP opposition or cut deals that will secure him the votes he needs. (His office did not respond to a request for comment last night.) He has little hope of appealing to Democrats, who neither trust nor respect a Republican leader who has spent the past seven years cozying up to Donald Trump.

Read: The new majority

The vote for speaker is the most formal of congressional roll calls and lasts well over an hour. Beginning alphabetically by last name, the clerk calls out the name of each of the 435 members, who then reply verbally with the candidate of their choice. No speaker vote has gone to a second ballot in more than a century, leaving no modern precedent for what happens if McCarthy does not get the support of 218 members. He could strike a quick deal and win on a second ballot by nightfall, or the series of ballots could drag out for days or even weeks, especially if the House recesses so that Republicans can convene privately to figure out what to do.

McCarthy is known for being affable but has no reputation for tactical or legislative brilliance. He has desperately tried to placate the five most ardent holdouts—a quintet that includes the Trump loyalist Representative Matt Gaetz of Florida—with concessions that would empower individual members at the expense of McCarthy’s sway as speaker. The most contentious of these involves what’s known as the “motion to vacate,” a mechanism by which members can force a vote to depose the speaker.

Until recent years, the motion to vacate was a rarely used relic of procedural arcana. But in 2015, then-Representative Mark Meadows of North Carolina—an ambitious conservative who would go on to greater notoriety as Trump’s final chief of staff—dusted off the motion to vacate and essentially pushed Speaker John Boehner into retirement. When Democrats regained the House majority in 2019, Nancy Pelosi, who’d once again ascended to the speakership, engineered a rules change so that only members of the party leadership could deploy the motion to vacate. McCarthy was hoping to keep that change largely in place, but his GOP opponents have demanded that the House revert to the old rules, which would make it much easier for them to oust the speaker as soon as he antagonized them (say, by going around conservatives to pass legislation with Democrats). Over the weekend, McCarthy told Republicans he’d be willing to create a five-member threshold for forcing a vote on the speaker—a significant move on his part but still not as far as his critics on the right would like.

Although the speaker vote today could be the most suspenseful in memory, McCarthy himself is not in an unfamiliar position. In 2015, he was the presumed successor to Boehner, but a poorly timed gaffe and mistrust among conservatives forced him to withdraw before the vote. He seems intent on avoiding that fate this time around. Nonetheless, McCarthy’s opponents see him as a stooge of the party establishment that they ran to dismantle; they also just don’t seem to like him very much. As yet, McCarthy has no real challenger. But the hardline holdouts have teased a mystery candidate who could step forward on the second ballot, and McCarthy’s ostensibly loyal second-in-command, Representative Steve Scalise of Louisiana, could emerge as a potential consensus choice.

“Governance will be a challenge,” Oklahoma’s Tom Cole, a longtime Republican lawmaker and McCarthy ally, told me a couple months ago. He said it back when Republicans seemed to be on the verge of a resounding midterm victory, one that likely would have smoothed McCarthy’s path to the speakership. Now it sounds like a significant understatement.

The high likelihood is that eventually, perhaps even today, Republicans will claim the narrow House majority that they won at the polls. But even if McCarthy squeaks by on the first or second ballot, the party’s struggle simply to organize itself behind a leader won’t soon be forgotten. It will stand as a painful reminder of the GOP’s electoral underperformance in November, and, almost certainly, it will serve as a harbinger of a rocky two years to come.

Russell Berman

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January 3, 2023
Doctors Are Failing Patients With Disabilities

This piece was originally published by Undark Magazine.

Ben Salentine, the associate director of health-sciences managed care at the University of Illinois Hospital and Health Sciences System, hasn’t been weighed in more than a decade. His doctors “just kind of guess” his weight, he says, because they don’t have a wheelchair-accessible scale.

He’s far from alone. Many people with disabilities describe challenges in finding physicians prepared to care for them. “You would assume that medical spaces would be the most accessible places there are, and they’re not,” says Angel Miles, a rehabilitation-program specialist at the Administration for Community Living, part of the Department of Health and Human Services.

Not only do many clinics lack the necessary equipment—such as scales that can accommodate people who use wheelchairs—but at least some physicians actively avoid patients with disabilities, using excuses like “I’m not taking new patients” or “You need a specialist,” according to a paper in the October 2022 issue of Health Affairs.

The work, which analyzed focus-group discussions with 22 physicians, adds context to a larger study published in February 2021 (also in Health Affairs) that showed that only 56 percent of doctors “strongly” welcome patients with disabilities into their practice. Less than half were “very confident” that they could provide the same quality of care to people with disabilities as they could to other patients. The studies add to a larger body of research suggesting that patients with conditions that doctors may deem difficult to treat often struggle to find quality care. The Americans With Disabilities Act of 1990 (ADA) theoretically protects the one in four adults in the U.S. with a disability from discrimination in public and private medical practices—but enforcing it is a challenge.

Laura VanPuymbrouck, an assistant professor in the Department of Occupational Therapy at Rush University, calls the 2021 survey “groundbreaking—it was the crack that broke the dam a little bit.” Now researchers are hoping that medical schools, payers, and the Joint Commission (a group that accredits hospitals) will push health-care providers for more equitable care.

Due in part to scant data, information about health care for people with disabilities is limited, according to Tara Lagu, a co-author of both the 2021 and 2022 papers and the director of the Institute for Public Health and Medicine’s Center for Health Services & Outcomes Research at Northwestern University Feinberg School of Medicine. The few studies that have been done suggest that people with disabilities get preventive care less frequently and have worse outcomes than their nondisabled counterparts.

About a decade ago, Lagu was discharging a patient who was partially paralyzed and used a wheelchair. The patient’s discharge notes repeatedly recommended an appointment with a specialist, but it hadn’t happened. Lagu asked why. Eventually, the patient’s adult daughter told Lagu that she hadn’t been able to find a specialist who would see a patient in a wheelchair. Incredulous, Lagu started making calls. “I could not find that kind of doctor within 100 miles of her house who would see her,” she says, “unless she came in an ambulance and was transferred to an exam table by EMS—which would have cost her family more than $1,000 out of pocket.”

In recent years, studies have shown that even when patients with disabilities can see physicians, their doctors’ biases toward conditions such as obesity, intellectual disabilities, and substance-use disorders can have profound impacts on the care they receive. Physicians may assume that an individual’s symptoms are caused by obesity and tell them to lose weight before considering tests.

For one patient, this meant a seriously delayed diagnosis of lung cancer. Patients with mobility or intellectual challenges are often assumed to be celibate, so their providers skip any discussion of sexual health. Those in wheelchairs may not get weighed even if they’re pregnant—a time when tracking one’s weight is especially important, because gaining too little or too much is associated with the baby being at risk for developmental delays or the mother being at risk for complications during delivery.

These issues are well known to Lisa Iezzoni, a health-policy researcher at Massachusetts General Hospital and a professor of medicine at Harvard Medical School. Over the past 25 years, Iezzoni has interviewed about 300 people with disabilities for her research into their health-care experiences and outcomes, and she realized that “every single person with a disability tells me their doctors don’t respect them, has erroneous assumptions about them, or is clueless about how to provide care.” In 2016, she decided it was time to talk to doctors. Once the National Institutes of Health funded the work, she and Lagu recruited the 714 physicians that took the survey for the study published in 2021 in Health Affairs.

Not only did many doctors report feeling incapable of properly caring for people with disabilities, but a large majority held the false belief that those patients have a worse quality of life, which could prompt them to offer fewer treatment options.

During the 2021 study, Iezzoni’s team recorded three focus-group discussions with 22 anonymous physicians. Although the open-ended discussions weren’t included in the initial publication, Lagu says she was “completely shocked” by some of the comments. Some doctors in the focus groups welcomed the idea of additional education to help them better care for patients with disabilities, but others said that they were overburdened and that the 15 minutes typically allotted for office visits aren’t enough to provide these patients with proper care. Still others “started to describe that they felt these patients were a burden and that they would discharge patients with disability from their practice,” Lagu says. “We had to write it up.”

Read: How wheelchair accessibility ramped up

The American Medical Association, the largest professional organization representing doctors, declined an interview request and would not comment on the most recent Health Affairs study. When asked about the organization’s policies on caring for patients with disabilities, a representative pointed to the AMA’s strategic plan, which includes a commitment to equity.

Patients with disabilities are supposed to be protected by law. Nearly 50 years ago, Congress passed Section 504 of the Rehabilitation Act of 1973, which prohibited any programs that receive federal funding, such as Medicare and Medicaid, from excluding or discriminating against individuals with disabilities. In 1990, the ADA mandated that public and private institutions also provide these protections.

The ADA offers some guidelines for accessible buildings, including requiring ramps, but it does not specify details about medical equipment, such as adjustable exam tables and wheelchair-accessible scales. Although these items are necessary to provide adequate care for many people with disabilities, many facilities lack them: In a recent California survey, for instance, only 19.1 percent of doctor’s offices had adjustable exam tables, and only 10.9 percent had wheelchair-accessible scales.

Miles says she’s noticed an improvement in care since the ADA went into effect, but she still frequently experiences challenges in health care as a Black woman who uses a wheelchair. “We need to keep in mind the ADA is not a building code. It’s a civil-rights law,” says Heidi Johnson-Wright, an ADA coordinator for Miami-Dade County in Florida, who was not speaking on behalf of the county. “If I don’t have access to a wellness check at a doctor’s office or treatment at a hospital, then you’re basically denying me my civil rights.”

The ADA isn’t easy to enforce. There are no “ADA police,” Johnson-Wright says, to check if doctor’s offices and hospitals are accessible. In many cases, a private citizen or the Department of Justice has to sue a business or an institution believed to be in violation of the ADA. Lawyers have filed more than 10,000 ADA Title III lawsuits each year since 2018. Some people, sympathizing with businesses and doctors, accuse the plaintiffs of profiteering.

And it’s not just about accessible equipment. In 2018, the Justice Department sued a skilled nursing facility for violating the ADA, after the facility refused to treat a patient with a substance-use disorder who needed medication to help maintain sobriety. Since then, the department settled with eight other skilled nursing facilities for similar discrimination. “It is a violation of the ADA” to deny someone care based on the medications they need, Sarah Wakeman, an addiction-medicine specialist at Massachusetts General Hospital, wrote in an email, “and yet continues to happen.”

Indeed, in the focus groups led by Lagu and Iezzoni, some of the doctors revealed that they view the ADA and the people it protects with contempt. One called people with disabilities “an entitled population.” Another said that the ADA works “against physicians.”

The Department of Health and Human Services is aware of the issue. In a response to emailed questions, an HHS spokesperson wrote, “While we recognize the progress of the ADA, important work remains to uphold the rights of people with disabilities.” The Office of Civil Rights, the spokesperson continued, “has taken a number of important actions to ensure that health care providers do not deny health care to individuals on the basis of disability and to guarantee that people with disabilities have full access to reasonable accommodations when receiving health care and human services, free of discriminatory barriers and bias.”

Researchers and advocates told me that the key to improving health care for those with disabilities is addressing it directly in medical education and training. “People with disabilities are probably one of the larger populations” that physicians serve, Salentine said.

Ryan McGraw, a community organizer with Access Living, helps provide education about treating patients with disabilities to medical schools in the Chicago area. He regularly receives positive feedback from medical students but says the information needs to be embedded in the medical-school curriculum, so it’s not “one and done.”

In one effort to address the issue, the Alliance for Disabilities in Health Care Education, a coalition of professionals and educators of which McGraw is a member, put together a list of 10 core competencies that should be included in a doctor’s education, including considerations for accessibility, effective communication, and patient-centered decision making.

Read: What police offers don’t know about the ADA

One of the simplest solutions might be hanging signs or providing accessible information in exam rooms on patients’ rights. “It’d be there for patients, but it’d be also there as a reminder to the providers. I think that’s a super easy thing to do,” Laura VanPuymbrouck says. Miles says this could be a good start, but “it’s not enough to just give people a little pamphlet that tells you about your rights as a patient.” Although all doctors should be willing and able to care for patients with disabilities, she thinks a registry that shows which providers take certain types of insurance, such as Medicaid, and also have disability accommodations, such as wheelchair-accessible equipment, would go a long way.

Some advocates have called on the Joint Commission for more than 10 years to require disability accommodations for hospitals that want accreditation. The step could be effective, because accreditation “is extremely important” to hospitals, Lagu says.

On January 1, 2023, new Joint Commission guidelines will require that hospitals create plans to identify and reduce at least one health-care disparity among their patients. Improving outcomes for people with disabilities could be one such goal. However, Maureen Lyons, a spokesperson for the Joint Commission, adds, “if individuals circumvent the law, standards won’t be any more effective.”

Finally, Lagu says, “we have to pay more when you are providing accommodations that take time or cost money. There’s got to be some accounting for that in the way we pay physicians.”

One of the most basic things people with disabilities are asking for is respect. The biggest finding of the 2021 survey, Iezzoni says, is that doctors don’t realize that the proper way to determine what accommodations a facility needs for patients with disabilities is to just ask the patients.

“I can’t tell you how many times I go to a doctor’s office and I’m talking, but they’re not hearing anything,” Salentine says. “They’re ready to speak over me.”

Emma Yasinski

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November 13, 2022
How Abortion Defined the 2022 Midterms

Ask anyone what Mehmet Oz said about reproductive rights during last month’s Pennsylvania Senate debate, and they’ll probably tell you that the TV doctor believes an abortion should be between “a woman, her doctor, and local political leaders.” The truth is, that dystopian Handmaid’s Tale–esque statement did not come verbatim from the Republican’s mouth. But it may have cost him the election anyway.

Instead, that catchphrase entered Pennsylvania voters’ consciousness—and ricocheted across social media—via a tweet by Pat Dennis, a Democratic opposition researcher. Dennis’s megaviral post included a clip purporting to show Oz pitching something akin to a pregnancy tribunal. But the clip was, well, clipped: In the 10-second video, Oz does not even say the word abortion. Did it matter? Not in the least. Here was Oz’s fuller, unedited response to the question:

There should not be involvement from the federal government in how states decide their abortion decisions. As a physician, I’ve been in the room when there’s some difficult conversations happening. I don’t want the federal government involved with that at all. I want women, doctors, local political leaders, letting the democracy that’s always allowed our nation to thrive to put the best ideas forward so states can decide for themselves.

Although that by no means utterly rebuts Dennis’s three-clause summary, it is different. Of course, voters zeroed in on—and recoiled from—the pithier version. Oz failed to shake his association with the thorny abortion hypothetical, much as he failed to shake the long-running joke that he actually lives in New Jersey. Abortion decided this race, and Oz was on the wrong side of history.

Read: Why this election is so weird

In red and blue states alike, reproductive autonomy proved a defining issue of the 2022 midterms. Although much pre-election punditry predicted that Pennsylvania Democratic nominee John Fetterman’s post-stroke verbal disfluency was poised to “blow up” the pivotal Senate race on Election Day, the exit polls suggest that abortion seismically affected contests up and down the ballot.

Concerns over the future of reproductive rights unequivocally drove Democratic turnout and will now lead to the rewriting of state laws around the country. In deep-red Kentucky, voters rejected an amendment that read, “Nothing in this Constitution shall be construed to secure or protect a right to abortion or require the funding of abortion.” In blue havens such as California and Vermont, voters approved ballot initiatives enshrining abortion rights into their state constitutions.

In Michigan, a traditionally blue state that in recent years has turned more purple, voters likewise enshrined reproductive protections into law, with 45 percent of exit-poll respondents calling abortion the most important issue on the ballot. In the race for the Michigan statehouse, the incumbent Democratic governor, Gretchen Whitmer, trounced her Republican challenger, Tudor Dixon, who had said that she supports abortion only in instances that would save the life of the woman, and never in the case of rape or incest. Dixon lost by more than 10 percentage points and almost half a million votes.

After the Supreme Court’s Dobbs v. Jackson Women’s Health Organization decision ended the federal right to abortion in June, many observers wondered whether pro-abortion-rights Democrats would remain paralyzed with despair or whether their anger would become a galvanizing force going into the election season. The answer is now clear—though, in fact, it has been for some time.

Mary Ziegler: If the Supreme Court can reverse Roe, it can reverse anything

In August, just six weeks after Dobbs, Kansas voters rejected an amendment to the state constitution that could have ushered in a ban on abortion. That grassroots-movement defeat of the ballot initiative was a genuine shocker—and it showed voters in other states what was possible at the local level.

Nowhere in the midterms voting did abortion seem to matter more than in Pennsylvania. Oz, like his endorser, former President Donald Trump, spent years as a Northeast cosmopolitan before he tried, and failed, to remake himself as a paint-by-numbers conservative. That meant preaching a party-line stance during the most contentious national conversation about abortion in half a century. It came back to haunt him.

At the October debate, Fetterman was mocked for (among other things) his simplistic, repetitive invocation of supporting Roe v. Wade. Even when asked by moderators to answer an abortion question in more detail, he simply kept coming back to the phrase. Whatever it lacked in nuance, Fetterman’s allegiance to his pro-abortion-rights position was impossible to misconstrue. This was an abortion election, and voters knew exactly where he stood.

John Hendrickson

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November 9, 2022
Democrats Keep Falling for ‘Superstar Losers’

In the early 2000s, the Japanese racehorse Haru Urara became something of an international celebrity. This was not because of her prowess on the track. Just the opposite: Haru Urara had never won a race. She was famous not for winning but for losing. And the longer her losing streak stretched, the more famous she grew. She finished her career with a perversely pristine record: zero wins, 113 losses.

American politics doesn’t have anyone quite like Haru Urara. But it does have Beto O’Rourke and Stacey Abrams. The two Democrats are among the country’s best known political figures, better known than almost any sitting governor or U.S. senator. And they have become so well known not by winning big elections but by losing them.

Both Abrams and O’Rourke have won some elections, but their name recognition far surpasses their electoral accomplishments. After serving 10 years in the Georgia House of Representatives, Abrams rose to prominence in 2018, when she ran unsuccessfully for the governorship. O’Rourke served three terms as a Texas congressman before running unsuccessfully for the Senate, then the presidency. And they are both running again this year, Abrams for governor of Georgia, O’Rourke for governor of Texas. They are perhaps the two greatest exponents of a peculiar phenomenon in American politics: that of the superstar loser.

The country’s electoral history is littered with superstar losers of one sort or another. Sarah Palin parlayed a vice-presidential nomination into a political-commentary gig, a book deal, and a series of short-lived reality-TV ventures. The landslide defeats that Barry Goldwater and George McGovern suffered made them into ideological icons. I’m talking about something a little more specific: candidates who become national stars in the course of losing a state-level race. There have been far fewer of these. There was William Jennings Bryan, who lost a race for the Senate in 1894, then ran unsuccessfully for the presidency three times. And there was the greatest of all the superstar losers, the one-term representative from Illinois whose unsuccessful Senate campaign nonetheless propelled him to the presidency two years later: Abraham Lincoln.

But never before has such small-scale loserdom so often been sufficient to achieve such large-scale stardom. Apart from Abrams and O’Rourke, there have also been other examples in recent years. Jaime Harrison made an unsuccessful bid for the DNC chairmanship, then an unsuccessful bid to unseat Lindsey Graham in South Carolina, and then a second bid, this time successful, for the DNC chairmanship. MJ Hegar, a Texas Democrat, lost a close House race in 2018, then a not-so-close Texas Senate race in 2020. Amy McGrath likewise used a close loss for a House seat, hers in Kentucky, to launch a Senate campaign against Mitch McConnell that ended in a 20-point loss. This, it seems, is the golden age of the superstar loser.

Read: Why Beto O’Rourke argues he has a new case to make to voters

Superstar loserdom has not been historically tracked, so it’s hard to say with certainty whether it’s really on the rise. But the general sense among the experts I spoke with was that it is. “I do think it is something that we’ve seen more of,” John Pitney, a political scientist at Claremont McKenna College, told me. Why, exactly, is a complicated question, the answer to which involves various conspiring forces, some technological, some political, some demographic.

Let’s start with Lincoln. His 1858 Senate race against Stephen Douglas produced some of the most celebrated rhetoric in American political history, but without the advent of shorthand, stenographers could not have taken down the hours-long Lincoln-Douglas debates word-for-word. Without the country’s new railroad and telegraph networks, those transcripts could not have been transmitted all across the country.

“Earlier in the century, Lincoln couldn’t possibly have become a national figure,” Pitney told me. “He might have made the same brilliant arguments, but nobody outside of Illinois would have ever heard them.” In that sense, his superstar loserdom—and his eventual ascent to the presidency—must be credited as much to the technological advances of the preceding decades as to the power of his speeches.

The same might be said of today’s superstar losers. Online fundraising platforms such as ActBlue and WinRed give even state-level candidates the ability to draw support from—and build a following among—donors all across the country, a phenomenon that David Karpf, a political scientist at George Washington University, told me has nationalized local and state races.

Candidates also have other tools to thrust themselves into the spotlight in a way they never have before—cable TV, podcasts, social media. Both Abrams and O’Rourke are skilled at using social media, and he in particular is a master of the viral moment (see his interruption of a press conference that Governor Greg Abbott held after the Uvalde shooting or his recent outburst at a heckler). Even when the campaign ends, no one can stop you from posting. Unlike a generation ago, “there are lots of avenues in the media today for former candidates to keep having their views known and to continue to be a spokesperson,” Seth Masket, a political scientist at the University of Denver, told me. (Neither the Abrams campaign nor the O’Rourke campaign agreed to an interview for this story.)

It would be wrong, though, to chalk up the staying power of superstar losers entirely to their social-media dexterity or telegenic appeal. In the end, “politics is a lot of What have you done for me lately?” Julia Azari, a political scientist at Marquette University, told me. And both Abrams and O’Rourke are also top-notch party builders. O’Rourke may not have secured a Senate seat in 2018, Azari said, but he has been credited with helping Democrats pick up seats in the Texas statehouse. Abrams, meanwhile, has founded an organization to protect voting rights and raised millions of dollars to organize and register voters. Largely as a result, she has been hailed as the driving force behind Democrats’ 2020 success in Georgia. “Anyone can tweet,” Azari said. “But the two of them behind the scenes, I think, have actually walked the walk and helped other people win, helped other people develop their campaign apparatus.”

Read: The art of giving a damn

Even though Abrams and O’Rourke have been helpful to their party, the golden age of superstar loserdom is closely tied to our current era of what Azari has called “weak parties and strong partisanship.” For one thing, vilification of the opposition allows challengers to especially despised candidates to quickly become household names. Even in extreme-long-shot races, donors have shown a willingness to pour vast amounts of money into these boondoggles. McGrath burned $90 million on the way to her 20-point loss. Harrison raised $130 million in his Senate race and fared only slightly better. In his contest against Ted Cruz, O’Rourke raised $80 million, including $38 million in a single quarter, the most of any Senate candidate in history—all to no avail.

Whether because they outperform expectations or because of what they’re up against, these candidates and their supporters are then able to frame the losses as moral victories. Sometimes, as for Abrams supporters, that means framing a defeat as the outcome of an unjust system. Other times, as for O’Rourke supporters, that means framing an unexpectedly good performance in an unfavorable state as a sign of things to come. This, perhaps, is one reason superstar loserdom has so far skewed Democratic, political scientists told me: Democrats desperately want to take advantage of some red states that have been trending purple. Or perhaps the disparity is a product of our post-Trumpian moment. Or perhaps something else entirely.

For now, polls suggest that things are not looking great for either O’Rourke or Abrams. Superstar-loser status, it seems, does not convert easily into electoral wins. Still, this is likely far from the end of superstar loserdom. Both Abrams and O’Rourke emerged during the 2018 midterms cycle, when Democratic voters energized by opposition to Donald Trump turned out in large numbers to break Republicans’ stranglehold on Congress. This year, Republican voters energized by opposition to Joe Biden will probably turn out in large numbers to break Democrats’ majority in Congress. This election could produce Republicans’ answer to Abrams and O’Rourke. But John James, the Michigan conservative who has made two failed bids for the Senate and was the one contemporary Republican superstar loser political scientists mentioned to me, seems poised to win his congressional race this year.

A meaningful defeat may be the most Abrams and O’Rourke can hope for: not so much superstar losers as losers with legacies. But losers have a special utility. Winners have to deal with the unglamorous minutiae of actual governance. They have to figure out how to translate campaign promises into concrete policies. They make mistakes, and people get disillusioned, and approval ratings decline. Losers are spared these indignities. Politically speaking, they don’t survive long enough to let anyone down. Unsullied by compromise, losers can be made into lodestars. Look at Goldwater or McGovern. Everyone, it turns out, can get behind a lost cause.

Jacob Stern

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November 1, 2022
America’s COVID Booster Rates Are a Bad Sign for Winter

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Yasmin Tayag

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October 25, 2022
What’s Really Going on With the Crime Rate?

Turn on a television in any state with a competitive Senate or gubernatorial race, and you’ll see that the criminal-justice reform agenda is under constant attack.

Republicans are pinning higher crime rates on Democrats who have expressed sympathy for almost any aspect of the movement to confront racial inequities in the criminal-justice system. In New York, a conservative super PAC opposing Democratic Governor Kathy Hochul is slamming her for defending “the state’s disastrous cashless bail experiment” and refusing to “remove liberal prosecutors, like [Manhattan’s] Alvin Bragg, who too often downgrade charges for dangerous criminals.” In Pennsylvania, the National Republican Senatorial Committee links John Fetterman to “sanctuary cities, weak prosecutors, crime skyrocketing—failed liberal policies, making us less safe.” In Wisconsin, Republican ads ominously ask, “What happens when criminals are released because bail is set dangerously low?” and accuse Mandela Barnes, the state’s lieutenant governor, of wanting to completely eliminate cash bail (not surprisingly, the full story is more complicated).

These attacks assume that the changes in criminal-justice policies that some states and many cities have pursued over the past few years are undermining public safety and fueling higher crime rates.

David A. Graham: America is having a violence wave, not a crime wave

But an exhaustive new study released today by the Center for American Progress refutes that allegation. Conducted by a team of seven academic researchers, the study compares cities that have elected so-called progressive prosecutors with places whose district attorneys continue to pursue more traditional approaches.

Countering conventional wisdom, the study found that homicides over recent years increased less rapidly in cities with progressive prosecutors than in those with more traditional district attorneys. It also found no meaningful differences between cities with progressive or traditional DAs in the trends for larceny and robbery. “I think it’s really important to emphasize the extent to which we looked for a relationship and found none” between a prosecutors’ commitment to reform and crime rates, Todd Foglesong, a fellow in residence at the University of Toronto and one of the co-authors, told me.

The data, from CAP, a liberal think tank and advocacy organization, reinforces the message from a study released earlier this year by Third Way, a centrist Democratic group. That report found that per capita murder rates in 2020 were 40 percent higher in states that voted for Donald Trump than in those that voted for President Joe Biden. The study found that eight of the 10 states with the highest per capita murder rates in 2020 have voted Republican in every presidential election in this century.

Progressive prosecutors have made major electoral gains since the mid-2010s, winning elections in New York City, Philadelphia, Boston, Chicago, San Francisco, and Los Angeles, among other big cities. In a recent interview, Larry Krasner, Philadelphia’s aggressively reform-minded DA, told me that about 20 percent of the nation’s population now lives in jurisdictions with a progressive prosecutor, compared with about 10 percent a little more than two years ago and essentially none 10 years ago. Fueled by the mass protests for racial equity that followed George Floyd’s murder in 2020, these prosecutors have pursued a range of common policies, including reducing reliance on cash bail, prosecuting fewer (or no) juveniles as adults, diverting more nonviolent offenders from prison to treatment programs, discouraging prosecution of quality-of-life violations associated with homelessness (such as public urination), and prosecuting more police misbehavior.

But rising crime rates—and, just as important, a sense of disorder linked to pervasive homelessness in multiple big cities—have forced the movement onto the defensive. San Francisco voters recalled Chesa Boudin, their progressive DA; polls showed that George Gascón, the like-minded Los Angeles district attorney, had a very good chance of being removed as well if opponents had collected enough valid signatures to qualify their recall effort. Meanwhile, the Republican-controlled state legislature in Pennsylvania, citing Philadelphia’s high homicide rate, is exploring whether to impeach Krasner (although he, and other legal scholars, say it lacks the legal authority to remove him).

Amid this storm, the CAP study represents probably the most comprehensive attempt yet to quantify the progressive prosecutors’ effect on crime rates. Looking at the period from 2015 to 2019, for instance, the study found that murder rates increased in a smaller share of cities with progressive prosecutors (56 percent) than in those with traditional prosecutors (68 percent) or prosecutors who fell in the middle (62 percent). (The study used a classification system for local DAs developed by a former federal prosecutor who is a critic of the progressive movement.) What’s more, the absolute number of murders increased by more in the cities with traditional and moderate prosecutors than in those with progressive ones. When homicide rates jumped from 2020 to 2021, the study found, the increase was slightly lower in the cities with progressive prosecutors than in those with traditional prosecutors.

Annie Lowrey: The people vs. Chesa Boudin

Similarly, the study found that from 2018 to 2021, robberies fell about as much in the cities with progressive prosecutors (down 5 percent) as they did in those with traditional DAs (down 8 percent). Trends in larceny looked about the same in both kinds of cities as well.

Foglesong told me that, despite all the political fire directed at progressive prosecutors, it shouldn’t be surprising that their choices haven’t exerted a notable influence on crime rates. Police make arrests only in a relatively small percentage of offenses, he said, and typically only about half of arrests result in prosecution (because of lack of witnesses or other factors). Small shifts in how prosecutors handle the very limited circle of cases that result in actual charges, Foglesong said, are mathematically too incidental to affect a community’s overall crime rate.

Conversely, it remains an open question whether the progressive prosecutors are advancing their stated goals of reducing the justice system’s racial bias. Foglesong said that although “some signs of evidence” point toward fewer racial disparities in charging practices, those trends have not been “thoroughly researched yet.”

But as the CAP report notes, the political problem for progressive prosecutors is that there’s no clear alternative explanation for rising crime. And so long as that’s true, the authors write, criminal-justice reforms will remain a tempting target, as the 2022 electoral season is dramatically demonstrating. “Our sense is that answers assigning blame to prosecutors and their policy changes will remain attractive in the absence of a more credible account of the interactions between crime and justice,” the authors conclude.

In fact, few areas of social science generate as much dispute—or as great a tendency for researchers to throw up their hands in uncertainty—than the long-term cycles of rising and falling crime. Adam Gelb, president and CEO of the nonpartisan Council on Criminal Justice, told me we know “not anywhere near as much as we should for a problem that is as pervasive and destructive to lives and families and communities, and ultimately to our democracy.”

The overarching trend in crime rates shows a significant decline from the heights of the early 1990s through roughly the middle of the last decade. Nationwide, according to federal statistics analyzed by the Brennan Center for Justice at NYU, the per capita homicide rate fell by more than half from 1991 through 2014, as did the per capita rate for all violent crimes. After 2014, though, the decline reversed, and both homicides and all violent crimes edged back up through 2016.

The rates then roughly stabilized again for the next few years, before exploding during the pandemic. Though both homicide and violent-crime rates remained far below their peaks in the 1990s, each was significantly higher in 2020 than at the low point in 2014. Murder rates continued to rise in 2021, though as the CAP report authors note, more slowly than in 2020 in every city experiencing increases.

The picture for 2022 is, as usual, complex. In a midyear tabulation of crime trends, the Council on Criminal Justice found that despite continued high incidence in some cities, the overall number of homicides slightly declined through this year’s first half (though they remained well above the pre-pandemic levels of 2019). But the data found that aggravated assaults and robberies increased from 2021, as did multiple measures of theft, including residential burglaries and motor-vehicle thefts. At the height of the pandemic, as the council noted, homicide increased and property crime fell; now those patterns have essentially reversed.

Criminologists broadly agree on the reasons behind some of these long-term shifts. Gelb can rapidly tick off the accepted explanations for the decline from the 1990s through the early 2010s: the waning of the crack epidemic, more effective policing (through the adoption of community policing), a better economy, more sophisticated anti-theft and security technology, and more incarceration of dangerous offenders. (More liberal analysts dispute that final point.)

Jeff Asher: The FBI’s next set of crime data is going to be a big mess

There’s also broad agreement that the pandemic itself was a crucial driver for the historic increases in homicide during 2020, though the exact mechanism for that isn’t clear. (One explanation is that shutdowns disrupted government services and increased the social isolation of the young people most prone to violence.)

But although competing theories abound (such as more guns or less conscientious policing amid increased scrutiny of their behavior), there’s no real consensus about why crime picked up again starting around 2014. Nor is there any consensus on whether it will now recede from its pandemic heights.

Rick Rosenfeld, a professor emeritus at the University of Missouri at St. Louis and one of the authors of the CAP study, told me some evidence suggests that homicide rates have peaked. But property crime is likely to continue rising, he said, largely because the high price of conventional goods amid soaring inflation has increased the market for lower-cost stolen goods, which creates more incentives to steal. “We live in a multicausal world,” Rosenfeld, a former president of the American Society of Criminology, told me. “Some things may be pushing up crime rates at the same time other things are pushing them down.”

“Multicausal” is far from the world most Democratic candidates are living in these final weeks before Election Day. The CAP study makes a thorough case that the new policies the progressive prosecutors are implementing can’t be blamed for the rising incidence of crime. But the slugfest on the campaign trail underscores an equally important truth: that as long as crime rates are elevated, those criminal-justice reforms will remain politically vulnerable anyway.

Ronald Brownstein

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October 20, 2022
The Glory of Feeling Fine

A few months ago, I got food poisoning. The sequence of events that led to my downfall began with a carton of discounted grocery-store sushi purchased and consumed on a Thursday, which led to me waking up a little queasy on a Friday, which devolved into a 12-hour stretch of me vomiting and holding myself in a fetal position, until my legs ached from dehydration. On Saturday the smell of my partner cooking breakfast still made me gag; I sipped water, napped fitfully, and nibbled little golf balls of white rice.

But Sunday, glorious Sunday, I awoke to a marvelous lack of pain and fatigue. The brain fog was gone. My skin felt plump with fluids. Enthralled by recovery, I found myself behaving with uncharacteristic serenity. When I dropped and broke a ceramic bowl while unloading the dishwasher, I didn’t curse and freak out. Instead, I swept up the shards with cheer. I wouldn’t sweat the small stuff. I was my normal self again, and it felt sublime.

Yet as I relished in my newfound bliss, a foreboding thought gnawed at me: I knew that as the hours passed and the specter of illness retreated, my fresh perspective, too, would fade. So much of my exuberance was defined by absence, the lifting of the burden of aches and puking. It would only be a matter of time until normal felt normal again, and I’d be back to worrying about all the petty minutiae I always worry about.

People have different baselines of health, and some might be more or less appreciative of whatever condition they’re in. Even so, humans have long lamented the ephemeral joy of relief. The feeling manifests in all kinds of circumstances: meeting a deadline, passing a test, finishing a marathon. And it can be especially acute in matters of wellness. “Health is not valued, till sickness comes,” wrote the 17th-century British scholar Thomas Fuller. Or as the 19th-century German philosopher Arthur Schopenhauer bemoaned: “Just as we do not feel the health of our entire body but only the small place where the shoe pinches, so too we do not think of the totality of our well-functioning affairs, but of some insignificant trifle that annoys us.”

So many of us, in other words, are very bad at appreciating good health when we’re fortunate enough to have it. And anyone experiencing this transcendent gratitude is unlikely to hold on to it for long. Indeed, by Monday morning, the afterglow of recovery had worn off; I was engrossed in emails and work again, unaware that just 60 hours prior I could barely sit upright in bed, let alone at my desk. This troubled me. Am I cursed to be like this forever? Or is there anything I can do to change?

To some extent, I’m sad to report, the answer might well be no. While certainly some people can have experiences of major illness or injury that change their entire outlook on life, the tendency to revert to forgetfulness seems to run pretty deep in the human psyche. We have limited attentional resources, the UC Davis psychology professor Robert Emmons told me, so in the interest of survival, our brain tends not to waste them focusing on systems that are working well. Instead, our mind evolved to identify threats and problems. Psychologists call this negativity bias: We direct our attention more to what’s wrong than what’s right. If your body’s in check, your brain seems to reason, better to stress about the project that’s overdue or the conflict with your friend than sit around feeling like everything’s fine.

Read: Does ‘counting your blessings’ work?

A second psychological phenomenon that might work against any enduring joy in recovery from illness is hedonic adaptation, the notion that after positive or negative life events we, basically, get used to our new circumstances and return to a baseline level of subjective well-being. Hedonic adaptation has been used to explain why, in the long term, people who won the lottery were no happier than those who didn’t; and why romantic partners lose passion, excitement, and appreciation for each other over time.

Arguably, adaptation need not be seen as any great tragedy. For health, in particular, there’s an element of practicality in the human capacity to exist without fussy attentiveness. This is how we’re supposed to operate. “If our body isn’t causing us problems, it doesn’t actually pay to walk around being grateful all the time. You should be using your mental energy on other things,” Amie Gordon, an assistant professor of psychology at the University of Michigan, told me. If we had to sense our clothes on our bodies all day, for example, we’d constantly be distracted, she said. (This is actually a symptom of certain chronic disorders, like fibromyalgia—Lauren Zalewski, a writer who was diagnosed with both fibromyalgia and lupus 22 years ago, told me that it makes her skin sensitive to the touch, as if she constantly has the flu.)

All that said, there are real costs to taking health for granted. For one, it can make you less healthy, if as a result you don’t take care of yourself. For another, maintaining some level of appreciation is a good way to avoid becoming an entitled jerk. Throughout the pandemic, for instance, there has been “this language around how the ‘only’ people dying are ‘old people’ or people with pre-existing conditions,” as if these deaths were more acceptable, Emily Taylor, a vice president for the Long-COVID Alliance, a group that advocates for research into post-viral illnesses, told me. Acknowledging that our own health is tenuous—and that certainly, many of us are going to get old—could counter this kind of callousness and encourage people to treat the elderly and those with chronic conditions or disabilities with more respect and kindness, Taylor argued.

In my view, there’s something to be gained on an individual level, too. In recent years I’ve seen friends and loved ones deal with life-altering injuries and diagnoses. I know that one’s circumstances can turn on a phone call or a moment of inattention. To be healthy, to have basic needs met—to have life be so “normal” that it’s even a little boring—is a luxury. While I am living in those blessedly unremarkable times, I don’t want my fortune to escape my notice. When things are good, I want to know how good I’ve got it.

Read: How to be thankful when you don’t feel thankful

What I want, really, is to hold on to a sense of gratitude. In the field of psychology, gratitude can be something of a loaded term. Over the past decade or so, articles, podcast episodes, self-help books, research papers, celebrities, and wellness influencers alike have all extolled the benefits of being thankful. (Oprah famously kept a gratitude journal for more than a decade.) At times, gratitude’s popularity has been to its own detriment: The modern-day gratitude movement has been criticized for overstating its potential benefits and pushing a Western, wealthy, and privileged perspective that can seem to ignore the realities of extreme suffering or systemic injustices. It’s also annoying to constantly be told that you should really be more thankful for stuff.

But part of the reason gratitude has become such a popular concept is due to bountiful research that does point to genuine emotional upsides. Feeling grateful has been associated with better life satisfaction, an increased sense of well-being, and a greater ability to form and maintain relationships, among other benefits. (The research on gratitude’s effects on physical health is inconclusive.) For me, though, the pull is less scientific and more commonsense anyway: Learning to genuinely appreciate day-to-day boons like having good health, or food in the fridge, seems like being able to tap into a renewable source of contentment. It’s always so easy to find stress in life. Let me remember the things to smile about, too.

One way to make the most of gratitude may be to reframe how people tend to think of it. A popular misconception, Emmons told me over email, is that gratitude is a positive emotion that results from something good happening to us. (This might also be part of the reason it can be hard to appreciate conditions like health that for many people remain stable day after day.) Gratitude is an emotion, but it can also be a disposition, something researchers call “trait gratitude.” Some people are more predisposed to feeling thankful than others, by virtue of factors like genetics and personality. But Emmons says this kind of “undentable thankfulness” can also be learned, by developing habits that contribute to more of a persistent, ambient awareness, rather than a conditional reaction to ever-changing circumstances.

What does this look like, practically speaking? “I don’t know that we can, with every breath we have every moment, feel grateful that we’re breathing. That’s a pretty tall order,” says Gordon. “But that’s not to say that you don’t build in a moment for it at some point in your day.” If you’re recovering from a cold, for example, you can practice pausing whenever you’re walking out the door to appreciate that your nose isn’t stuffy before just barreling on with life. Another tactic, from Emmons, is to reflect upon your worst moments, such as times you’ve been ill. “Our minds think in terms of counterfactuals,” he said, which are comparisons between the way things are and how they might have been. “When we remember how difficult life used to be and how far we have come, we set up an explicit contrast in our mind, and this contrast is fertile ground for gratefulness.”

Read: Don’t teach your kids to fear the world

You can also think of gratitude as an action, Emmons has written. This hews closer to the historical notion of gratitude, which as far back as the Roman days was associated with ideas like duty and reciprocity—when someone does something kind for us, we’re expected to return the favor, whether that’s thanking them, paying them back, or paying it forward. In that sense, being grateful for your body probably means doing your best to care for it (and, probably, refraining from risky behaviors like rolling the dice on discounted grocery-store sushi).

In 2015, Lauren Zalewski, the writer with fibromyalgia, founded an online community that supports people living with chronic pain by helping them to cultivate a grateful mindset. She tells me that before her diagnosis, she took her health for granted and “beat her body up.” Now, she eats vegan, takes supplements, does yoga, stretches, sleeps more, and gets sun regularly—these are the small things she has personally found helpful for managing her constant pain. “So while I am a chronically ill person,” she muses, “I consider myself pretty healthy.”

Looking back on my food-poisoning incident, I think I was primed to ruminate more deeply than usual on the topics of sickness and health. In the past two and a half years, I’ve watched COVID-19 show that anyone can get ill, perhaps seriously so. Now, as the head of the World Health Organization tells us that “the end is in sight” for the pandemic (and President Joe Biden controversially declares the pandemic over), it’s tempting to imagine that humanity is on the brink of waking up the morning after a hellish sickness.

It’s probably delusional to hope that even a global pandemic could prompt some kind of long-term collective mental shift about the impermanence of health, and of life. I didn’t become a radically different person after recovering from puking my guts out a few months ago either. But maybe the simple act of remembering the health we still have in the pandemic’s wake can make a small difference in how we go forward—if not as a society, then at least as individuals. I’m sure I’ll never fully override my tendency to take my body for granted until it’s too late. But for now, each day, I still get the golden opportunity to try. And I’d like to take it.

Gloria Liu

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September 23, 2022
The Fatal Error of an Ancient, HIV-Like Virus

Many, many millions of years ago, an HIV-like virus wriggled its way into the genome of a floofy, bulgy-eyed lemur, and got permanently stuck.

Trapped in a cage of primate DNA, the virus could no longer properly copy itself or cause life-threatening disease. It became a tame captive, passed down by the lemur to its offspring, and by them down to theirs. Today, the benign remains of that microbe are still wedged among a fleet of lemur genes—all that is left of a virus that may have once been as deadly as HIV is today.

Lentiviruses, the viral group that includes HIV, are an undeniable scourge. The viruses set up chronic, slow-brewing infections in mammals, typically crippling a subset of immune cells essential to keeping dangerous pathogens at bay. And as far as scientists know, these viruses are pretty uniformly devastating to their hosts—or at least, that’s true of “all the lentiviruses that we know of,” says Aris Katzourakis, an evolutionary virologist at the University of Oxford. Which means, a long time ago, that lemur lentivirus was likely devastating too. But somewhere along the way, the strife between lemur and lentivirus dissipated enough that their genomes were able to mix. It’s proof, says Andrea Kirmaier, an evolutionary virologist at Boston College, that lentivirus and host “can coexist, that peace can be made.”

Détentes such as these have been a fixture of mammals’ genomic history for countless millennia. Scientists have stumbled across lentiviruses embedded in the DNA of not just lemurs, but rabbits, ferrets, gliding mammals called colugos, and most recently, rodents—all of them ancient, all of them quiescent, all of them seemingly stripped of their most onerous traits. The infectious versions of those viruses are now extinct. But the fact that they posed an infectious threat in the past can inform the strategies we take against wild lentiviruses now. Finding these defunct lentiviruses tells us which animals once harbored, or might still harbor, active ones and could potentially pass them to us. Their existence also suggests that, in the tussle between lentivirus and host, the mammal can gain the upper hand. Lemurs, rabbits, ferrets, colugos, and rodents, after all, are still here; the ancient lentiviruses are not. Perhaps humans could leverage these strange genetic alliances to negotiate similar terms with HIV—or even extinguish the modern virus for good.

When viruses assimilate themselves into animal genomes in a heritable way, a process called endogenization, scientists generally see it as “kind of a mistake,” says Daniel Blanco-Melo, a virologist at the Fred Hutchinson Cancer Center. Once cemented into one host, the virus can no longer infect others; much of its genome may even end up degrading over time, which is “certainly not what it evolved to do.” The blunders usually happen with retroviruses, which have RNA-based genomes that they convert into DNA once they enter cells. The flip allows the viruses to plug their genetic material into that of their host, which is then forced to manufacture its pathogen’s proteins alongside its own. Sometimes, a retrovirus will inadvertently stitch itself into the genome of a sperm or an egg, and its blueprints end up passed to its host’s progeny. If the melding doesn’t kill the animal, the once-pathogen can become a permanent fixture of the creature’s DNA.

Over time, the human genome has amassed a horde of these viral hitchhikers. Our DNA is so riddled with endogenous retroviruses, ERVs for short, that they technically occupy more space in our genomes than bona fide, protein-manufacturing genes do. But on the long list of ERVs that have breached our borders, lentiviruses are conspicuously absent, in both our genomes and those of other animals; up until the mid-aughts, some scientists thought lentiviruses might not endogenize at all. It wasn’t a totally wonky idea: Lentiviruses have complex genomes, and are extremely picky about the tissues they invade; they’re also quite dangerous, not exactly the kind of tenant that most creatures want occupying their cellular real estate. Or perhaps, some researchers posited, lentiviruses were endogi-capable, but simply too young. If they had only begun infecting mammals within the past few hundreds of thousands of years, there might not have been time for such accidents to occur.

Then, some 15 years ago, a team led by Katzourakis and Rob Gifford, an evolutionary virologist at the University of Glasgow, discovered an endogenous lentivirus called RELIK in the genomes of rabbits and then in hares, a hint that it had lodged itself in the animals’ mutual ancestor at least 12 million years before. In an instant, the lentivirus timeline stretched, and in the years since has kept growing. Scientists have now identified endogenous lentiviruses in a wide enough array of mammals, Gifford told me, to suspect that lentiviruses may have been a part of our history for at least 100 million years—entering our very distant ancestors’ genomes before the demise of the dinosaurs, before the rise of primates, before the land masses of North and South America kissed. “That tells us just how long virus and host have been connected,” Katzourakis told me. Through those eons, lentiviruses and the mammals they afflict have been evolving in concert—the pathogen always trying to infect better, the animal always trying to more efficiently head its enemy off.

Knowing that lentiviruses are so deeply laced into our past can help us understand how other mammals are faring against the ones that are still around today. Two species of monkeys, sooty mangabeys and African green monkeys, have spent so much evolutionary time with a lentivirus called SIV—the simian version of HIV—that they’ve grown tolerant of it. Even when chock-full of virus, the monkeys don’t seem to suffer the severe, immunocompromising disease that the pathogen induces in other primates, says Nikki Klatt, a microbiologist and an immunologist at the University of Minnesota. The key seems to be in the monkeys’ ultra-resilient, fast-healing guts, as well as their immune systems, which launch more muted attacks on SIV, keeping the body from destroying itself as it fights. Such immunological shrugs could enable certain retroviruses to eventually endogenize, says Lucie Etienne, an evolutionary virologist at the International Center for Infectiology Research, in Lyon, France.

Many mammals have also developed powerful tools to prevent lentiviruses from reproducing in their bodies in the first place—proteins that can, for instance, mess with viral entry or replication, or prevent new viral particles from busting out of already infected cells. Viruses, too, can mutate and evolve, far faster than animals can. That’s given the pathogens plenty of chances to counteract these defenses; HIV, for instance, has no trouble sidestepping or punching through many of the shields that human cells raise against it.

Read: Could genetics be the key to never getting the coronavirus?

But take the equivalent immune-defense protein from a monkey, and HIV “cannot degrade that,” says Michael Emerman, a virologist at the Fred Hutchinson Cancer Center. Other primates have had different infectious histories from ours, which have shaped their immune evolution in distinct ways. Studying those primates’ genomes—or maybe even the genomes of mammals that are carrying lentiviruses as neutered genetic cargo—might eventually inspire therapies that “augment our immunity,” Emerman told me. At the very least, such experiments could point scientists to lentiviruses’ common weak spots: the parts of the virus that ancient immune systems once targeted successfully enough that their hosts survived to tell the tale. “Evolution has already taught us the best places to target retroviruses,” says Maria Tokuyama, a virologist at the University of British Columbia. “Why not push for the types of interactions that we already know have worked?”

Another, perhaps more radical idea might yet give way to an HIV cure: speeding the path toward endogenization—allowing lentiviruses to tangle themselves into our genomes, in the hopes that they’ll stay permanently, benignly put. “We could figure out a way to silence the virus, such that it’s there but we don’t care about it,” says Oliver Fregoso, a virologist at UCLA. One of the holy grails of HIV research has always been cooking up a vaccine that could prevent infection—an extraordinarily difficult thing to do. But if some sort of gentle armistice can be reached, Boston College’s Kirmaier told me, “maybe we don’t need to go that far.”

Cedric Feschotte and Sabrina Leddy, virologists at Cornell, are among those pushing for such an intervention. They’re capitalizing on HIV’s tendency to go dormant inside cells, where it can hide from some of our most powerful antiretroviral drugs. The virus essentially “plays dead,” Leddy told me, then reawakens when the coast is clear. But if HIV could be silenced stably, its rampage would end when it jammed itself into the genome. “We’re hoping to emulate this natural path that ERVs have taken,” where they’re effectively locked in place, Leddy said. The imprisoned viruses could then be excised from cells with gene editing.

The idea’s ambitious and still a way off from yielding usable treatments. But if it works, it could produce an additional perk. After setting up shop inside us, our viral tenants can start to offer their landlord benefits—such as fighting off their own active kin. In recent years, researchers have found that some animals, including cats, chickens, mice, primates, sheep, and even humans, have been able to co-opt proteins from certain endogenous retroviruses to create blockades against incoming viruses of similar ilk. Blanco-Melo and Gifford were part of a team that made one such discovery in 2017, describing an ERV that ancient monkeys and apes might have used to strip viral entryways off the surfaces of their cells. When encountering an ERV-ed-up host, the infectious, still-pathogenic version of that ERV would no longer have been able to get in.

Eventually, the active retrovirus “just went extinct,” Blanco-Melo told me—an outcome that he thinks could be attributable to the antics of its endogenous counterpart. It’s a devious move, essentially a way to “turn the virus against itself,” Kirmaier said. This sort of friendly-fire tactic may already be at work among lentiviruses, duking it out inside and outside host genomes: Species with endogenous lentiviruses usually aren’t bedeviled by active lentiviruses, at least none that has been identified yet, Fregoso told me. With any luck, the same could someday be true for HIV, the virus little more than a memory—or an idle fragment in our cells.

Katherine J. Wu

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September 21, 2022
Polio Is Exploiting a Very Human Weakness

In 1988, the World Health Assembly announced a very ambitious goal: Polio was to be vanquished by the year 2000. It was a reach, sure, but feasible. Although highly infectious, polioviruses affect only people, and don’t hide out in wild animals; with two extraordinarily effective vaccines in regular use, they should be possible to snuff out. Thanks to a global inoculation campaign, infections had, for years, been going down, down, down.

But 2000 came and went, as did a second deadline, in 2005, and a third, in 2012, and so on. The world will almost certainly miss an upcoming target at the end of 2023 too. In theory, eradication is still in sight: The virus remains endemic in just two countries—Pakistan and Afghanistan—and two of the three types of wild poliovirus that once troubled humanity are gone. And yet, polio cases are creeping up in several countries that had eliminated them, including the United Kingdom, Israel, and the United States. Earlier this year, New York detected America’s first paralytic polio case in nearly a decade; last week, the governor declared a state of emergency over a fast-ballooning outbreak.

This is the cruel logic of viruses: Give them enough time—leave enough hosts for them to infect—and they will eventually find a way to spread again. “You have to stop transmission everywhere, all at the same time,” says Kimberly Thompson, a health economist and the president of the nonprofit Kid Risk. Which means eradication will demand a near-perfect syncing of vaccine supply, access, equity, political will, public enthusiasm, and more. To beat the virus, population immunity must outlast it.

Right now, though, the world’s immunological shield is too porous to stop polio’s spread. At the center of the new epidemics are vaccine-derived polioviruses that have begun to paralyze unimmunized people in places where immunity is low—a snag in the eradication campaign that also happens to be tightly linked to one of its most essential tools. Vaccine performance has always depended on both technology and human behavior. But in this case especially, because of the nature of the foe at hand, those twin pillars must line up as precisely as possible or risk a further backslide into a dangerous past.

In the grand plan for eradication, our two primary polio vaccines were always meant to complement each other. One, an ultra-effective oral formulation, is powerful and long-lasting enough to quash wild-poliovirus transmission—the perfect “workhorse” for a global vaccination campaign, says Adam Lauring, an evolutionary virologist at the University of Michigan. The other, a supersafe injectable, sweeps in after its colleague has halted outbreaks one country at a time, maintaining a high level of immunity in post-elimination nations while the rest of the world catches up.

For decades, the shot, chaser approach found remarkable success. In the 1980s, wild poliovirus struck an estimated 300,000 to 400,000 people each year; by 2021, the numbers had plummeted to single digits. But recently, as vaccine coverage in various countries has stalled or slipped, the loopholes in this vaccination tactic have begun to show themselves and grow.

The oral polio vaccine (OPV), delivered as drops in the mouth, is one of the most effective inoculations in the world’s roster. It contains weakened forms of polioviruses that have been altered away from their paralysis-causing forms but still mimic a wild infection so well that they can stop people from spreading wild pathogens for years, even decades. In the weeks after people receive the vaccine, they can also pass the weakened virus to others in the community, helping protect them too. And OPV’s transportability, low price point, and ease of administration make it a “gold standard for outbreak interruption,” says Ananda Bandyopadhyay, the deputy director for the polio team at the Bill & Melinda Gates Foundation. Since its mid-20th-century debut, OPV has helped dozens of countries—including the U.S.—eliminate the virus. Those nations were then able to phase out OPV and switch to inoculating people with the injected vaccine.

But OPV’s most potent superpower is also its greatest weakness. Given enough time and opportunity to spread and reproduce, the neutered virus within the vaccine can regain the ability to invade the nervous system and cause paralysis in unvaccinated or immunocompromised people (or in very, very rare cases, the vaccine recipient themselves). Just a small handful of genetic modifications—three or fewer—can spark a reversion, and the mutants, which are “better at replicating” than their kin, can take over fast, says Raul Andino, a virologist at UC San Francisco. In recent years, a few thousand cases of vaccine-derived polio have been detected around the world, far outstripping the toll of wild viruses; dozens of countries, the U.S. now among them, are battling such outbreaks, and the numbers seem to be only going up. Vaccine-derived polio is still a true rarity: Billions of oral vaccines have been delivered since the global campaign began. But it underscores “the real problem” with OPV, Lauring told me. “You’re fighting fire with fire.”

Read: The epidemic that preyed on children

The injected polio vaccine, or IPV, which contains only chemically inactivated versions of the virus, carries none of that risk. To purge all polio cases, “you have to stop using oral polio vaccine,” Thompson told me, and transition the entire globe to IPV. (Post-eradication, countries would need to keep IPV in their routine immunization schedule for at least 10 years, experts have said.) But the injected vaccine has a different drawback. Although the shot can very effectively stave off paralysis, IPV doesn’t elicit the kind of immunity that stops people from getting infected with polioviruses and then passing them on. In places that rely on injected vaccines, “even immune individuals can participate in transmission,” Thompson told me. Which opens up a vulnerability when too many people have skipped both types of vaccines: Paralyzing polioviruses erupt out of communities where the oral vaccine is still in use—then can spread in undervaccinated areas. It might be tempting to blame OPV for our troubles. But that’s not the main threat, Bandyopadhyay told me. “It’s the lack of adequate vaccination.”

As things stand, the goal in the endemic countries of Pakistan and Afghanistan remains achieving sufficiently high vaccine coverage, Bandyopadhyay said. But many of the communities in these nations are rural or nomadic, and tough to reach even with convenient drop-in-the-mouth vaccines. Civil and political unrest, misinformation, natural disasters, and most recently, the COVID pandemic have raised additional hurdles. So have intermittent bans on house-to-house vaccination in Afghanistan, says John Vertefeuille, the chief of the polio-eradication branch at the CDC. Cases of wild polio have experienced a recent jump in Pakistan, and have also been imported into the non-endemic countries of Malawi and Mozambique.

But the toll of those outbreaks—all featuring type 1 polio—currently pales in comparison with those featuring vaccine-derived type 2. The last case of wild type 2 polio was detected in 1999, but that version of the virus has persisted in its modified form in oral polio vaccines. And when it reverts to its dangerous form, it gains particularly infectious oomph, allowing it to spread unchecked wherever immunity is low. Some 30 countries around the world are battling outbreaks of poliovirus whose origin can be traced back to the oral inoculations; vaccine-derived type 2 is what’s been circulating in Jerusalem, London, and New York, where it ultimately paralyzed an unvaccinated young man. The extent to which the virus is churning in other parts of the country isn’t fully known; routine immunization has dropped since the COVID pandemic’s start, and the U.S. hasn’t regularly surveyed its wastewater for the pathogen.

The success of these vaccine-derived viruses is largely the result of our own hubris—of a failure, experts told me, to sync the world’s efforts. In 2016, 17 years after the last wild type-2 case had been seen, officials decided to pivot to a new version of OPV that would protect against just types 1 and 3, a sort of trial run for the eventual obsolescence of OPV. But the move may have been premature. The switch wasn’t coordinated enough; in too many pockets of the world, type-2 polio, from the three-part oral vaccine, was still moseying about. The result was disastrous. “We opened up an immunity gap,” Thompson told me. Into it, fast-mutating vaccine-derived type-2 viruses spilled, surging onto a global landscape populated with growing numbers of children who lacked protection against it.

A new oral vaccine, listed for emergency use by the WHO in 2020, could help get the global campaign back on track. The fresh formulation, developed in part by Andino and his colleagues, still relies on the immunity-boosting powers of weakened, replicating polioviruses. But the pathogens within have had their genetic blueprints further tweaked. “We mucked around” with the structure of poliovirus, Andino told me, and figured out a way to make a modified version of type 2 that’s far stabler. It’s much less likely to mutate away from its domesticated, non-paralyzing state, or swap genes with related viruses that could grant the same gifts.

Technologically, the new oral vaccine, nicknamed nOPV2, seems to be as close to a slam dunk as immunizations can get. “To me, it’s just super cool,” Lauring told me. “You keep all the good things about OPV but mitigate this evolutionary risk.” In the year and a half since the vaccine’s world premiere, some 450 million doses of nOPV2 have found their way into children in 22 countries—and a whopping zero cases of vaccine-derived paralysis have followed.

But nOPV2 is “not a silver bullet,” Andino said. The vaccine covers just one of the three poliovirus types, which means it can’t yet fully replace the original oral recipe. (Trials for type-1 and -3 versions are ongoing, and even after those recipes are ready for prime time, researchers will have to confirm that the vaccine still works as expected when the three recipes are mixed.) The vaccine’s precise clinical costs are also still a shade unclear. nOPV2 is a safer oral polio vaccine, but it’s still an oral polio vaccine, chock-full of active viral particles. “You can think of it as more attenuated,” Thompson said. “But I don’t think anybody expects that it won’t have any potential to evolve.” And nOPV2’s existence doesn’t change the fact that the world will still have to undergo a total, coordinated switch to IPV before eradication is won.

As has been the case with COVID vaccines, and so many others, the primary problem isn’t the technology at all—but how humans have deployed it, or failed to. “Vaccine sitting in a vial, no matter how genetically stable and how effective it is, that’s not going to solve the problem of the outbreaks,” Bandyopadhyay said. “It’s really vaccination and getting to that last child in that last community.”

Read: How the poor get blamed for disease

If dwindling vaccination trends don’t reverse, even our current vaccination strategies could require a rough reboot. In 2013, health officials in Israel—which had, for years prior, run a successful IPV-only campaign for its children—detected wild type-1 virus, imported from abroad, in the country’s sewage, and decided to roll out another round of oral vaccines to kids under 10. Within a few weeks, nearly 80 percent of the targeted population had gotten a dose. Even “polio-free countries are not polio-risk-free,” Bandyopadhyay told me. The situation in New York is different, in part because type-1 polio causes paralysis more often than type-2 does. But should circumstances grow more dire—should substantial outbreaks start elsewhere in the country, should the nation fail to bring IPV coverage back to properly protective levels—America, too, “may have to consider adding OPV as a supplement,” says Purvi Parikh, an immunologist and a physician at NYU, “especially in rural areas” where emergency injected-vaccine campaigns may be tough. Such an approach would be a pretty extreme move, and a “very big political undertaking,” Thompson said, requiring a pivot back to a vaccine that was phased out of use decades ago. And even then, there’s no guarantee that Americans would take the offered oral drops.

The CDC, for now, is not eager for such a change. Noting that most people in the U.S. are vaccinated against polio, Katherina Grusich, an agency spokesperson, told me that the CDC has no plans to add OPV or nOPV to the American regimen. “We are a long way from reaching for that,” she said.

But this week, the U.S. joined the WHO’s list of about 30 nations with circulating vaccine-derived-poliovirus outbreaks. The country could have avoided this unfortunate honor had it kept shot uptake more uniformly high. It’s true, as Grusich pointed out, that more than 90 percent of young American children have received IPV. But they are not distributed evenly, which opens up vulnerabilities for the virus to exploit. Here, the U.S., in a sense, had one job: maintain its polio-free status while the rest of the world joined in. That it did not is an admonition, and a reminder of how unmerciful the virus can be. Polio, a fast mutator, preys on human negligence; the vaccines that guard against it contain both a form of protection and a catch that reinforces how risky treating these tools as a discretionary measure can be.

Katherine J. Wu

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September 16, 2022
The Val Demings Gamble

On a hot D.C. Wednesday in the middle of July, an 11-foot statue honoring Mary McLeod Bethune—carved out of marble extracted from the same Tuscan quarry that Michelangelo used for his David—stood draped in a black cloak in the U.S. Capitol’s National Statuary Hall. A group of distinguished guests had gathered to honor Bethune, the prominent educator and civil-rights activist who founded a college for Black students in Daytona Beach, Florida, and later served as an adviser to President Franklin D. Roosevelt. She is now the first Black American to have a state statue in the hall.

The group, which included several members of Florida’s congressional delegation, smiled as cameras flashed. Two of those present, Senator Marco Rubio and Representative Val Demings, are opponents in the race for Rubio’s Senate seat—a race that could secure the Democrats’ control of the Senate. Together, they tugged at the sheet, revealing the white-marble figure clothed in academic regalia, holding a black rose—which, in life, Bethune viewed as a symbol of diversity.

One by one, speakers approached a lectern in front of the statue to offer remarks. “I remember as a little girl listening to my mother and my father talk about a Black woman, a woman who looked like us, who started a college,” Demings told those who had gathered in the amphitheater. “As I listened to my parents tell the story, it seemed impossible. But Dr. Mary McLeod Bethune made what seemed impossible possible.”

Demings hopes to conjure some of Bethune’s magic. The race has for some time been considered a long shot for the 65-year-old former Orlando police chief; to win she’ll need to make what seems impossible possible in a state where the voter rolls have flipped from a more-than-100,000-voter Democratic advantage in 2020 to a Republican lead of nearly the same size in less than two years. And for months the polls reflected that, showing Demings trailing Rubio; but in recent weeks, a new batch of polls has shown Demings pulling into an effective tie, or even a slight lead.

Read: What Biden owes Black voters

If the race does break her way, the Democrats will have the convergence of two separate story lines to thank. The first is the story of Val Demings herself: a centrist Black woman with a background in law enforcement—just the profile the party has placed its bets on in recent years. It’s no coincidence, after all, that Demings joined then-Senator Kamala Harris and former Atlanta Mayor Keisha Lance Bottoms, who both worked as prosecutors before seeking elected office, on Joe Biden’s shortlist for his running mate two years ago.

Political moderates could admire her centrism; people of color could identify with her race; women could identify with her gender. Demings has converted that appeal into a fundraising advantage, pulling in millions more in donations than Rubio so far this cycle, and spending more than twice as much as him on television ads.

And if the national Democratic Party’s unpopularity had been weighing on her fortunes, the events of recent weeks may have buoyed them. In early August, Democrats in Congress passed a mammoth bill on climate change, health care, and taxes. Though the Inflation Reduction Act is by nature full of compromises, as my colleague Robinson Meyer notes, it “will touch every sector of the economy, subsidizing massive new investments in renewable and geothermal energy, as well as nuclear power and carbon capture and removal, and encouraging new clean-energy manufacturing industries to develop in the United States.” Demings has contrasted her own legislative record with that of Rubio, who has one of the worst attendance records in the Senate. With Congress showing that it can actually function, voters might be more receptive to that argument.

Demings watches the House Intelligence Committee’s impeachment hearings in 2019. (Damon Winter/The New York Times/Redux)

Demings likes to say she’s living the American dream. In 1957, when she was born, her family lived in a three-room shack in Mandarin, Florida—a rural part of Duval County, just south of Jacksonville. Her father worked as a janitor, and her mother was a housekeeper. A year later, they upgraded to a two-bedroom house, but the roof leaked and for several years it lacked working bathrooms.

In the sixth grade, Demings helped integrate Loretta Elementary School, which she used to ride past to get to the Black elementary school 15 miles away. Shortly after enrolling, Demings was chosen to serve on the school patrol. She loved it. “You had to have good citizenship and good grades—and I was selected. I had my little orange belt, and I just fell in love,” she told me in July. “It was such an honor to be selected, because it was a big deal.”

Read: Has America given up on the dream of racial integration?

As soon as she was old enough to get a real job, she did: first washing dishes at a retirement home, and later working fast-food gigs. After high school, she went off to Florida State University to study criminology, with an eye toward becoming a lawyer. “My dad used to say, ‘You’re a pretty good talker. You need to make some money talking,’ and he thought being a lawyer was a pretty cool thing,” she said. But scraping her way through college meant she needed a job—not law school—after graduation. “I was broke broke,” she quipped. So she moved back to Jacksonville, where she became a social worker with the Department of Health and Rehabilitative Services. But she soon grew disillusioned, doubting how much good she’d ever be able to do with so little power.

“I had this 10-year-old boy on my caseload,” Demings said. “He started having some problems, exhibiting behavior that made him really a threat to himself.” She went to her supervisor to see if she could get a psychological evaluation for him, but was told it would be roughly three weeks before a referral could be made; the panel that made those decisions met only once a month.

Demings was shocked. “This kid would be dead by then,” she recalled telling her boss. So she went around her supervisor to the juvenile judge—waiting outside his chambers until she was able to plead his case. To Demings’s relief, the judge granted an emergency order. She saw it as a small victory in a tough system, until it backfired: Demings was reprimanded by her supervisor for subverting their structure. She felt deflated by the experience, and began to think about what she wanted to do next.

In 1983, Demings got word that the Orlando Police Department was recruiting at Edward Waters College, the historically Black college in Jacksonville, and she figured that she would go down to speak with someone. That ultimately led to a 27-year career at the department, where Demings worked her way through its ranks: patrol officer, juvenile-crime detective, community-relations officer, public-information officer, hostage negotiator, then supervisor of the patrol, investigations, and airport units. (Some aspects of her career were less deliberate: She always told herself that she’d never date a fellow officer—then she ended up marrying one.)

As a police captain, she developed a reputation as a tough-on-crime enforcer on everything from traffic violations to violent infractions. “The message has to be clear for the violators: There are no deals,” she said in 2005 after a string of dangerous-driving incidents.

But that approach, which continued after she was promoted to deputy chief, drew criticism from members of the Black community in the city. She was lambasted after an Orlando Sentinel story examined the department’s overuse of tasers and aggressive traffic stops and she told the paper that her officers were “kicking butt” in the historically Black neighborhood of Parramore. “If that [vehicle or pedestrian] stop results in something greater and leads to drugs or drug paraphernalia, I call that good police work,” she said at the time.

Still, by late 2007, her policing record, and a succession of departures, led to her being selected as Orlando’s chief of police. She was the first woman and second Black person—after her husband, Jerry, who left that role in 2002 to become the county’s public-safety director—to lead the department.

From the start, she took an aggressive approach to the job. “We will be courteous to law-abiding citizens but relentless in our efforts to disrupt violent criminals who have no respect for the police, citizens or their property,” she wrote in a New Year’s Day Orlando Sentinel op-ed in 2008. Later that year, Jerry won his race for county sheriff, making the duo the first Black husband and wife to serve as sheriff and chief of police in the same county at the same time.

Demings often cites the fact that under her leadership, Orlando experienced a 40 percent drop in violent crime. But a string of excessive-force complaints—including a 2010 incident in which an officer broke an 84-year-old man’s neck by flipping him upside down—revealed some of the clear dangers of the aggressive policing tactics that were employed during her tenure. “Apparently it’s perfectly acceptable to break old men’s necks for no reason,” John Kurtz, the founder of the blog Orlando CopWatch, said at the time. Demings initially defended the officer’s actions in the incident, but eventually modified the department’s use of the technique that led to the octogenarian’s fractured vertebrae. In 2011, after 27 years with the department, Demings stepped down and set her sights on a new challenge.

Elected office wasn’t something Demings had initially been interested in. But as she was about to retire, Mayor Buddy Dyer called her to let her know that the Democratic Congressional Campaign Committee thought she would be a good candidate to run for the House seat that represented Orlando. “I just burst out laughing,” she told me. “And the mayor’s like, ‘Chief, are you okay?’” She thought he must have been joking. “You know your police chief. I’m a little rough around the edges,” she recalls telling him. “And I don’t know if I’d make a good politician.” Still, she met with Representative Steve Israel, who was the committee chair at the time—and ultimately decided that running for Congress was a logical next step.

She lost her first campaign and suspended another run for mayor two years later. But her defeats only raised her public profile. By 2016, court-ordered redistricting meant that the Tenth District was significantly more Democratic than it had been when she first ran for office—which meant that her biggest hurdle would be her primary opponent. She won 57 percent of the vote in a four-person primary—and received 15,000 more votes than her nearest competitor. She then won in the general election by nearly 100,000 votes.

Thirty-three years after Demings had packed everything she owned in the trunk of her Oldsmobile Firenza and headed to Orlando for her new job with the police department, she would be taking her tough-on-crime bona fides to Washington.

Across two terms, Demings has sponsored or co-sponsored dozens of bills that have become law—though a divided Congress means she does not have a signature piece of legislation to hang her hat on. But her most significant moment came when, in January 2020, she served as an impeachment manager during the first Senate trial of then-President Donald Trump. Though the Senate ultimately acquitted Trump—voting along party lines except for the sole defection of Senator Mitt Romney—Demings’s prominence continued to grow. She was profiled by The Washington Post, NPR, and other national outlets. “Was it worth it? Every day it has been worth it,” she said of the trial after its conclusion. “Just like when I was a law enforcement officer, when I saw someone breaking the law, I did not stop and think about, well, my goodness, what will the judge do? … I did my job to stop that threat and then go to court and plead my case.”

After that, she landed on Biden’s shortlist for vice president—evidence of both her meteoric rise and the Democratic Party’s relentless search for its next phenom who can capture the national imagination the way Barack Obama did.

Demings makes phone calls to constituents from the Pinellas County Democratic headquarters in Florida. (Octavio Jones / Getty)

“Florida, vota por la jefa de la policía, no por el politiquero,” Demings’s first Spanish-language ad, aired in June, said. Vote for the chief of police, not the politician. Demings is trying to define herself for voters she hopes will form her coalition—particularly the Latino voters who have been tilting Republican in recent years She’s on the defensive: The Rubio campaign has tried to pin the Democratic Party’s most left-wing sensibilities on her.

In a campaign ad of his own, Rubio touts his endorsement from Florida’s Fraternal Order of Police and 55 sheriffs, and suggests that Demings supported the “Defund the Police” movement—or, at the very least, did not reject it fiercely enough. “Senator Rubio has not only tried not to defund the police; he’s defended the police,” Al Palacio, the Miami Dade public-schools Fraternal Order of Police president, says in the ad. “And we’re here to defend him.” Rubio’s campaign believes that this is a winning issue; an October 2021 Pew Research Center survey found that 47 percent of Americans want to see more spending on police, compared with 15 percent who would like to see budgets reduced.

Demings dismissed the ad out of hand, responding with a brief statement: “I am the police. This is ridiculous.”

Brian Klaas: Focus on who police are, not what they do

Though Florida has not seen the same jumps in crime rates as some other parts of the country over the past two years, the race has focused on policing and crime issues. The irony is, were she running as a Republican, Demings would be seen as emblematic of the tough-on-crime policies some voters say they want.

But because she’s running in a state that is turning redder and redder, Demings has to strike the right balance of being the police enforcer she’s always been while appearing open to reform, and being unrelentingly liberal on issues such as access to abortion while emphasizing her Christian faith so as not to isolate Catholic voters. And she has to highlight her identity—her family’s economic status growing up and, perhaps most important, her race—while not making it the central plank of her campaign. Over the past several years, Florida Republicans have passed laws that limit discussions of identity in classrooms and other public spaces—a bit of a contrast with the political campaign Demings has run, explaining to voters how being a Black woman has shaped her life and informed her policy preferences.

That’s been a difficult sell: How do you convince voters that you’ll be a senator who can get stuff done if the Democrats can manage to keep their Senate majority, when the Democrats had—at least in the public’s view—gotten so little done? But with the passage of the Inflation Reduction Act, the party’s chances look different now, and maybe, just maybe, Demings will be the beneficiary. If Demings pulls off an upset, it will be not solely because she’s a Black woman, but because the Democrats finally figured out how to rack up some wins in D.C. And what could be a greater crowd-pleaser than that?

Adam Harris

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September 6, 2022
You’ve Probably Seen Yourself in Your Memories

Pick a memory. It could be as recent as breakfast or as distant as your first day of kindergarten. What matters is that you can really visualize it. Hold the image in your mind.

Now consider: Do you see the scene through your own eyes, as you did at the time? Or do you see yourself in it, as if you’re watching a character in a movie? Do you see it, in other words, from a first-person or a third-person perspective? Usually, we associate this kind of distinction with storytelling and fiction-writing. But like a story, every visual memory has its own implicit vantage point. All seeing is seeing from somewhere. And sometimes, in memories, that somewhere is not where you actually were at the time.

This fact is strange, even unsettling. It cuts against our most basic understanding of memory as a simple record of experience. For a long time, psychologists and neuroscientists did not pay this fact much attention. That has changed in recent years, and as the amount of research on the role of perspective has multiplied, so too have its potential implications. Memory perspective, it turns out, is tied up in criminal justice, implicit bias, and post-traumatic stress disorder. At the deepest level, it helps us make sense of who we are.

The distinction between first- and third-person memories dates back at least as far as Sigmund Freud, who first commented on it near the end of the 19th century. Not for another 80 years, though, did the first empirical studies begin fleshing out the specifics of memory perspective. And it was only in the 2000s that the field really started picking up steam. What those early studies found was that third-person memories were far less unusual than once thought. The phenomenon is associated with a number of mental disorders, such as depression, anxiety, and schizophrenia, but it is not merely a symptom of pathology; even among healthy people, it is quite common.

Just how common is tricky to quantify. Peggy St. Jacques, a psychology professor at the University of Alberta who studies perspective in memory, told me that roughly 90 percent of people report having at least one third-person memory. For the average person, St. Jacques estimates, on the basis of her research, that about a quarter of memories from the past five years are third-person. (At least a couple of papers have found that women tend to have more third-person memories than men do, but a third study turned up no statistically significant difference; on the whole, research on possible demographic disparities is scant.) In certain rare cases, people may have only third-person memories. As you try to recall your own, be warned that things can get confusing fast. Perhaps you can call to mind early-childhood scenes that you picture from a third-person perspective. But it’s hard to know whether these are genuine memories translated from the first person to the third person, or third-person scenes constructed from stories or photographs. To some people, third-person memories are second nature; to others, they sound like science fiction.

Why any given memory gets recalled from one perspective rather than the other is the result of a whole bunch of intersecting factors. People are more likely to remember experiences in which they felt anxious or self-conscious—say, when they gave a presentation in front of a crowd—in the third person, St. Jacques told me. This makes sense: When you’re imagining how you look through an audience’s eyes in the moment, you’re more likely to see yourself through their eyes at the time of recall. Researchers have also repeatedly found that the older a memory is, the more likely you are to recall it from the third person. This, too, is fairly intuitive: If first-person recollection is the ability to adopt the position—and inhabit the experience—of your former self, then naturally you’ll have more trouble seeing the world the way you did as a 6 year old than the way you did last week. The tendency for older memories to be translated into the third person may also have to do with the fact that the more distant the memory is, the less detail you’ll likely have, and the less detail you have, the less likely you are to be able to reassume the vantage point from which you originally witnessed the scene, David Rubin, a Duke University psychology professor who has published dozens of papers on autobiographical memory, told me.

Less intuitive, perhaps, is the reverse: People are able to recall a scene in greater detail when they’re asked to take a first-person perspective than when they’re asked to take a third-person perspective. “Sometimes in a courtroom, an eyewitness to a holdup might be asked to recall what happened from the perspective of the clerk,” St. Jacques told me. But if her research is any indication, such tactics may blur rather than sharpen the witness’s memory. “Our research suggests that might actually be more likely to make the memory less vivid, make the eyewitness less likely to remember the specifics.”

Even without an examiner’s instructions, such an eyewitness might be predisposed to recall the robbery in the third person: Researchers have found that people often translate traumatic or emotionally charged memories out of the first person. This may be because first-person memories tend to elicit stronger emotional reactions at the time of recall, and by taking a third-person perspective, we can distance ourselves from the painful experience, Angelina Sutin, a psychologist at Florida State University, told me. It may also be a function of the information at our disposal. In charged situations, Rubin said, people tend to zero in on the object of their anger or fear. Take the bank-robbery scenario: The police “want the teller to describe the person who’s robbing them, and instead he describes in great detail the barrel of the gun pointed at his head.” He can’t remember much beyond that. And so, lacking the information necessary to situate himself in his original perspective, he floats.

This distancing effect has some fairly mind-bending potential applications, none more so, perhaps, than to the problem of near-death experiences. For many years, philosophers and psychologists have documented instances of people reporting that, in moments of trauma, they felt as though they were floating outside—usually above—their body. Rubin points out, however, that such reports are not in-the-moment descriptions but after-the-fact accounts. So he has a controversial idea: What in retrospect seems like an out-of-body experience may in fact be only the trauma-induced translation of a first-person memory into a third-person memory, one so compelling that it deceives you into thinking the experience itself occurred in the third person. The recaller, in this theory, is like a person peering through a convex window, mistaking a distortion of the glass for a distortion of the world.

Traumatic dissociations are dramatic but by no means isolated cases of what Rubin calls the “constructive nature of the world.” In a 2019 review article on memory perspective, St. Jacques noted that shifting your vantage and fabricating an entirely new scene rely on the same mental processes occurring in the same regions of the brain. So similar are recollecting the past and projecting into the future that some psychologists lump them into a single category: “mental time travel.” Both are acts of construction. The distinction between memory and imagination blurs.

At some level, people generally understand this, but rarely do we get so incontrovertible an example as with third-person memories. If you and a friend try to recall the decor at the restaurant where you got dinner last month, you might find that you disagree on certain points. You think the wallpaper was green, your friend thinks blue, one of you is wrong, and you’re both sure you’re right. With third-person memories, though, you know the memory is distorted, because you could not possibly have been looking at yourself at the time. If, without even realizing it, you can change something so central as the perspective from which you view a memory, how confident can you really be in any of the memory’s details?

In this way, third-person memories are sort of terrifying. But shifts in perspective are more than mere deficiencies of memory. In her lab at Ohio State University, the psychologist Lisa Libby is investigating the relationship between memory perspective and identity—that is, the way shifts in our memory play a role in how we make sense of who we are. In one experiment, Libby asked a group of female undergraduates whether they were interested in STEM. The students then participated in a science activity, some in a version designed to be engaging, others in a version designed to be boring. Afterward, when she surveyed the undergrads about how they’d found the exercise, she instructed some to recall it from a first-person perspective and others from a third-person perspective. The first-person group’s answers corresponded to how interesting the task really was; the third-person group’s corresponded to whether they’d said they liked STEM in the initial survey.

Libby’s takeaway: Each type of memory seems to have its own function. “One way to think about the two perspectives is that they help you represent … two different components of who you are as a person,” Libby told me. Remembering an event from a first-person perspective puts you in an experiential frame of mind. It helps you recall how you felt in the moment. Remembering an event from a third-person perspective puts you in a more narrative frame of mind. It helps you contextualize your experience by bringing it in line with your prior beliefs and fitting it into a coherent story. Memory is the—or at least a—raw material of identity; perspective is a tool we use to mold it.

Maybe the most interesting thing about all of this is what it suggests about the human proclivity for narrative. When we shift our memories from one perspective to another, we are, often without even realizing it, shaping and reshaping our experience into a story, rendering chaos into coherence. The narrative impulse, it seems, runs even deeper than we generally acknowledge. It is not merely a quirk of culture or a chance outgrowth of modern life. It’s a fact of psychology, hardwired into the human mind.

Jacob Stern

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August 29, 2022