Medical News

The Trump administration is by its own account devoted to stamping out obesity, cancer, and many other chronic diseases in America. But its public-health officials are also attuned to a very different sort of threat: a faulty cast of mind. “Groupthink is the fundamental problem,” said National Institutes of Health Director Jay Bhattacharya in May. The nation’s scientific institutions have become hidebound.

According to Bhattacharya, Health Secretary Robert F. Kennedy Jr., and other top figures in the “Make America Healthy Again” movement, the pandemic brought this problem to the point of crisis. A small group of elite scientists settled upon the use of masks and lockdowns to fight the coronavirus. They closed ranks around their strategies and expelled dissenters. All of this was classic groupthink, the MAHA crowd has argued: a psychological phenomenon that occurs when people’s tendency to go along with the crowd prevents them from considering other courses of action. As a result, in their view, the public-health response to the coronavirus turned into catastrophe. Kids fell behind in school. Drug-overdose numbers exploded. Poor nations starved from supply-chain disruptions.

[Read: Revenge of the COVID contrarians]

Now the government is out to quash this plague of poor decision making. In June, when Kennedy sacked all 17 members of the nation’s top vaccine-advisory panel, a Health Department spokesperson said that it was a remedy for “vaccine groupthink.” Upcoming changes to the U.S. dietary guidelines have been cast as a way of fighting groupthink too. Both Bhattacharya and the MAHA leader Calley Means have decried the groupthink infestation in our scientific institutions. And two months before his nomination to be FDA commissioner, Marty Makary published an entire book about the perils of medical groupthink. Health Department Press Secretary Emily Hilliard told me via email that Kennedy is “confronting groupthink by rebuilding a culture where scientists can question, debate, and follow evidence freely so that truth—not conformity—drives public health decisions.” The epidemic of consensus, as he sees it, must be stopped.

Yet, ironically, MAHA’s core concern—that the nation’s most seasoned public-health experts have been rendered senseless over many years by a groupthink dynamic—is itself the product of a shaky sort of group belief. The phenomenon of groupthink has been studied now for decades. More than 1,300 academic papers and dozens of books have been published on the topic. Even after all of this time and effort, the evidence is wanting. In fact, most experts now believe that the old story of groupthink being a prime cause of bad decision making is wrong. Some don’t think that the phenomenon is even real.

“A very curious thing has been taking place in this country—and almost without our knowing it,” the journalist William H. Whyte Jr. warned in a story touted on the cover of the March 1952 issue of Fortune: College kids had gotten meek and group-oriented. Corporations were hiring social scientists to cultivate conformity in their workers. Even literary heroes had been growing more submissive, Whyte claimed. Riffing on George Orwell’s 1949 dystopian nightmare Nineteen Eighty-Four, which popularized words such as doublethink, he dubbed this new American herd mentality groupthink.

The coinage went viral. As his biographer later noted, groupthink was a “broad term that could be used to cast any number of aspersions.” And in mid-century America, there were so many aspersions to be cast! “If you want creativity, abandon the groupthink and concentrate on the lonethink,” begins a news report from an advertising conference in 1959. (“Meetings are for meatheads,” one groupthink-hating executive declared.) One columnist with the New Pittsburgh Courier even slapped Whyte’s label on the United Nations, suggesting that countries, like individuals, had a primal aversion to yielding their sovereignty to the groupthink of world governance.

[Read: Pete Hegseth’s Pentagon is becoming a bubble]

Whyte’s concept started to appear in management textbooks, too, identified as a concerning philosophy in which people “begin to worship the group.” But the idea really found its place in academia when Irving Janis, a Yale psychologist, borrowed Whyte’s buzzword to label a novel bureaucratic disease that he’d identified. In a 1971 article for Psychology Today titled “Groupthink,” Janis described how the White House had been overcome by a psychological contagion in the lead-up to the Bay of Pigs invasion. Despite their brainpower, President John F. Kennedy’s famously eggheaded advisers had fallen prey to a crowd mentality that had caused them to set aside their misgivings about the attempt to overthrow Fidel Castro’s government so as to preserve, as Janis put it, the cozy and cohesive “we-feeling” of the group. Groupthink explained not just the Bay of Pigs, he claimed, but also the government’s failure to anticipate Pearl Harbor, the Korean War stalemate, and the quagmire in Vietnam.

This rebranding of groupthink, from Whyte’s pop critique of 1950s corporate life to the specific management dysfunction described by Janis, raised its stakes dramatically: Now the epicenter of the problem was in Washington, and an Ivy League scientist was saying that the contagion was to blame for many world-shaking tragedies. In his follow-up book from 1972, Victims of Groupthink, Janis insisted that he was only laying out a “hypothesis,” and he acknowledged that he had no idea what percentage of fiascos were really caused by group pressures that could impel people to set aside their misgivings. But his idea took off just the same.

In the years that followed, whenever a big-time screw-up happened, someone would swoop in and attribute it to groupthink. That included academics, who cited Janis in the context of many of the 20th century’s lousiest decisions, including: Nazi Germany’s invasion of the Soviet Union, Ford’s decision to market the Edsel, Chemie Grünenthal’s distribution of the drug thalidomide, the Carter administration’s approach to rescuing American hostages in Iran, and NASA’s launch of the Challenger space shuttle. Over the course of two generations, then, from the Boomers through Gen Xers, groupthink had come to signify a dark energy that seemed to exert its power at the worst possible times.

Sally Riggs Fuller, an organizational sociologist and a retired University of South Florida professor, remembers hearing about groupthink in a decision-making seminar taught by Ramon Aldag, her graduate-school adviser at the University of Wisconsin at Madison School of Business. He was giving the standard groupthink spiel, starting with the Bay of Pigs and explaining Janis’s model. This was part of the management-studies canon in the late 1980s. “Students loved it,” Aldag told me. But Fuller was skeptical. The groupthink story sounded wrong.

After class, Fuller said, she hustled to Aldag’s office. “I think there’s a lot of other explanations for those bad decisions,” she told him. For a decade before grad school, Fuller had worked various office jobs in the aerospace industry, and she felt that she had a good understanding of how groups made hard decisions. Usually, several factors came to the fore: internal power struggles, organizational self-interest, the legacy of past decisions. It wasn’t just some herd mentality, she insisted. Aldag suggested that she start digging through the scientific literature so that they could evaluate the published evidence.

By the time Fuller and Aldag had done enough research to give a talk at a 1990 professional meeting, the picture wasn’t pretty. The baseline problem, both Fuller and Aldag told me, was that Janis had more or less dreamed up his groupthink model based on his own intuitions and inferences: It was an armchair theory—he hadn’t measured anything. The concept was so sticky and compelling, though, that others started mining histories of notorious debacles for more examples of the same. “It’s a lot of retrospective sensemaking,” Aldag said. (Janis died in 1990, a few years before Fuller and Aldag’s critique of his idea was published in an academic journal.)

[Read: Seven tips from Susan Sontag for independent thinking]

A few experimental studies of groupthink had been attempted over the years, but these were plagued with methodological problems. Researchers would construct hypothetical decision-making scenarios for groups of college students, and then measure dozens of variables to test Janis’s model. When a handful of those findings came back as “statistically significant,” researchers concluded that their study provided “partial support” for the theory, Fuller said. “We were aghast at what these academics were doing,” she told me. Contrary to Janis’s theory, the evidence suggested that tight-knit groups—ones with that cohesive “we-feeling”—tend to make better decisions, Aldag said.

“Groupthink is a compelling myth,” Fuller and Aldag argued in their contribution to an academic journal’s special issue for the 25th anniversary of Janis’s theory. “Despite a quarter century virtually devoid of support for the phenomenon, groupthink refuses to die.” Other papers in the journal took more specific aim at the theory. One argued that what Janis took to be a herd mentality might just as well be seen as deliberate, venal compliance. In other words, the misguided bureaucrats weren’t so much “victims” of groupthink as they were savvy operators who were minding which way the political winds were blowing. Another paper, by the Stanford psychologist Roderick Kramer, drew upon newly declassified documents to reanalyze the Bay of Pigs and Vietnam cases from Janis’s book, and found that much of the new evidence did not support the original interpretation. According to Kramer, neither case showed groupthink; they both showed “politicothink.” (Needless to say, Kramer’s coinage has not caught on.)

That special issue marked a turning point for the academic bandwagon that Janis had kicked off. “It would be hard now to get a groupthink paper published in a top journal,” Aldag, who is retired but still sits on editorial boards, told me.

The implosion of Janis’s model has left groupthink in an odd place. In popular discourse, the word has taken on a life of its own, as an insult deployed without clear reference to any theory of psychology. “I don’t think people always know what it means,” Fuller said. Dominic Packer, a Lehigh University psychologist who has written about groupthink, told me that the term has become a useful pejorative. “It’s what the other people think,” he said. “You never hear people say it to their own group.”

Taking potshots at groupthink has become especially popular on the political right, where rugged individualism is beloved and elite consensus makers are not. From 2016 to 2023, Tucker Carlson often signed off from his weeknight Fox News show with a tagline declaring it “the sworn enemy of lying, pomposity, smugness, and groupthink.” Before taking roles in government, both Makary and Bhattacharya joined the chorus in their appearances on Fox News, taking whacks at the groupthink in the U.S. pandemic response.

To be sure, there is something deeply familiar about the idea that human beings will sometimes follow the crowd because they cherish their place in the group. Yet the claim that our public-health mistakes can be pinned on some special force called groupthink is both unhelpful and misguided. For one thing, the label implies that we’d all be better off if a monkish master of “lonethink” could be recruited to weigh the science on their own, and then arrive at the objective answer to a thorny problem, such as whether to shut down schools and when to reopen them. But decisions like these are usually carried out in the face of competing values, squabbling constituencies, and genuine uncertainty about the facts. Deciding what to do requires negotiation and democratic politics. It’s a group activity.

[Read: Kennedy’s hand-picked vaccine committee is a mess]

Indeed, the failure of our leaders to explain that public health is never just a matter of “following the science” may be one of the pandemic’s most enduring fiascos. Now the MAHA crusaders themselves seem ready to repeat that error in extravagant ways. “This group is going where the science takes them,” Hilliard, the HHS spokesperson, told me when I asked about Kennedy’s decision to stack the nation’s vaccine-advisory panel with a group of his like-minded associates. To insist that this was necessary to rescue the committee from “vaccine groupthink” is to get the matter backward: It labels a triumph of systematic decision making—one that has saved countless lives—as a tragedy; it courts disaster rather than forestalls it. (Hilliard did not respond to a question about the scientific controversy surrounding groupthink.)

Well-managed groups operating under clear and transparent rules—groups such as the vaccine-advisory committee and the U.S. Preventive Services Task Force (which Kennedy seems ready to also dismantle)—are some of the most powerful and trustworthy decision-making tools that we have. They are guided by published research and hard-won experience on how to avoid bad group decisions. For example, group leaders should not impose their views at the outset, and should make it clear that they value candid input from the team.

But our MAHA leaders don’t appear to be heeding this advice. “A core aspect of the Trump administration is that these leaders are not willing to admit a single mistake ever,” Packer told me. That might drive team members to hide their own mistakes, and to never criticize their bosses, even when leadership is screwing up, he said. Any group decision comes with a degree of acquiescence and a leap of faith. But the best decisions involve bringing groups together, hearing out their different views, and not denying that we have a social nature. Our nation’s thinking isn’t broken, and this administration shouldn’t try to fix it.

Updated at 3:42 p.m. ET on October 31, 2025

During America’s hardest economic times, canned goods were a lifeline. From 1929, the start of the Great Depression, to 1941, when the United States entered World War II, people ate nearly 50 percent more canned fruit, by weight, compared with the preceding 13 years. Some used new community canning centers to safely preserve food for the long term, or depended on the U.S. government’s first food-stamp programs to buy “surplus goods,” including canned beef, mutton, goat, and peas.

Millions of Americans are now waiting to find out whether they will receive their November benefits from the Supplemental Nutrition Assistance Program. SNAP was set to run out of funds on November 1—tomorrow—because of the ongoing government shutdown. As anxiety about hunger mounts, some state agencies have advised SNAP beneficiaries to stock up on canned goods such as beans, soup, fruit, and tuna. Only, those foods aren’t so reliably affordable as they once were, in part because of restrictions on the materials that go into the cans themselves.

Roughly 42 million Americans rely on SNAP for food. This week, a number of Democrat-led states sued the Trump administration for refusing to tap into a $5 billion SNAP emergency reserve. After this article was published, a federal judge in Rhode Island ruled that the administration had to continue funding SNAP through the shutdown. But the administration could appeal the decision to the Supreme Court—or simply ignore the court order, as it has several others this year. “SNAP benefit recipients wouldn’t have to worry at all if Democrats would stop using them as political ‘leverage,’” Kush Desai, a White House spokesperson, told me earlier this week; when I reached out to the White House again today to ask about the administration’s plans to respond to the federal judge’s ruling, I was directed to the Office of Management and Budget, which did not immediately respond to my questions. The USDA website also blames Democrats for the suspension in food assistance; when I emailed the USDA’s press office, an auto-reply from a spokesperson said they were furloughed and would respond when funding was restored.

Canned foods have been a lifeline in lean times because they’re long-lasting, generally nutritious, and, most of all, cheaper than their fresh counterparts—largely because the necessary materials could be imported reliably and cheaply. Canning requires a special type of metal called tin-mill steel, which the U.S. imports from Canada, Germany, the United Kingdom, and the Netherlands, Tom Madrecki, vice president of supply-chain resiliency at the Consumer Brands Association, told me. Tin-mill steel is unwieldy and fragile, he said, and less valuable than steel meant for cars and machinery. So U.S. steel manufacturers have deprioritized making it. As a result, the U.S. produces only about 20 percent of the tin-mill steel used by domestic can manufacturers, Scott Breen, the president of the Can Manufacturers Institute, a trade group, told me. “We have no choice but to import the other 80 percent,” he said.

Since Trump’s first term, those imports have been subject to a 25 percent tariff; in June, it rose to 50 percent for steel coming from most countries. Trump’s tariffs are meant to stimulate American manufacturing, but the U.S. is simply not equipped to produce enough tin-mill steel: Since 2018, the nation’s 12 plants have dwindled to three, and there’s no sign of further investment, Breen said. The administration has not yet heeded the canning industry’s calls for a tariff exemption on tin-mill steel. Trade negotiations with Canada, which involved metal tariffs, recently disintegrated. (The U.S. also imports roughly $2 billion worth of canned food a year, Breen said—about 10 percent of the national supply. According to the Can Manufacturers Institute, nearly a quarter of that food comes from China, which negotiated a 47 percent average tariff on imports that Trump announced yesterday morning.)

[Listen: SPAM: How the American dream got canned]

The price of tin-mill steel has never been higher, Madrecki said. Canned-food manufacturers have been passing the extra cost to retailers and, inevitably, consumers. From September 2024 to September 2025, the average consumer price of canned fruits and vegetables rose by 5 percent, nearly double the increase observed in food in general, according to government data. Over time, a 50 percent tariff on tin-mill steel could raise the sticker price of canned foods by as much as 15 percent, according to a June analysis by the Consumer Brands Association.

That increase is a matter of cents per can, but it does add up quickly. “It’s really hitting the lower-income customers that rely on SNAP benefits,” Usha Haley, an international-business professor at Wichita State University, told me. In an average week, a SNAP beneficiary eats seven cans of food, according to the Can Manufacturers Institute. (Those who don’t use SNAP consume about five.) With a 15 percent price increase, the same amount of money that beneficiary spends would cover only six cans. “At the end of the day, you put one fewer can in your cart,” Madrecki said.

The government itself has been affected, too. One of the biggest purchasers of canned goods is the USDA, Madrecki told me, which uses them to supply food to prisoners, for school meals, and to the Women, Infants, and Children program. By raising tariffs, “the government is increasing its own prices,” Breen said.

State governments have encouraged families to continue to gather shelf-stable foods at food banks if the SNAP benefits stop coming. But charitable food organizations are already strained: Rising food costs due to inflation have driven more people to seek donated items. The implications of taking SNAP away would be “catastrophic” for food banks, Ami McReynolds, interim chief of government relations at Feeding America, told me. Plus, some of the goods such centers stock are donated, but the rest are purchased wholesale by the organizations that run them. “The prices go up for them as well,” Breen said. (Several states have announced plans to send more money to food banks next month.)

Most families spend all of their SNAP credits within three weeks of receiving them at the beginning of each month, Joel Berg, the CEO of the nonprofit Hunger Free America, told me. Those who want to follow states’ guidance to stock up now, before a SNAP cliff, most likely don’t have anything left to budget. Families who can’t afford as much canned food as they normally buy now have limited alternatives for supplementing their diet: Delaware’s suggestions for shelf-stable foods include cereal, oatmeal, peanut butter, nuts, applesauce, pasta, and granola bars—hardly a filling or nutritious diet. A can of beans for protein, or canned pears for fiber, could turn a bowl of carbohydrates into a healthier and more satisfying, if still meager, meal.

[Read: A ‘MAHA box’ might be coming to your doorstep]

Modern-day hunger isn’t as stark as it was during the Depression: In 1933, a New Yorker died every 12 days from hunger, according to The New York Times, and many more Americans developed illnesses associated with malnutrition. Today, when budgets run low, people tend to reduce portion size, skip meals, or buy less healthy food; they generally don’t go long periods without eating, Berg told me. But if the first few days of November pass without the restoration of SNAP benefits, he said, “you’re going to start seeing, for the first time in modern American history, large amounts of Americans going without any food at all.”

For most of my adult life, I’ve felt helpless about being overweight. When I met with a doctor a few years ago to discuss my high cholesterol, he held up a hunk of faux flesh meant to model a pound of excess fat and encouraged me to lose 20 of said gelatinous blobs. Perhaps, he suggested, I should eat less red meat and start exercising. I still remember his perplexed stare after I told him I had an established gym routine and had been a vegetarian for the better part of a decade.

Starting an obesity drug was supposed to be triumphant. The days of being winded after walking up the stairs to my apartment, and buying T-shirts marketed for guys with big bellies, would finally be over. Or so I thought. My health insurance didn’t cover Wegovy or Zepbound, the two GLP-1 drugs approved for weight loss. (Both medications are also sold for diabetes, under the brand names Ozempic and Mounjaro, respectively.) Despite my pleading, the insurance company wouldn’t budge.

For all the hype over GLP-1s, Americans have struggled to access these weekly injections. Seniors can’t get these drugs because Medicare is barred by law from covering them for obesity. Drugmakers previously couldn’t make enough of the drugs to keep up with demand, prompting the FDA to formally declare a shortage. The supply issues have now abated, but getting these drugs has somehow become even harder. The problem is that insurance companies are refusing to cover them.

Consider Zepbound, the more effective GLP-1 for weight loss. More than half of all private insurance plans do not cover Zepbound at all, up from 18 percent last year. That’s according to recent data from GoodRx, a site that compares prescription-drug prices. Plans are more likely to cover Wegovy, according to GoodRx, but a dwindling share let you get the drug without first going through barriers that may end up curtailing access.

Eli Lilly, the pharmaceutical company that makes Zepbound, blames the lack of coverage on the stigma of obesity. “Despite obesity being recognized as a chronic, complex disease, insurance and federal programs still do not provide broad coverage to people who live with this disease,” the company wrote in a statement. But that isn’t the full story. Many Americans get health insurance through their job, and GLP-1s are so expensive that many companies simply can’t afford the drugs. It might feel like magic when insurance picks up the tab for your prescriptions, but part of those cost savings are actually paid by your employer. A month’s supply of a GLP-1 retails for at least $1,000. When you consider that roughly three-quarters of American adults are overweight or obese, employers could be faced with hundreds or even thousands of GLP-1 bills each month. (Americans who are overweight but not obese are eligible for GLP-1s if they have high cholesterol or certain other health conditions.) “It’s brutal, and it’s forcing employers to make tough decisions,” James Gelfand, the president of the ERISA Industry Committee, a lobbying group that advises large employers on health-insurance issues, told me.

[Read: Ozempic or bust]

For companies looking to manage the costs, “the solution to the problem is just making it more difficult to get the drugs,” Ameet Sarpatwari, a drug-pricing expert at Harvard, told me. Smaller companies are especially struggling; a survey released last week by the Kaiser Family Foundation found that just 16 percent of employers with 200 to 999 employees are covering Wegovy or Zepbound, compared with 43 percent of employers that have 5,000 or more employees. But even major corporations are making patients go through hurdles before they can access these drugs. One of the most common policies requires doctors to submit additional paperwork explaining why a patient needs these drugs before a prescription can be picked up. That might not sound all that onerous, but peer-reviewed research shows it delays patients from getting the drugs their doctors say they need. In my experience, it also requires sustained effort from the patient to corral a doctor’s office into submitting the necessary paperwork.

If employers need to put restrictions on the GLP-1s patients can access, it would seem logical that they would start with Wegovy. Notably, the drug costs about $300 more a month than Zepbound—and it also works less well. (A head-to-head trial of the two medications, funded by Eli Lilly, found that patients on Zepbound lost an average of 20 percent of their weight, versus about 14 percent for those on Wegovy.) Nevertheless, it’s much harder to get Zepbound than Wegovy. “You can’t assume that just being the best product means that you’ll be on the formulary,” Gelfand said.

Insurers are basing their coverage decisions, in part, on “rebates,” discounts that are offered by drugmakers as a negotiating chip to persuade insurers to cover one product over a competitor. For example, in July, CVS Caremark, a pharmacy-benefit manager hired by insurance companies to help determine which drugs to cover, began recommending Wegovy over Zepbound in most cases. Ed DeVaney, the president of CVS Caremark, told me that the decision was made because his company deemed the two drugs very similar in terms of efficacy, and because the deal represented “the highest value” for the health plans and employers the company works for. But the move hasn’t been popular. Doctors favor Zepbound over Wegovy, according to prescribing data analyzed by the analytics firm Truveta. Prescriptions may go unfilled once patients realize that their insurance companies won’t foot the bill. (CVS Caremark is facing a class-action lawsuit filed by customers who were prescribed Zepbound but weren’t able to get it through their insurance. )

Without insurance coverage, patients have to turn elsewhere for these drugs. Eli Lilly and Novo Nordisk sell their drugs to patients directly for a major discount, but they still are prohibitively expensive: A vial of Zepbound costs $500 a month when purchased straight from the manufacturer. Patients can opt for cheaper versions of these drugs that are made by compounding pharmacies, but they can be unreliable and unsafe. Neither of these alternatives were solutions for me, and they likely won’t be for many Americans. Although I tried a few months of compounded drugs, the risks of injecting myself with a serum that hadn’t been reviewed for safety by the FDA started to weigh on me. Ultimately, I was able to get on my fiancée’s insurance, and now I finally have access to Wegovy. (Her plan refuses to cover Zepbound.) But very few patients can turn to this sort of backup plan when their own insurance comes up short.

GLP-1s are hardly perfect. They come with sometimes severe side effects, including nausea, and the weight-loss results last only as long as people keep taking them. But the upside for people with obesity is undeniable. Eventually, millions of Americans who are waiting for these drugs should be able to get them. More competition should lead to modestly larger rebates, making it cheaper for employers to cover these drugs, Sarpatwari said. Novo Nordisk is developing a new obesity drug that clinical trials suggest rivals Zepbound in effectiveness, and Eli Lilly is testing a drug that could end up being even more effective than the current products on the market. Several companies, including Novo Nordisk and Eli Lilly, are also developing oral versions of these drugs for those who do not want to inject themselves weekly. The new drugs will almost certainly be more expensive than those already on the market, but they should make it slightly easier for patients to access older GLP-1 drugs.

That future remains far away. The start of the GLP-1 era focused on the exciting transformations patients have made on these drugs. If something doesn’t change, the next few years are going to focus on all the people who could benefit from GLP-1s but are unable to access them.

Immediately after Hamas and Israel agreed to the first phase of President Donald Trump’s peace plan, food and medical supplies were supposed to start flooding into the Gaza Strip. Like other key aspects of the agreement, that influx did not go exactly as planned. Some food, fuel, medical supplies, and other resources are moving, but the flow of aid remains clogged.

The success of the Gaza cease-fire—which Trump has called perhaps “the greatest deal” of any he’s made—depends on the United States’ continued involvement. Top U.S. officials, including Vice President J. D. Vance and Secretary of State Marco Rubio, have flown to Israel, trying to shore up the cease-fire. (Israeli media, The Wall Street Journal reports, have taken to calling the visits “Bibisitting.”) On the immediate agenda is “giving people some food and medicine,” Vance said during a press conference last week.

Faced with humanitarian crises in the past, the White House could lean on USAID’s experience with global aid and its expertise in postwar recovery. But since DOGE was unleashed on the U.S. government, that agency essentially no longer exists. Work on aid in Gaza was not exempt, former and current aid workers told me: The Trump administration fired people actively working on this conflict, and the State Department now must figure out, largely on the fly, how to help aid reach Gaza.

As much as the Trump administration has undermined American aid around the world, its interest in peace between Israel and Palestine shows that the U.S. still intends to be very involved in humanitarian work in some places. Gaza is both the most high-profile test yet of Trump’s decision to slash the United States’ humanitarian capacity and the best available example of what relief work his administration is capable of when it is extremely invested.

In the first 12 days of the cease-fire, the UN’s World Food Programme brought in an average of just over 700 tons of food a day, a WFP spokesperson, Martin Penner, told me. The UN says cooking gas has also entered the Gaza Strip for the first time since March. Excluding weekends, when crossings into Gaza may be closed, enough aid trucks have entered on average to meet the minimum laid out in the cease-fire deal, according to a source with direct knowledge of State Department activities. But the World Food Programme says it would need to bring in twice as much food to reverse pockets of famine. The program’s meal distribution in northern Gaza, the epicenter of the Strip’s starvation, began only about two weeks into the cease-fire, Penner said. Twice during the cease-fire, the Israeli government has said it would restrict the flow of aid into Gaza: once in response to the slow release of deceased hostages, and then after a spate of violence. The source with direct knowledge of the State Department told me that humanitarian aid is now “widely accepted” to be a phase-two priority—still a goal, but one that follows the completed exchange of both Israelis’ and Palestinians’ remains.

At least some State Department officials key to pursuing that goal were not at work early during the cease-fire. Instead, they were furloughed by the government shutdown, according to one current and one former federal employee. (They, like other current and former aid workers I spoke with for this story, requested anonymity for fear of retribution.) During the first week of the cease-fire, the Trump administration pulled those officials back into the office, the current and former federal employees told me. The furloughed staff were able to get up to speed quickly, according to the current employee and the source with direct knowledge of events in the department.

But those workers represent just a fraction of the effort that the U.S. once put toward ensuring aid was entering Gaza. Before Trump took office, for example, a team of about 30 USAID experts in D.C. and the Middle East had been working full-time on providing humanitarian relief in the Strip, Andy Hall, a former USAID officer who worked on the Gaza response, told me. American involvement was key to aid getting in at all: As NPR has reported, almost nothing entered unless top officials called Israeli Prime Minister Benjamin Netanyahu, his adviser Ron Dermer, or his defense minister. At least one USAID official met daily with COGAT, the Israeli military agency that has controlled what aid enters Gaza, Paul Martin, a former USAID inspector general, told me.

UN agencies and other NGOs also participated in those meetings. But because the U.S. has a better working relationship with the Israeli agency than the UN does, the Americans made a difference in securing humanitarian access to Gaza, according to three sources with direct knowledge of the meetings. Eri Kaneko, a spokesperson for the UN’s Office for the Coordination of Humanitarian Affairs, told me that “it’s no secret that the UN and our partners have not always seen eye to eye” with COGAT, and that the UN would “welcome the support from the U.S. and other member states to ensure we’re able to deliver lifesaving aid swiftly.” Samantha Power, the top USAID official under Biden, said in a January interview with Politico Magazine that UN officials relied on USAID to lobby Israel to renew the visas of its staff so that they could continue working in Gaza.

Then the Trump administration fired every humanitarian expert employed by USAID, and many of those employed by the State Department. The USAID staffer detailed to Israel’s aid-coordination board was fired by early February, Martin told me. This doesn’t mean that the U.S. has abandoned the project permanently: In response to a request for comment, the White House directed me to the State Department, which told me in an email that officials have met with the Israeli military unit coordinating aid and directed me to its October 16 X post announcing that a disaster-response team, working without pay during the shutdown, was helping “surge and coordinate aid into Gaza.” (The person who responded did not provide their name. They did not say whether any American representatives kept attending the daily board meetings after USAID collapsed.)

Still, the federal government’s push to cancel foreign aid meant that it entered the cease-fire deal with a smaller team just assembled. In July, when the United Nations put out its own plan for surging food and medicine into Gaza in the event of a cease-fire, the State Department was still hiring the people currently coordinating its Gaza relief work, the current federal employee and one of their colleagues told me. “The lack of engagement by the U.S. on the response in the interim has undoubtedly affected the level of preparedness for ‘day 1’ of a peace deal,” the current federal employee told me.

The Trump administration’s approach to aid in Gaza has also weakened the UN’s work there. Without USAID to intervene, Israel has, as my colleague Franklin Foer wrote in August, pursued “a string of policies that seem intended to permanently push the UN out of Gaza.” Israel refused to renew the visas of top officials at at least three UN agencies operating in Gaza and de-registered major aid groups that had been working in Gaza for decades.

Beginning in May, after Israel halted all aid to Gaza for 11 weeks, the Gaza Humanitarian Foundation, a months-old nonprofit, became the primary food supplier in Gaza. The U.S. was directly involved in this venture: It was designed by American management consultants (along with Israeli officials and businessmen), staffed by American security contractors, and funded in part with American taxpayer dollars. Whereas the UN system once ran about 400 aid sites, GHF never ran more than four. According to food-security experts, extreme malnutrition in Gaza, already high, skyrocketed after GHF took over; according to Netanyahu, the foundation failed to prevent looting by Hamas. (In an email, a GHF spokesperson wrote that the non-profit was “the only organization that delivered aid directly to the Palestinian people including women, children and elderly.” He also noted that GHF was now down to three distribution sites, all “temporarily paused during the ongoing hostage exchange.”)

Now, though, the Trump administration is counting on the United Nations to help fulfill the cease-fire’s goals. Last month, in front of the UN’s General Assembly, the president essentially called it a coalition of paper pushers. But his cease-fire plan explicitly calls for the UN to distribute aid, alongside the Red Crescent and “other international institutions.” He’s also dispatched American troops to Israel to help ensure aid groups are allowed to do their work; American diplomats are set to join them.

Exactly how all of these pieces will fit together is unclear. Usually, civilian groups lead relief efforts and coordinate with the military for protection. In this case, roughly 200 U.S. soldiers are setting up a civil-military coordination center, which has also been given the job of facilitating the flow of humanitarian aid into Gaza. The person with inside knowledge of the State Department said that the UN will play a role in the civil-military collaboration, but American officials are still determining its precise shape. At last week’s press conference, Trump’s son-in-law Jared Kushner (a senior adviser in the first Trump administration, whom the president has said he “called in” to work on the cease-fire) said that coordination between the United Nations and Israel has so far been “surprisingly strong.”

Trump’s cease-fire has undeniably improved conditions in Gaza. But humanitarians’ job there is particularly difficult. Many of the people whom the UN is rushing to serve are starving, enough to require urgent medical treatment in addition to food. When starving people can’t trust that relief will come, they take what they can find, Tess Ingram, a UNICEF spokesperson who was in Gaza City when we spoke earlier this month, told me. Early in the cease-fire, as a convoy of trucks carrying food rolled into southern Gaza, Palestinians stripped them bare in 20 minutes mid-route, The New York Times reported: “Young men fared best. Children had to look for what openings they could.” How much better their situation gets will depend in part on how well the new American approach to aid works.

Eight Sleep—often called Silicon Valley’s favorite bed—is like a full-body Fitbit. It is a $3,050 mattress cover filled with sensors to monitor heart rate and body temperature. For people who pay $199 to $399 for an annual subscription, the cover will automatically heat and cool itself throughout the night to keep the owner at a sleep-optimal temperature. The add-on base (about $2,000) raises the angle of the bed to make reading more comfortable or to help stop snoring. Eight Sleep gently vibrates its users awake; it lulls them to sleep with “deep rest” meditations narrated by the wellness-science podcaster Andrew Huberman. To buy the Eight Sleep is to buy fully, with your whole body, into the idea that the future of sleep is technological.

On Monday, the future glitched. Eight Sleep’s features run on the AWS Cloud, so when one of Amazon Web Services’ data centers went offline at about 3 a.m. ET, the sleep system went haywire. Eight Sleep generally warms when the user is drifting off, then gets cooler as they enter deeper sleep. Santiago Lisa, a software engineer in Pittsburgh, told me he woke up because his bed was stuck in deep-sleep frigidity. He tried to warm it up using the Eight Sleep app, but no dice—the app was down. Then he tried the system’s manual buttons. No dice there, either—they also require the Cloud to function. Jordan Arnold, who works in the video-game industry in Washington State, told me that his girlfriend couldn’t sleep because her side of the bed was stuck at its highest temperature, 110 degrees Fahrenheit. She slept on the couch. Other poor souls, who had put their bed in a sitting position to read and were now stuck there, spent the night in the world’s most high-tech Barcalounger. A Jetsons vision of the 21st century did not include Mrs. Jetson stuck in an upright and locked position because her bed could not connect to a data center in Northern Virginia.

The disruption was short-lived: Eight Sleep’s products were up and running once AWS was. (The company is working to diversify its cloud setup, a spokesperson told me, and on Wednesday, it launched a backup mode that uses Bluetooth.) But that this fiasco happened at all is a sign of how much Americans’ desire to optimize their rest has grown—along with the market to sate that desire. We are being offered more and more ways to become, essentially, sleep cyborgs who depend on technology to enhance what should be a basic aspect of being alive. Those interested in “sleepmaxxing,” along with people who want to sleep better but don’t have a Silicon Valley–style term for it, have made sleep tech a $29.3 billion industry, by one measure. The value of the industry is expected to more than quadruple, to $135 billion, by 2034.

Shalini Paruthi, a physician who’s on the American Academy of Sleep Medicine committee for emerging technology, told me that she mostly sees her patients using sleep tech through meditation and bedtime-story platforms. Those with the Calm app can fall asleep to Harry Styles narrating a story called “Dream With Me,” Matthew McConaughey pontificating on “the mysteries of the universe,” or Travis Kelce’s mom talking about football. Devices have permeated all aspects of sleep, Paruthi said. Wearables such as the Oura Ring and Apple Watch track the wearer’s vitals. Red-light lamps aim to help people feel sleepier, noise machines play soundscapes as they drift off, and alarm clocks mimic sunlight to wake them up. I thought I was a little high-maintenance for using a fabric eye mask, but for north of $100, I could acquire a “smart” one that not only blocks light but also vibrates in sync with my heartbeat. For help falling asleep faster, people can buy a $350 “neurotech headband.” And those who aren’t ready to spend $3,000 on a sensor-filled mattress cover could instead opt for a $1,400 “dual zone climate control bed-making system”—a duvet connected to air hoses that pair with Alexa voice command. Notably, the Eight Sleep has aggregated much of the most popular consumer sleep equipment available into a single piece of technology.

Whether or not  these gadgets actually help with sleep is an open question. Sleep-tracking devices do a “pretty good job of figuring out when a person fell asleep and when they woke up, based on their movement and heart rates,” Shalini said. (So does looking at your clock.) But they don’t “always do the best job in between.” Patients will come to her because their wearable says they got no REM sleep, which, she said, “quite frankly, would be impossible.” At the very least, these devices can encourage better sleep hygiene: One too many bad “sleep scores,” and a person might just start going to bed earlier and leaving their phone in another room.

For those with actual sleep disorders, cyborg sleep can be a very good thing. People who have extreme nightmares from PTSD can use NightWare, a prescription-only system that comes with a preprogrammed Apple Watch and detects if the wearer is having a nightmare. It will vibrate enough to stop the bad dream but not enough to wake the user. And for those with restless legs syndrome, there is Nidra, a cuff worn around the calves that helps alleviate RLS symptoms. Even Eight Sleep can be FSA/HSA-eligible with a doctor’s note explaining why it might help a preexisting health condition.

But in general, the more technology in a sleep routine, the more possible points of failure. Our bed might not connect to the cloud and remain stuck at an incline. We might open our phone to summon the soothing voice of Matthew McConaughey and instead be spirited away by Instagram. Technology, one of the main reasons we can’t sleep, has entered the last part of our life that is usually free from it. Before Eight Sleep announced its new offline mode, some Reddit users discussed “jailbreaking” their bed so that it could function without the AWS Cloud. A simpler hack might be to let our bodies do what they’re already primed to do. Even when his Eight Sleep malfunctioned on Monday and remained at frigid temperatures, Lisa told me, “I ended up sleeping. It was just cold.”

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On a road in Aurora, Colorado, lined with used-car dealers and pawnshops sits a tan, low-rise building called Mango House. Inside, among international-food stalls and ethnic-clothing shops, is a family-medicine clinic that serves a largely refugee and immigrant community. Improbably, the clinic makes enough money to sustain itself and pay staff well without relying on grants or donations. And it does so through Medicaid.

The prevailing wisdom is that Medicaid is a losing proposition for health facilities, an insurance program so stingy that many can’t afford to take it. Some of those that do essentially segregate Medicaid patients into separate clinics. Here, Medicaid is preferred. 

Because the clinic relies so heavily on that program, I expected that the Trump administration’s upcoming Medicaid cuts might force Mango House to close or pare back. Instead, when I spoke recently with the clinic’s founder and owner, P. J. Parmar, they were far from his mind. Medicaid’s practices—and patients’ coverage—already fluctuate enough that he and his staff are used to weathering such unpredictable forces. Even if 15 percent of his patients fell off Medicaid because of the cuts, his practice would be fine, he said, showing me his calculations.

Parmar is a family physician who opened the practice—officially named Ardas Family Medicine, but now better known by its location inside Mango House—in 2012. He wanted to reengineer how a clinic could run, designing systems that maximized efficiency and ease of access. For starters, Parmar eliminated scheduled appointments, which he called “an exercise in craziness.” In theory, appointments ensure that people don’t have to wait long to see their doctor, but Parmar found scheduling to be so inherently erratic—some patients need only a few minutes, others half an hour; many don’t show up at all—that he could see more patients, while keeping wait times short, by simply having them walk in. On the Wednesday I was there, the practice hummed along. Medical assistants from Nepal, Myanmar, Somalia, and Afghanistan greeted patients; the average wait time hovered around 10 minutes. Even during the Monday-afternoon rush, Parmar said, waits rarely exceed 30 minutes.

Most days of the year (and it’s open all but five), the clinic is staffed with three clinicians—a mix of doctors and nurse practitioners—who together see about 100 patients. Each provider has a dedicated exam room arranged how they like, so they don’t waste time hunting for supplies or shuttling between spaces. They escort patients from the waiting room and perform vital signs themselves: The clinic doesn’t employ nurses. (Lower-cost medical assistants handle routine tasks such as giving shots and drawing blood.) The providers see patients in order of arrival. Of course, some patients still have favorites, so staff will mark any preferences when they check in. 

In American medicine, short appointment times are often a cause for complaint. But from what I observed at the Mango House clinic, the ease of access, rather than undue pressure on clinicians, seemed to keep many visits brief. An older woman Parmar has long cared for came in with a cough, and even as he was writing her a prescription, she asked, “Can I go now?” She told him that if she didn’t feel better in a week, she’d just walk into the clinic again. Parmar also deliberately streamlines clinic notes by encouraging his providers to avoid the common habit of copying and pasting blocks of obsolete or redundant information in favor of quick updates that can be scanned easily at subsequent visits. When I described this practice to Asaf Bitton, a Harvard professor and a primary-care researcher, he told me it likely helps clinicians see more patients without feeling overextended.

Small efficiencies add up, for both staff and patients. The morning I was there, a Nepalese man, Gam Sunuwar, chose to fill his prescription for blood-pressure medication at the clinic’s in-house pharmacy, even though he’d need to cut the pills in half. (Better to walk out with what he needed than wait hours at his neighborhood pharmacy for pills in the specific dose.) The pharmacy sometimes operates at a loss, but it helps keep patients loyal to the clinic. Clinicians also hand out dozens of over-the-counter medications and reading glasses for free. Patients sometimes ask the clinic to complete immigration paperwork; Parmar keeps the service cheap (and less tedious for clinic workers) with a computer formula he wrote that pulls vaccine data from the state website into federal immigration forms with one click.

The clinic accepts anyone, but about 70 percent of its patients are on Medicaid. Almost all of the rest are seen for free. Parmar’s two billers are very adept with Medicaid—the only insurer they have to master, unlike others juggling different health plans’ whims. (Parmar himself rattles off Medicaid billing codes like it’s second nature.) Here, private insurance is not desirable, because it can be difficult to get companies to pay up. During my visit, when one patient, a 9-year-old, was registered with a commercial insurance, Parmar pored over its payment sheet without making much sense of it. “In the amount of time we’ve looked at this, we could’ve seen the girl already,” he said. The clinic would bill her insurance, but if the insurer demanded more paperwork, which it likely would, the claim would be abandoned.

The clinic’s ethos—just take care of patients—is both an ethical imperative and a practical tactic to keep the clinic running at full speed. Medicaid patients often cycle off coverage because they forget to renew, or their paperwork never reaches them; Parmar called this “the churn of Medicaid.” Many patients have “no idea” what their insurance is, a status so common that staff use the term in the clinic’s tracking spreadsheet. The staff will try to figure it out, but at some point, it’s not worth haggling over insurance and demanding documents from patients. Pressing for payment could humiliate people, who often arrive with their extended families, Parmar explained, and in a community this close-knit, that could mean losing dozens of patients, including many of the Medicaid patients who keep the clinic afloat. 

And for a practice that relies on Medicaid, survival is ultimately a “volume game,” Parmar said. That phrase would usually sound ominous in health care: Seeing more patients often means rushed visits and burned-out staff. But the clinic does well on the state’s performance indicators and, from what I observed, is set up so that patients who need extra time get it. Tigist Desta, one of the nurse practitioners, spent the better part of an hour trying to figure out the vaccination status of a child who had just arrived from Ethiopia, for instance. 

The clinic had a few lean years in which Parmar lost money—particularly when he bought the old JCPenney building where Mango House is now located—but he has more than made it back. The practice’s profits are considerably higher than the average family physician’s: Parmar told me he puts much of the money back into Mango House. (He opened his QuickBooks for me, but asked that I not publicly share the numbers.) This year, he significantly raised staff salaries; several years ago, he added a dental practice, though it has yet to break even.

When I first heard about Mango House, I was curious whether its model could be duplicated elsewhere. For one, it seemed to offer a glimpse of the kind of health care Americans might experience if the country ever moved toward a single-payer system. I also found its operations appealing, particularly that it seemed to focus on what mattered to patients and doctors rather than to administrators. The simple fact that it’s an independent clinic may be an asset: Some studies have found that physician-owned clinics achieve greater cardiovascular outcomes while also being associated with lower burnout for staff. “More and more primary-care docs work for these big health systems, and they’re not independent business owners,” who are better at seeing more patients and recouping their work on the billing side, Ateev Mehrotra, the chair of health policy at Brown, told me. Parmar can adjust on the fly—he added an extra provider on those busy Monday afternoons, starting the week after I visited—because, as he put it, “there’s no committee looking over me.”

But independence can also seem like idiosyncrasy, or merely choosing different corners to cut. At Mango House, patients don’t change into gowns, except for intimate exams, and a patchwork of multilingual staff, family members, and neighbors handles interpretation—an approach that experts oppose because these unofficial translators might not explain medical terms properly or could compromise patient privacy. (Parmar countered that he retired his remote-interpreting service after finding that patients preferred their family and community members—who also often know details they themselves neglect to mention.)

As Katherine Baicker, the provost and a health economist at the University of Chicago, told me, “Often things that work in one setting may not work in another.” In at least 16 other states, Medicaid pays as well or better than it does in Colorado, which could make replication feasible if clinics could get the same volume. But not every state allows medical assistants to give injections, erasing that cost savings. Other patient populations may be more litigious than those served by the clinic, which could pressure providers to order extra tests and unnecessary referrals. 

Neither Baicker nor Bitton, the Harvard professor, has studied Mango House, but both see the clinic’s strength as tailoring care to the local community. Bitton thought it probably shared features with the few “bright spots” he has studied—places defined by a “sort of radical simplicity,” he said, where clinicians essentially work within a single-payer system to serve a defined community of patients. Yet that may be exactly what makes Mango House tough to replicate. Parmar himself acknowledged that the clinic’s casual, community-like style might not jibe with every population. He doesn’t bother with satisfaction surveys, anyway; for him, the true measure is how many patients return. For now, it’s more than enough.

To eat 10,000 calories a day, you might try putting away a family-size box of Oreos, a box of packaged cakes, a pint of Ben & Jerry’s, takeout from Five Guys and McDonald’s, and many, many Reese’s cups—all between your regular three meals.

Dru Borden subsisted on this diet throughout his 20s and 30s. As a competitive bodybuilder—fans know him as Big Dru—he needed the calories. Since the mid–20th century, one of the core tenets of bodybuilding has stipulated that gaining muscle requires putting on weight, regardless of how. In Big Dru’s case, it worked: In early-career photos, he appears to have been cobbled together from boulders.

Body-composition researchers have established that a surplus of calories, plus resistance training, is required to gain muscle. The basic idea is that repetitive exercise causes muscles to break down, so the body needs energy and additional nutrients to build them back bigger and stronger. But spending months “dirty” bulking, as the ice-cream-and-burgers method is sometimes called, can also generate huge amounts of fat. Bodybuilders traditionally starved that fat off in the subsequent cutting phase, a period of caloric restriction that can last just as long as the bulk.

But these days, Big Dru and his fellow muscle-maxxing enthusiasts are embracing a new approach: moderation. At a time when celebrities, wellness influencers, and the nation’s top health officials are proclaiming the evils of processed foods, many bodybuilders—professionals like Big Dru, but also young, shirtless amateurs documenting their gains online—are leaving the old way of bulking behind.

On gym-bro social media, the hashtag #leanbulk is ubiquitous. (So is #cleanbulk, used interchangeably.) The term broadly refers to working out while consuming only slightly more calories than the body needs to maintain itself, and getting those calories from healthy sources. A typical lean-bulking TikTok features a young man showing off a comically ripped six-pack and C-cup pecs while meticulously documenting the food that fueled them: cottage cheese and eggs, sweet potatoes and tuna, berries and almonds, but never Twinkies.

[Read: Brace yourself for watery mayo and spiky ice cream]

“The paradigm has definitely shifted,” Guillermo Escalante, a kinesiology professor at California State University at San Bernardino and a competitive bodybuilder, told me. The concept of clean bulking emerged in the past decade or so, but it took off only recently, he said. The trend partly reflects the bodybuilding community catching up to the science. A 2020 review found that, for all but the most elite athletes, the body needs roughly 10 percent more calories to gain muscle than it does to maintain itself—certainly not anywhere near 10,000 calories. Beyond that point, research suggests, any extra calories are stored as fat. That not only obscures your gains but can hinder their growth: Working off fat sacrifices some lean muscle, Escalante said. Muscle growth can also be inhibited by the downstream effects of excess fat, such as insulin resistance and the release of inflammatory molecules, Brad Schoenfeld, an exercise-science professor at Lehman College, told me.

Lean bulking tends to produce big muscles more slowly, but it’s more sustainable over time. The effect of too much salty, fatty, and sugary food is the same for bodybuilders as it is for the less ripped: It disrupts the microbiome and immune system and increases blood sugar, triglycerides, and LDL cholesterol. “That’s really going to wreak havoc on your cardiovascular system long-term,” Escalante said. Around 2021, Big Dru switched to clean bulking because his previous diet gave him digestive issues, headaches, hormonal imbalances, and heartburn. (Now in his early 40s, he still looks like he’s been hewn from a monolith.)

But the rise of lean bulking seems to be primarily a product of broader shifts in American culture, not health data. For competitive bodybuilders, all that matters is how you appear on the day of an event. These days, people want to look like a bodybuilder 365 days a year, Escalante said. That makes dirty bulking—and its attendant buildup of fat—a less attractive option. In recent years, America has more aggressively embraced a chiseled aesthetic and made heroes of the supremely jacked. They fill social-media feeds: punching each other in Ultimate Fighting Championship matches, hosting popular podcasts, hanging on Taylor Swift’s arm, leading the Department of Health and Human Services. More than 90 percent of boys see online messages about body image, and 75 percent see videos specifically about muscles, according to a new report from the nonprofit Common Sense Media. Meanwhile, Robert F. Kennedy Jr.’s “Make America Healthy Again” movement has stoked Americans’ hunger for “natural,” “clean,” and minimally processed foods—all compatible with a clean bulk, but not a dirty one.

[Read: The body-positivity movement is over]

Clean bulking may be a healthier option than slamming fast food, but that doesn’t mean it’s good for you. If social media is any indication, lean bulking still commonly involves extreme dieting, which can lead to nutrition deficiencies, hormonal changes, eating disorders, and loss of muscle and bone density. “For any kind of adolescent, growing human body, I don’t like it,” Nicole Lund, a nutritionist at NYU Langone Health’s Sports Performance Center, told me. Among the athletes she treats, Lund has seen calorie deficits precede fractures and disturbances in mood, hormones, and growth. Eating disorders, which Escalante said are already a major concern in the bodybuilding community, seem to be rising faster among men and boys than women and girls. A study published this year found that muscle dysmorphia, a pathological obsession with obtaining a jacked physique that is sometimes called “bigorexia,” is more common among young men than previously thought. In a 2021 study of more than 4,000 American teenage boys, 11 percent had used muscle-building supplements, including anabolic steroids, to bulk up.

The collision of wellness culture with the age-old pursuit of a Greek-god bod makes it tempting to believe that swoleness is akin to health. Sometimes that’s true. But for all that lean bulkers profess online that their physical changes serve their health, many of them are primarily motivated by aesthetics. Bill Campbell, an exercise-science professor and the director of the Performance & Physique Enhancement Laboratory at the University of South Florida, told me that most of the questions he gets about clean bulking come from young men, and they’re asking “for cosmetic, physique reasons,” such as wanting to fill out a tight shirt. The world of amateur bulkers seems to be mirroring that of competitive bodybuilders: In the end, the muscles are for show.

As Andrea Baccarelli, the dean of Harvard’s School of Public Health, prepared to open a virtual town hall earlier this month, members of the university’s graduate-student union gathered for a watch party with “Baccarelli Bingo” cards. The game boards were filled with phrases the dean was expected to use: “these are difficult times”; “i know it’s not a satisfying answer but we don’t know”; “… which is why we must be innovative!” At the center of the grid was a free space, bedazzled with emojis, that read, “no meaningful commitments made.”

Baccarelli’s stated goal was to provide an update on the school’s financial crisis. Of Harvard’s schools, HSPH has been by far the most reliant on government grants—and so was the hardest hit by the Trump administration’s cuts to federal research funding. In the spring, essentially overnight, the school lost about $200 million in support. Although a federal judge has ruled that those grant terminations were illegal, the school’s future relationship with the federal government remains uncertain. Long-term survival for HSPH would require dramatic change, Baccarelli said at the town hall: It needed to become less dependent on federal funds. In the process, it would have to cut $30 million in operations costs by mid-2027 and potentially slash up to half of its scientific research. HSPH is one of the most consequential public-health institutions in America: The school once contributed to the eradication of smallpox and the development of the polio vaccine, led breakthroughs linking air pollution to lung and heart disease, and helped demonstrate the harms of trans fats. If the Trump administration’s aim has been to upend American science, HSPH is a prime example of what that looks like.

But the school’s dean, too, has become something of an emblem—of how unprepared many scientists are to face this new political reality. At the town hall, Baccarelli had to address his controversial work linking acetaminophen—Tylenol—to autism and answer for how he’d communicated with the Trump administration about it. (Another Baccarelli Bingo square: “acetaminophen mentioned.”) At a press conference in late September, Donald Trump and several of his top officials announced that they would update Tylenol’s labeling to discourage its use during pregnancy, leaning heavily on Baccarelli’s research on the subject and on expert witness testimony he’d given. “To quote the dean of the Harvard School of Public Health,” FDA Commissioner Marty Makary said, “‘There is a causal relationship between prenatal acetaminophen use and neurodevelopmental disorders of ADHD and autism spectrum disorder.’”

Plenty of the school’s faculty were taken aback to hear Trump officials warmly referencing their dean, especially given that Tylenol’s connection to autism—a complex condition with many contributing factors—is shaky at best. Karen Emmons, an interim co-chair of HSPH’s department of social and behavioral sciences, told me she almost crashed her car when she heard Makary quoting Baccarelli on the radio. Many were also surprised to learn, from press reports, that Baccarelli had fielded calls about his research from Health and Human Services Secretary Robert F. Kennedy Jr. and National Institutes of Health Director Jay Bhattacharya earlier in September.

The dean’s interactions with the administration quickly became a new vulnerability for the school. As other experts criticized the methodology of Baccarelli’s work on Tylenol and called his claims about causality unfounded, Baccarelli began to look like a biased researcher, allied with the same political leaders “who are starving us of our funding and basically killing the school,” Erica Kenney, a nutrition researcher at the school, told me. In the view of many faculty members, Baccarelli had undermined the public position Harvard spent months cultivating—as a beacon of academic integrity, unwilling to bend to the administration’s political pressure. (Baccarelli declined interview requests for this story and answered a series of in-depth questions with a brief statement saying that he looked forward to “continuing the work of building a sustainable future” for the public-health school.)

At the town hall, Baccarelli seemed to recognize these consequences. “I’m really sorry about the impact this has had on our school,” he said. But he was also defensive, describing himself as a researcher who wanted to explain the value of his work and help set evidence-based policy. He had spoken with the administration as a scientist, not as a Harvard dean, he said, and hadn’t anticipated that Trump officials would focus so pointedly on his affiliation with the school. His instinct, in other words, was to treat science as severed from politics. He seemed unaware of how unrealistic that split now is for American scientists.

Some nine months into the Trump administration’s assault on academic science, Harvard’s public-health school has just about everything going against it that an American academic institution can. It is part of Harvard, which the administration has accused of failing to protect students from anti-Semitism. It has excelled in several fields that the administration has declared unworthy of federal funds: infectious disease, health equity, climate change, global health. About half of the school’s faculty contributes in some way to international research, which the administration has also taken a stand against. Many HSPH researchers are themselves from other countries—including roughly 40 percent of the school’s students—and their ability to stay here is uncertain under the Trump administration’s immigration policies.

Historically, nearly half of HSPH’s revenue and 70 percent of its research funding have come from federal grants. And unlike academics supported largely by tuition or endowments, HSPH researchers typically have had to bring in nearly all of their own research funds, including to cover their own salaries and those of staff and trainees. “Faculty members essentially function as a small business,” Jorge Chavarro, HSPH’s dean for academic affairs, told me. When researchers’ federal income dried up, they had to shrink those businesses. David Christiani, a cancer researcher, laid off four staff members; to pay the rest of his people, he told me, he’s blown through nearly half of the roughly $900,000 in discretionary funds that he’s accumulated since the 1990s. Roger Shapiro, an infectious-disease researcher, fired half of a research team in Botswana that has been studying the use of HIV antiretroviral drugs during pregnancy. Erica Kenney’s team will likely shrink from about a dozen people to three. And the school’s incoming cohort of Ph.D. students this year was half its usual size. (In 2018, I earned a Ph.D. in microbiology from Harvard’s Graduate School of Arts and Sciences. My thesis adviser, Eric Rubin, holds an appointment at the public-health school.)

When the funding crisis hit, Harvard distributed emergency funding across its schools. But what reached HSPH faculty offered little relief—in Christiani’s case, it was “too small to have kept anything going other than literally the freezers and some data management,” he told me. (The office of the Harvard University president did not respond to a request for comment.) The public-health school has put limits on the amount of discretionary funds that faculty can spend to keep their research going, to ensure the longevity of those resources during the crisis. “This is supposed to be the most flexible amount of money you have, so people try to save it for as long as possible,” one faculty member, who requested anonymity because they are not a U.S. citizen, told me. To plug the gaps, faculty have been frantically applying for nonfederal sources of money. But whereas grants from the NIH could total millions of dollars, many foundation grants come in the tens of thousands, not even enough to sustain a single postdoctoral fellow for a year.

As their professional world fell apart, many staff, students, and faculty waited for Baccarelli to articulate a clear path forward. He left the task of divvying up emergency funds to HSPH’s nine department chairs, and many researchers grew frustrated as different parts of the school scrambled to make ends meet in different ways. In one department, at least one faculty member has used personal funds to cover trainees’ travel expenses; the biostatistics department has pushed at least 10 Ph.D. students to do data-analysis externships in exchange for coverage of stipends. Across the school, three senior lecturers and three tenure-track junior faculty members have been notified that they will likely be terminated in 12 months, unless they secure alternative funding.

Some faculty members took those notices as a clear indication of HSPH’s more cutthroat future. One, who requested anonymity to speak about the school’s strategies, felt relatively secure because the school would “forfeit about $900,000 of overhead if they got rid of me,” they said. “When you become a financial liability, they cut you loose.” (Stephanie Simon, the school’s dean for communications and strategic initiatives, told me that prospects for future federal funding don’t motivate potential terminations, but also that grant reinstatements could prompt the school to rescind the notices for the tenure-track faculty.)

Baccarelli has repeatedly declined to say how many people the school has laid off this year, a common point of frustration among the HSPH scientists I spoke with. “So many of us have left, and you can’t tell us the impact?” said Matthew Lee, a former HSPH postdoctoral fellow who lost his position this summer because of the funding crisis. At the town hall, Baccarelli said that the university had asked him not to share those details. But he did share that HSPH had already cut $16 million from its operations budget, $7 million of which accounted for losses in personnel.

This was the path forward. In the brief statement he sent in response to my questions,  Baccarelli said that he had “developed and communicated a strong vision for the future of the school.” The statement linked to a strategic vision on the HSPH website, which acknowledged that the school “cannot maintain the status quo” but asserted that it would emerge as “a focused, resilient, and unambiguously world-class school of public health.” Left unsaid was that it would almost certainly be a smaller, less enterprising one.

In many ways, Baccarelli, who assumed the deanship at the start of 2024, has limited power: He can’t force the Trump administration to relinquish funds, or raid the pool of money that Harvard University holds centrally. Still, for months, many trainees and faculty have been calling for their dean to “stand up more forcefully” to the administration’s siege on science and defend his school’s most vulnerable researchers, Sudipta Saha, a Ph.D. student at HSPH and the vice president of Harvard’s graduate-student union, told me. Before the town hall, the school’s faculty council conducted a poll—unlike anything they’d seen before, several faculty told me—about the dean’s ability to do his job and the impact that the Tylenol debacle will have on the school. (The results have not been made public, but at the town hall, Baccarelli described the feedback as “very direct.”) Several of the faculty I spoke with defended the dean. “He did nothing wrong,” David Christiani told me; Karen Emmons and Erica Kenney emphasized that they were sympathetic to his plight. But most HSPH researchers I spoke with said they were deeply frustrated with him.

To his critics, Baccarelli’s recent actions have revealed how willing he is to play fast and loose with scientific certainty, at a time when much of the scientific establishment has denounced the Trump administration for doing exactly that. Baccarelli’s research focuses on topics such as air pollution and aging, but for years he has had a side interest in Tylenol use during pregnancy. In 2023, he gave expert-witness testimony on behalf of plaintiffs suing the maker of Tylenol, for which he was paid about $150,000 and spent some 200 hours preparing. In that testimony, Baccarelli asserted that taking the drug during pregnancy was not just linked to neurodevelopmental conditions such as autism but probably caused them. Neither his own research nor others’ has demonstrated such a strong conclusion, and the presiding judge picked up on that. Although Bacarelli was “the plaintiffs’ lead expert on causation,” she noted, he had co-authored a study in 2022 arguing that more research was needed before changing recommendations for using Tylenol during pregnancy. She ultimately excluded his testimony.

Baccarelli later seemed concerned about how he’d come off in the case, Beate Ritz, an epidemiologist at UCLA who studies neurodevelopmental conditions, told The Atlantic. According to Ritz, Baccarelli approached her at a conference and explained that he wanted to write a paper to clarify why he’d concluded that Tylenol should be used cautiously: He had been accused of being in it for money, and hoped to set the record straight. Ritz agreed to collaborate with Baccarelli. Their resulting manuscript, published in August, stopped short of saying that Tylenol use during pregnancy caused autism, but argued for a strong link between the two. Since the Trump administration thrust the study into the limelight, several other scientists have lambasted it, saying it overemphasizes evidence that supports the authors’ preset biases. (Ritz told The Atlantic that she asked Baccarelli and her other co-authors to correct an early version of the paper because it gave undue weight to lower-quality studies. But she stands behind the final version.)

When Kennedy called, Baccarelli wanted to promote his findings as any other researcher would, he said at the town hall: “As a scientist, I felt it was my responsibility to answer his questions.” He said he had not discussed the school’s financial situation with the administration. He also declined to attend the press conference on autism; instead, he released a statement that day noting that further research was needed to determine a causal relationship between the drug and autism, but advising “caution about acetaminophen use during pregnancy.” (Andrew G. Nixon, the director of communications for the Department of Health and Human Services, did not answer my questions about the administration’s association with Baccarelli, but acknowledged that some recent studies other than Baccarelli’s “show no association” between Tylenol and autism. The administration’s current guidance “reflects a more cautious approach while the science is debated,” he wrote.)

Baccarelli’s intentions were understandable, Emmons told me: “He doesn’t want to give up his science.” At the same time, though, “when you’re a dean, you’re always a dean.” Baccarelli’s assumption that he could selectively cleave himself from his role at the school, several HSPH researchers told me, was at best clueless and politically unsavvy. At worst, it represented reckless neglect of his duty as the primary steward of his school’s reputation and future. Even in a less politically charged climate, Baccarelli’s controversial paper and overzealous witness testimony might have blemished his reputation. Under current conditions, they cut against his own vision of leading a world-class institution—which requires proving to other parts of the research enterprise that the school has maintained its commitment to scientific rigor.

Prior to this year, many HSPH researchers saw the school’s reliance on federal funds as a strength. Government support was exceptionally stable, and HSPH researchers were exceptionally good at winning it. By Harvard’s standards, the school’s endowment was not its primary boasting point—public-health alumni don’t tend to become billionaires —and in times of wider financial turmoil, HSPH remained well insulated, Amanda Spickard, the associate dean for research strategy and external affairs, told me. Now, for the first time, the school is confronting the risks of sourcing half of its operating budget from a single entity.

The government was public health’s ideal funder in part because it could play science’s long game: funding research that might not be immediately profitable or even beneficial. That pact is now broken, and as the school seeks alternative routes, several researchers worry that some of the most important science will be the fastest to fall by the wayside. If, as some faculty suspect, more commercializable research is likelier to survive at the school, HSPH also risks abandoning a core public-health mission—meeting the needs of the underserved—and detracting from Baccarelli’s own strategic vision of building “a world where everyone can thrive.”

I asked multiple faculty members in top leadership roles how HSPH planned to deal with these imbalances. None of them delivered satisfying answers. Spickard and Jorge Chavarro both mentioned getting faculty to think more creatively about pursuing funding. Both also acknowledged that some faculty will lose out more than others. (Emmons, the interim department co-chair, suggested that making research more interdisciplinary could appeal to funders across a wider range of fields.) Chavarro also said that HSPH leadership planned to clarify which of the school’s decisions are temporary, emergency measures versus actions that will guide the school long-term. But when I asked for examples from each of those categories, he hesitated, and ultimately named only emergency actions.

Although more than a month has passed since a federal judge declared the grant terminations at Harvard illegal, money is only just starting to trickle back to the public-health school, and several faculty told me they still don’t have access to their funds. (An internal communication sent by Baccarelli last week indicated that the university was still “in the process of reconciling the payments.”) HSPH has also been cautious about lifting spending limits on its faculty, in part because Harvard worries that the administration will continue to appeal the judge’s decision, or otherwise renew or escalate its attacks, Christiani told me. Late last month, HHS referred Harvard for debarment, which would block the institution from receiving any federal funds in the future.

Many HSPH scientists expect that this is far from the end of the most difficult era of their career. A few pointed toward William Mair, who studies the links between metabolic dysfunction and aging, as one scientist already stretching to do the kind of interdisciplinary work that might help the school survive. In recent months, Mair has been reaching out to colleagues across the school to collaborate on a healthy-aging initiative that will draw on multiple public-health fields. But Mair, too, has had to whittle his lab down to just five people and shelved many of the team’s more ambitious experiments. Originally from the United Kingdom, he came to the U.S. nearly 20 years ago for his postdoctoral fellowship, then stayed in the country that he felt was the best in the world at supporting science. (He became a citizen earlier this year.) “I don’t want to leave this community,” he told me. “But every minute I stay here at Harvard is currently detrimental to my own science career.” The university that once promised to buoy scientific aspirations now feels like a deadweight.

Tom Bartlett contributed reporting.

Politicians sometimes do silly things to draw attention to their favorite issues. In 2015, then-Senator Jim Inhofe famously brought a snowball onto the floor of Congress to argue against the existence of climate change. Representative Marjorie Taylor Greene toted a balloon to the 2023 State of the Union to mock the Biden administration’s handling of a Chinese spy craft. But in terms of sheer spectacle, few can top Jared Polis and his “forbidden” feast.

In 2015, Polis, then a Democratic congressman from Colorado, dined on hemp scones and washed them down with a glass of raw milk. The point was to highlight the purported absurdity of the government’s rules for what people can and cannot eat. He was pushing Congress to pass the Milk Freedom Act, a bill that aimed to make unpasteurized dairy easier for Americans to buy. At the time, the beverage was a delicacy for hippies in cities like Boulder, not a rallying cry for Robert F. Kennedy Jr. and the “Make America Healthy Again” movement. In May, the health secretary, who has said he drinks only raw milk, downed a shot of the stuff during a podcast taping in the White House.

Polis, now the governor of Colorado, still speaks fondly of his stunt. “Raw milk is relatively low-risk compared to many things that people choose to do in their everyday lives,” he told me recently. “We should lean into freedom,” he said, and allow “people to make their own decisions on what to eat.” (For the record, raw milk can lead to serious cases of foodborne illness.) I spoke with Polis not just to ask him about unsafe milk. Few prominent Democratic politicians want anything to do with RFK Jr. and his agenda to remake American health; Polis is the exception.

From the moment last year that Kennedy was picked to lead the Department of Health and Human Services, Polis has taken a different route than the rest of his party. Many quickly came out and said that Kennedy’s past anti-vaccine activism disqualified him from the position. “I’m excited by the news that the President-Elect will appoint @RobertKennedyJr,” Polis posted on X. “He helped us defeat vaccine mandates in Colorado in 2019 and will help make America healthy again.” During Polis’s first year as governor, in 2019, he allied with Kennedy in opposing a bill that would have made it more difficult for parents to get vaccine exemptions for their kids. Since Kennedy’s confirmation, Polis has worked directly with the Trump administration. In August, he got permission from Washington to ban the purchase of soda using food stamps in Colorado, a controversial policy that Kennedy has repeatedly held up as one of his priorities. So far, 12 states have signed on to test the idea—Colorado is the only one that is run by a Democrat.

[Read: Republicans are right about soda]

When I asked Polis why he supports RFK Jr.’s soda agenda, his response was scattered. He told me that if people really want to drink soda, they still can, just like how Coloradans are free to buy marijuana or alcohol. “People with their own money can make whatever decisions they want,” he said. But the government “shouldn’t be subsidizing cavities and diabetes,” he added. He also claimed that banning soda from being purchased with food stamps was an act of “moral integrity.” The food-stamps program—formally the Supplemental Nutrition Assistance Program—is supposed to support nutrition, he said, and “soda has zero nutritional content.”

The response underscores the eclectic nature of Polis’s politics. While in Congress, he was at one point the only Democratic member of the House Liberty Caucus—a home of staunch libertarianism—but he also sat on the Congressional Progressive Caucus. As governor, he has taken a decidedly populist, and at times combative, approach to reforming the health-care industry; within a month in office, he set up an aptly named Office of Saving People Money on Healthcare. Polis’s varied political beliefs make him a lot like Kennedy, who was a Democrat until 2023. Kennedy has managed to bridge three specific tendencies—toward fiscal conservatism, social liberalism, and a belief that improving societal health is a moral imperative—and present them as one overarching ideology. During his confirmation hearing in January, Kennedy struck a similar tone in explaining the MAHA agenda. “This is not just an economic issue. It is not just a national-security issue. It is a spiritual issue, and it is a moral issue,” Kennedy said. “We cannot live up to our role as an exemplary nation, as a moral authority around the world, when we are writing off an entire generation of kids.” (An HHS spokesperson did not respond to a request for comment.)

Polis, in other words, may be the closest thing there is to a MAHA Democrat. When I asked him what he thought of that title, he pushed back, noting that MAHA is a bit too close to MAGA. “Unfortunately it’s only one letter away from an acronym that is something I’m staunchly opposed to,” he said. The governor also went out of his way to distance himself from Kennedy’s recent moves to roll back vaccine access. Kennedy’s decisions—namely his push to narrow approval of COVID vaccines—have “slanted the field against individual choice,” he explained. Although Polis opposes vaccine mandates, he is not an anti-vaxxer. Last month, the governor bucked Kennedy by signing an order allowing pharmacists to continue giving COVID shots without a prescription. “We will not allow unnecessary red tape or decisions from Washington to keep Coloradans from accessing life-saving vaccines,” he wrote on X at the time. Yesterday, Polis joined more than a dozen other Democratic governors to form a public-health alliance to counter RFK Jr.

Polis’s positioning seems politically savvy. Kennedy’s focus on tackling obesity and chronic disease by overhauling the American diet is popular—much more so than his policies limiting vaccines. (According to one poll by Healthier Colorado, a nonpartisan group, residents in the state support banning the purchase of soda with SNAP benefits—albeit by a narrow margin.) And by not openly identifying with MAHA, Polis avoids alienating himself from Colorado’s Democratic voters. “They think of it as Trump’s label,” Celinda Lake, a Democratic pollster who has surveyed voters on the topic, told me about MAHA. “If you put Trump in front of Cheez-Its, Democrats wouldn’t like it.”

Polis is not the only Democrat trying to do a similar dance. Jesse Gabriel, a Democratic state lawmaker in California who spearheaded the state’s recent effort to phase out ultra-processed foods in schools—another Kennedy priority—has sought to draw distinctions between his efforts and those of the administration. “Here in California, we are actually doing the work to protect our kids’ health, and we’ve been doing it since well before anyone had ever heard of the MAHA movement,” Gabriel said in a recent press conference.

Before RFK Jr. came along, Democrats were indeed the party of healthier diets. As my colleague Tom Bartlett recently wrote, “Let’s Move,” Michelle Obama’s campaign to reduce childhood obesity, has a lot of similarities with MAHA. Kennedy has pressured companies to stop using synthetic food dyes, prompting red states to pass food-dye regulations of their own. They are following in the footsteps of California, which was the first state to ban a dye, Red 3, back in 2023.

[Read: RFK Jr. is repeating Michelle Obama’s mistakes]

The GOP’s embrace of these food policies has put Democrats in an odd position. The party hasn’t quite figured out how to interact with the MAHA movement. Democrats might be serious about tackling chronic disease, but they’ve ceded that issue to Kennedy in recent months, likely because of trepidation about being seen as allies of the secretary. Democratic strategists I spoke with emphasized that their party needs to figure out a message that demonstrates it is more serious than the Trump administration in attacking these issues—especially one that can appeal to certain groups (namely suburban moms) that are gravitating to the MAHA message.

Even Polis, who is willing to go further than most other Democrats in aligning himself with RFK Jr., has struggled to articulate his own alternative to MAHA. (When I asked how he’d like his record as governor to be remembered, if not as one of a MAHA Democrat, he simply said, “Effective.”) As we spoke, it often felt like Polis and I were talking past each other. When I asked him why other Democratic governors weren’t pursuing a ban on buying soda using food stamps, he talked about his own opposition to Republicans’ recent cuts to SNAP. For the most part, Polis didn’t want to talk about Kennedy; he wanted to talk about his health-care achievements. Therein lies the predicament for Polis, and other members of his party: RFK Jr. has so quickly laid claim to issues of food and nutrition that it’s difficult to talk about them at all without invoking the health secretary.

It was a strange weekend for employees of the Centers for Disease Control and Prevention, to say the least. On Friday, hundreds of workers at the agency, many of whom have been furloughed since the federal government shut down on October 1, found out they were being fired as part of widespread layoffs across federal agencies. Less than a day later, a curt follow-up email landed in many of their inboxes informing them that they weren’t being let go after all. No explanation, no apology.

Staffers spent the weekend trading calls and texts, trying to piece together who had been axed, who had been spared, and, most puzzling, why. “There’s really no strategy that they’re using, no real approach—at least any thoughtful approach—to how they are doing these cuts,” Daniel Jernigan, who directed the National Center for Emerging and Zoonotic Infectious Diseases before he resigned in August, told me.

I spoke with half a dozen current and former CDC officials, and foremost on their mind was what they described as the ineptitude of the botched downsizing. For example, almost all editors of the “Morbidity and Mortality Weekly Report,” which the CDC has published since 1960, were among those notified on Friday night that their work was “unnecessary or virtually identical to duties being performed elsewhere in the agency.” By Saturday, several CDC sources told me, they had their jobs back.

Andrew Nixon, the communications director for Health and Human Services, wrote in an email that “the employees who received incorrect notifications were never separated from the agency and have all been notified that they are not subject to the reduction in force.” He declined to answer specific questions about layoffs.

Many of the cuts that have stuck so far seem to conflict with the administration’s stated aims. A branch of the National Center for Health Statistics that coordinates an annual survey of the dietary habits of Americans—a topic presumably of interest to those attempting to make America healthy again—was eliminated, according to its former chief, David Woodwell. Secretary of Health and Human Services Robert F. Kennedy Jr. has accused the agency’s vaccine advisory board of being “plagued with persistent conflicts of interest” and insisted that such conflicts must be eliminated in order to restore Americans’ trust in the CDC. And yet, the agency’s human-resources office—which handled ethics issues—has been scrapped, according to Alt CDC, a team of anonymous public-health officials that has been crowdsourcing updates on the firings. “I would think, if you are monitoring for conflicts of interest, particularly when you’ve accused the agency of having them, you would want to have an office to do that,” Debra Houry, who was the CDC’s chief medical officer until she resigned in August, told me.

One veteran researcher who still has his job (and, like other public-health workers I spoke with for this story, requested anonymity for fear of losing it) told me he believes that Kennedy’s ultimate goal is to “silence the scientific voice of career CDC scientists.” And indeed, perhaps the clearest result of the firings is that they appear to consolidate Kennedy’s power over the agency. Every member of the CDC’s Washington office, which serves as a conduit between the agency’s Atlanta headquarters and Capitol Hill, was fired; barring a second round of reversals, that office appears to be closed. The person managing Alt CDC’s Bluesky feed yesterday, who identified herself as an epidemiologist in a state health department, told me she’d heard that CDC personnel who normally share information with state officials during outbreaks have been eliminated. “So the only contact they have is going to HHS—is going to RFK,” the epidemiologist told me.

For CDC scientists who received layoff notices, the past few days have been disorienting. I spoke with one longtime scientist at the agency who learned on Friday that she would lose her job but then, on Saturday, received an email with the subject line “Rescission of Previous Notice of Reduction in Force.” In other words, her job—deemed redundant the day before—was again apparently necessary. She told me that her short-lived firing “felt like the culmination of eight months of abuse” under the Trump administration. She was particularly distressed by Kennedy’s June decision to fire the entire vaccine advisory board and stack it with his allies, but recent months have offered even more opportunities for stress and indignation. In August, a gunman who blamed COVID vaccines for his depression opened fire on the agency’s Atlanta campus, killing a police officer. (The veteran scientist told me she shopped online for a bulletproof vest to wear to work, though she ended up not buying one.) Weeks later, Kennedy pushed out the agency’s newly confirmed director, Susan Monarez. Three top CDC officials—Houry, Jernigan, and Demetre Daskalakis, the former director of the National Center for Immunization and Respiratory Diseases—subsequently resigned in protest.

[Read: ‘It feels like the CDC is over’]

On Friday, hours before layoff notices went out, Jim O’Neill, who took over as acting CDC director after Monarez’s ouster, posted two photos on X of what appeared to be a bald eagle soaring over the Capitol building. His message: “Good morning we are going to win.” For the people I spoke with who remain at the CDC, what exactly the acting director hopes to win—and for whom—isn’t clear, in part because they haven’t heard anything else from O’Neill. On Friday, instead of discussing the growing turmoil at the agency he oversees, Kennedy posted on X congratulating President Donald Trump for his new drug-pricing deal and defending comments he made at a recent Cabinet meeting linking autism with the use of Tylenol after circumcision. As of this evening, he still hadn’t addressed the firing about-face.