Medical News

Gas-station weed was never supposed to exist. And yet, convenience stores across the country—even in states where marijuana is illegal—sell a trove of fizzy drinks, vape pens, and confections all promising to get you high. My neighborhood liquor store has an entire cooler full of weed drinks, including a seltzer aptly named Bong Water, a can of which has 25 milligrams of THC. About five milligrams of that chemical, which is the main psychoactive component in marijuana, will make the occasional weed user feel a light buzz. If that’s not enough for you, you might be able to buy a vape pen with 5,000 milligrams at your corner store.

These products are available because Congress messed up. In 2018, it passed a bill that was meant to support farmers by allowing them to grow hemp—essentially, weed bred with minimal THC—for industrial uses such as paper, insulation, and even guitars. In the process, it also accidentally created a new industry of intoxicating hemp products that are virtually indistinguishable from those made using traditional marijuana, except for the fact that they’re federally legal.

If Congress has its way, however, such products could soon disappear. Tucked into the funding legislation that ended the government shutdown was a bill that would outlaw virtually any THC product not sold at a licensed dispensary—a mortal threat to the industry that’s brought Americans Trips Ahoy cookies and THC-infused Dorito knockoffs.

The particulars of the current loophole are wonky, but the law allows companies to sell any hemp product that doesn’t contain more than 0.3 percent THC by dry weight. A company selling a 40-gram cookie, for example, could add 100 milligrams of THC and still be under that limit. Crucially, this applies to products sold anywhere in the country. Kansas hasn’t legalized either recreational or medical cannabis, but as I’ve previously reported, when I went to Topeka in 2023, I was able to find intoxicating hemp products in 10 shops within an afternoon. In a state like Illinois, where legal marijuana abounds, the distinction between weed sold in licensed dispensaries and hemp sold at convenience stores might seem pedantic. But dispensaries have to follow rules meant to keep users safe, and they must keep the product cordoned off from people under 21. Sellers of THC-containing hemp products don’t have to follow the same rules. Technically, many states don’t even specify a minimum age to buy these products.

The downsides of this system were immediately apparent. In a recent nationwide survey, approximately 11 percent of high-school seniors reported trying hemp products that feature Delta 8, one of the mind-tweaking compounds found in marijuana. Mitch McConnell, who championed the amendment closing the loophole, said on the Senate floor during the debate over the bill that passing it would “keep these dangerous products out of the hands of children.” Plus, many of these technically legal hemp products are filled with potentially dangerous synthetic compounds. Delta 8, for example, naturally occurs in marijuana only in very small amounts, so the substance added to vapes and drinks is typically created by chemically manipulating CBD, a more prevalent compound in the plant. The FDA has warned that this process may include “potentially unsafe household chemicals” and may be done “in uncontrolled or unsanitary settings, which may lead to the presence of unsafe contaminants or other potentially harmful substances.”

[Read: The new war on weed]

Now, after seven years, Congress has decided that enough is enough. Under the new funding bill, any product with more than 0.4 milligrams total THC—virtually nothing—would be considered a Schedule I narcotic, just like heroin, LSD, and regular old marijuana. The law will for the most part not affect dispensaries in states that have legalized weed, but it will make more than 95 percent of the current hemp market illegal, Jonathan Miller, a lobbyist for the industry group U.S. Hemp Roundtable, told me. And that’s the point: I asked Kevin Sabet, who runs an anti-marijuana group that lobbied for the new legislation on Capitol Hill, what successful implementation would look like. “A lot of the major players out of business,” he told me.

The new legislation doesn’t go into effect for a year, and already, the hemp industry is trying to persuade lawmakers to call off the crackdown. When I spoke with Miller on Tuesday, he told me that he was set to discuss the issue with an influential member of Congress the next day. The Hemp Roundtable, which spent $320,000 lobbying Congress last year, is hoping to persuade lawmakers to abandon the 0.4-milligram THC limit for something more workable—perhaps five or 10 milligrams, Miller told me. Ed Marszewski, the president of Marz Community Brewing Co., which makes Bong Water, told me that his company also wants regulations on serving sizes for hemp products, as well as age restrictions and safety testing.

Hemp companies might also wait to see how the new law will be enforced before taking any dramatic action. Despite the 2018 hemp loophole, selling food to which THC or CBD has been added is unequivocally prohibited by the FDA. However, the agency has typically gone after only those companies making unsubstantiated health claims or marketing their products to kids, Jonathan Havens, a cannabis attorney at the law firm Saul Ewing, told me. Since 2018, roughly 100 companies have received warnings from the FDA for selling cannabis-containing products. The industry, clearly, has kept on making its forbidden treats.

[Read: Marijuana is too strong now]

The question is whether the status quo changes in 2027, given the higher stakes. Selling a Schedule I narcotic typically carries a stiffer penalty than violating FDA rules does. But the Drug Enforcement Administration doesn’t currently have the resources to surveil every gas station, smoke shop, and liquor store in the country, and closely policing those settings would mean taking agents off more serious cases, Jim Crotty, a former DEA official, told me. (The DEA did not respond to a request for comment.) The federal government hasn’t shown a willingness to police local cannabis sales in the past: Licensed marijuana dispensaries are technically illegal under federal law too, but the feds have typically not interfered with shops that abide by state law. A similar scenario could play out with hemp products, Douglas Berman, the executive director of the Drug Enforcement and Policy Center at Ohio State University, told me.

Proponents of this new law may hope that the days of hemp gummies and seltzers are limited. But passing a policy like this is easy compared with the work required to enforce it. Americans may soon find out if the government is up to the job.

Let me make a small concession on behalf of the medical community: The CDC is technically correct when it asserts, as it did this week in a surprise update to its website, that “studies have not ruled out the possibility that infant vaccines cause autism.” But the underlying logic of this change clearly goes beyond the wispy double negative. Robert F. Kennedy Jr. has already said that he believes in the affirmative: Vaccines do cause autism. And because he is now secretary of Health and Human Services, he can order his bureaucracy to lean ever further toward that same belief. A causal link hasn’t not been found, the CDC is saying now—at least not completely, not quite yet.

If this pretzel logic is confusing, that’s the point. Bewilderment and doubt are among the anti-vaccine movement’s most powerful weapons. It’s true that doctors cannot say with absolute certainty that some ingredient in some vaccine, or combination of vaccines, does not contribute in some way, however small or large, to the rise in autism diagnoses. We also can’t rule out the possibility that infant vaccines cause tornadoes or bad movies. Uncertainty is inseparable from science.

[Read: The CDC’s website is anti-vaccine now]

Kennedy has firsthand knowledge of how difficult it is to prove a medical assertion. He began his crusade against immunizations 20 years ago, with the argument that the vaccine preservative thimerosal was causing a spike in autism rates. In his discredited 2005 article on the topic, he said he was “convinced that the link between thimerosal and the epidemic of childhood neurological disorders is real.” In fact, the evidence was very weak, and additional real-world observations have further undermined his claim. Throughout the 1990s and 2000s, thimerosal was removed, as a precaution, from childhood inoculations in many developed countries, and yet autism diagnoses continued to climb. Denmark took the preservative out of its shots in 1992, for instance, yet experienced a fivefold increase in autism diagnoses among young children by the end of the millennium.

In a New York Times interview yesterday, Kennedy acknowledged that studies had shown no link between thimerosal and autism. But he and his fellow anti-vaccine activists are undeterred by this contradiction. They have expressed little, if any, regret about their misguided crusade. (In fact, Kennedy has lately taken his anti-thimerosal campaign global.) But even if they were to grant that this ingredient is not, in fact, a cause of autism, they’d still be pointing at all the other vaccine components. Can each and every one be ruled out as a risk? Notably, the word thimerosal does not appear in this week’s update from the CDC. (A separate, preexisting page on CDC.gov says that the preservative has “no connection with autism.”) Instead the agency now points to another boogeyman ingredient: aluminum. That’s what warrants “further investigation,” circa 2025. (HHS Press Secretary Emily Hilliard told me that Kennedy supports the removal of thimerosal from all U.S. influenza vaccines, and that his “comprehensive review of autism’s causes” will emphasize “transparency, reproducibility, and gold-standard science.”)

[Read: The U.S. is going backwards on vaccines, very fast]

Kennedy has a clever way of playing with the evidence: He will hack apart robust results that support the safety of vaccines while canonizing any bit of information that could be seen to go the other way. The CDC-website update is a perfect specimen of this disordered scientific thinking. It shows how drops of doubt can be squeezed from even the most rock-solid data. One of the site’s citations, for example, is to a major study of aluminum-based vaccines that came out in the Annals of Internal Medicine earlier this year. Danish researchers examined the medical records of more than 1 million children and found no association between the amount of aluminum present in vaccines administered early in life and 50 different medical conditions. When that analysis was published, Kennedy demanded that it be retracted: “The only thing this study proves is the thorough corruption of the scientific journals that publish such garbage-in, garbage-out exercises in statistical manipulation,” he wrote in an op-ed last August. Yet now, improbably, the CDC is pointing to this very study in support of its double-negative conclusion. Are aluminum vaccines a cause of autism? Not necessarily no.

Echoing Kennedy’s assertions, the CDC site maintains that one should just ignore the Danish study’s overall results in favor of its secret truth. The paper’s real result, it suggests, is hidden in the supplementary tables, where one reveals that “moderate” aluminum exposure is linked to higher rates of neurodevelopmental conditions. But on closer look, the table also shows that any such relationship disappears at higher doses of aluminum—a quirky finding that should make the whole idea appear unsound.

The CDC continues on to cite aluminum’s apparent link to reported diagnoses of Asperger’s syndrome. This conclusion, too, is highly suspect: The data point in question, buried in supplemental figure 4, was seen only in a tiny subsample of 51 children with the condition. A more complete analysis of 3,000 children with neurologic disorders in the study found something like the opposite: Greater levels of aluminum were associated with fewer problems. None of this should be treated as a demonstration that aluminum-based vaccines are dangerous or beneficial; the details of these supplemental tables show only that science is a messy business. (Anders Hviid, the senior author of the paper, has responded to Kennedy’s assertions by maintaining that his study “does not provide support for the hypothesis that aluminum used as adjuvants in vaccines are associated with increased risks of early childhood health conditions.”)

The best doctors are aware of all these opportunities for confusion. Well-calibrated doubt is an important tool in medicine—more essential than a stethoscope or an X-ray—and the uncertainties it yields should be acknowledged and communicated. So why do physicians keep insisting that vaccines don’t cause autism? They are not “lying to you,” as Kennedy has alleged. Instead, they are doing what doctors are supposed to do: digesting a large amount of information in order to produce the most reasonable conclusion. They know that double negatives don’t help in matters of life and death. (As a pathologist, I try not to tell patients, “Well, you don’t not have cancer.”) Professional skeptics like Kennedy thrive on raising questions—but the public thrives on getting answers.

If Robert F. Kennedy Jr., the secretary of Health and Human Services, did bother to ask CDC scientists about using their website to turn anti-vaccine talking points into agency guidance, it didn’t matter much. “My understanding is that none of the leadership were asked about it, or if they were asked about changing the website, they did not agree with the change,” Daniel Jernigan, the former director of the National Center for Emerging and Zoonotic Infectious Diseases, told me. But as of last night, there it was: The CDC’s new official stance is that “studies have not ruled out the possibility” that routine childhood immunizations contribute to autism.

A senior CDC scientist told me that many people at the agency heard about the change only yesterday evening, hours before the revamped website launched. The decision appears not to have passed through the normal channels, which would involve staff at the Immunization Safety Office, Jernigan said. When asked via email whether CDC scientists had been bypassed, Andrew Nixon, an HHS spokesperson, didn’t answer. Instead, he reiterated bullet points from the website update, including the claim that studies supporting a link between autism and vaccines “have been ignored by health authorities”—essentially, the CDC accusing itself of having disregarded scientific evidence.

The new language appears in the “Vaccine Safety” section of the agency’s website. Until yesterday, that page laid out autism researchers’ long-standing consensus that vaccines do not cause the disorder. It noted that no link has been found between vaccine ingredients and autism, and that a National Academy of Medicine review of eight routine immunizations found that, “with rare exceptions, these vaccines are very safe.” The website’s affirmation that vaccines do not cause autism was important enough that during Kennedy’s confirmation process earlier this year, Senator Bill Cassidy, a physician, made him promise not to remove it. But instead of keeping his promise, Kennedy—who oversees the CDC as head of HHS—appears to be using the CDC website to advance his own anti-vaccine beliefs.

Technically, the statement “Vaccines do not cause autism” has not been removed from the CDC website. Instead, it has been appended with an asterisk, which is explained at the bottom of the page: “The header ‘Vaccines do not cause autism’ has not been removed due to an agreement with the chair of the U.S. Senate Health, Education, Labor, and Pensions Committee that it would remain on the CDC website.” That asterisk is an obvious farce, because the page is now devoted to undermining the scientific consensus. “‘Vaccines do not cause autism’ is not an evidence-based claim,” the site now states, despite the fact that multiple large studies have found no such association. The site notes that reviews on the measles, mumps, and rubella vaccine concluded that there is no association between the MMR vaccine and autism—but goes on to criticize those reviews as methodologically flawed. It also asserts that the rise in autism rates “correlates with the rise in the number of vaccines given to infants.”

In fact, autism researchers attribute much of that increase to improved screening and broader diagnostic criteria. Studies suggest that about 80 percent of a person’s autism risk comes from inherited mutations in their DNA. (The webpage doesn’t mention genes.) And yet, parents considering whether to vaccinate their child and seeking the CDC’s advice will now get the impression not only that the jury is out on whether vaccines cause autism but also that there is reason to believe they do.

[Read: The U.S. is going backwards on vaccines, very fast]

Kennedy himself has suggested as much for years in books and interviews, and as chair of the anti-vaccine nonprofit Children’s Health Defense. Such statements raised Cassidy’s suspicions during Kennedy’s confirmation process, though Cassidy still voted him into office. Demetre Daskalakis, who was the director of the National Center for Immunization and Respiratory Diseases before resigning alongside Jernigan and former CDC Chief Medical Officer Debra Houry, told me that it seemed to him that Kennedy had tricked Cassidy. “It’s a slap in the face,” he said. (Cassidy’s office did not respond to a request for comment. When reporters for Punchbowl News asked the senator today to comment on Kennedy’s broken promise, he lamented the “double tragedy” of falling vaccine rates and resources being wasted investigating “things we know do not cause autism,” but said nothing about Kennedy.)

Changing the website won’t affect the availability of routine vaccinations for children, at least not in the short term. It could, however, signal an intent by HHS to make it easier for parents of autistic children to pursue claims through the National Vaccine Injury Compensation Program. Houry told me she worries that the cherry-picked evidence on the new site will make parents hesitate over vaccinating their children against dangerous illnesses. In a statement, the Autism Science Foundation condemned the change, saying that the CDC’s vaccine-safety page “is now filled with anti-vaccine rhetoric and outright lies about vaccines and autism.”

Since taking office, Kennedy has been careful to moderate some of his more strident anti-vaccine views, at least in public. During his confirmation hearing, he insisted that he is not anti-vaccine, though he sidestepped questions about whether immunizations cause autism, saying that he would look at the data. In the midst of a measles outbreak in West Texas earlier this year, he paid lip service to the fact that vaccines protect children and the community, but in private, he was more openly conspiratorial. As the father of a girl who died from the measles told me in April, Kennedy said to him that we “don’t know what’s in the vaccine anymore.” Kennedy also fired the CDC’s outside vaccine advisers and replaced them with allies whose views are closer to his own—flouting another promise to Cassidy that he would maintain the advisory board “without changes.”

[Read: Bill Cassidy’s failure on vaccines]

All of those moves broke norms and sowed doubt about vaccines. But if they were a dog whistle, the new CDC website is a siren. Kennedy’s most radical doubts about vaccines have now been enshrined as official government guidance. Children’s Health Defense praised the website change on X, calling it “the biggest public health reversal of our lifetime.” It is indeed.

Medical weight loss might be on the verge of a further revolution. For starters, people will likely have the option of taking a new class of medications that seem to have fewer bothersome side effects, such as nausea—which affects about half the people on Ozempic and similar drugs.

Those now-familiar medications target a pathway involving the appetite-regulating hormone GLP-1; the new ones target cell receptors for a different hormone, amylin. AstraZeneca, Eli Lilly, Zealand Pharma, and, of course, Novo Nordisk, which makes Ozempic, are all testing amylin-based obesity drugs. And if the increasing number of new weight-loss medications seems hard to choose from, you might not have to pick just one. Some medications in development, such as CagriSema, go one step beyond, combining components that target amylin and GLP-1 to make even more powerful drugs.

In a recent trial, individuals with obesity who took an amylin-based drug called cagrilintide lost about 12 percent of their weight over the course of 16 months. Those on semaglutide, the active ingredient in Ozempic, lost about 15 percent. Those taking CagriSema lost, on average, more than 20 percent. (By comparison, bariatric surgery, a dramatic procedure that reconfigures the digestive system, can cause a person to lose about 30 percent of their weight—but it comes with the possibility of serious complications such as hernias and life-threatening infections.) These new combination drugs are pressing weight loss far enough past the limits of existing drugs that the field of obesity research is facing an unprecedented question: How far should medical weight loss go?

Thomas Lutz, who is known by his contemporaries as the “amylin guy,” has been conducting amylin research at the University of Zurich since the early 1990s, beginning only a few years after amylin had been isolated and characterized in pancreatic cells. Some scientists looked at the molecule with suspicion because it had been isolated in deposits within the pancreas of diabetic patients. Lutz and others helped show that it could reduce appetite in animals. But, perhaps partly because of the lingering mystery of why amylin deposits occur in the body, he found that the wider field took quite a while to get interested in his and other amylin researchers’ work. “We were probably considered outsiders by many others in the field,” Lutz told me. Most of his peers were focused on GLP-1, or leptin, or other peptides—molecules made of the same building blocks as proteins, but smaller. “Not many labs really focused on amylin.”

The compound has been used as a drug in the past, Lutz said, albeit in less potent incarnations. Pramlintide, an analogue of amylin, was approved by the FDA for treating diabetes in 2005. The formulation degrades rapidly enough that it has to be injected before every major meal, though; cagrilintide sticks around longer and is injected only once a week. Pramlintide also doesn’t have as big an effect on weight loss compared with the more recent array of amylin drugs. In one trial, twice as many people receiving it lost at least 5 percent of their body weight after four months, relative to those receiving the placebo. But that’s a modest effect.

Amylin is just one of a bevy of hormones involved in metabolism that pharmaceutical companies are thinking of using as components in future weight-loss therapies. “Companies are kind of going down the list,” looking at peptides that are secreted after meals and might have commercial potential, Kevin Hall, a metabolism scientist and co-author of the new book Food Intelligence, told me. There are drugs in the works that join the action of GLP-1 with that of GIP, a hormone released from the upper intestine, despite uncertainty about how GIP influences appetite. Some companies are looking at drugs based on the hormone glucagon. Others are investigating peptide YY, a gut hormone that signals to the brain that a meal has been consumed.

Because the body tends to adapt to drugs that depend on just one hormonal mechanism, combination medications that target multiple hormones should yield more effective treatments, Beverly Tchang, an endocrinologist at Weill Cornell Medicine who’s on the governing board of the Obesity Society, told me. As the available combinations increase and the weight-loss effects presumably nudge up as well, the question becomes: How much weight loss should these medications aim to produce? “The fact that we have to ask that question is crazy,” Tchang said. “Five years ago, we couldn’t ask that question, because we weren’t hitting these thresholds.”

For many individuals with obesity who lose about 5 percent of their weight, their blood levels of certain fat molecules start to improve. At about 10 percent weight loss, their risk of heart attack and stroke typically goes down. When weight loss reaches more than 15 percent, some people start to see the resolution of health problems that often go hand in hand with obesity. “It’s not that their high blood pressure is only getting better,” Tchang said. “It’s going away.”

But not everyone sees their risk factors go away when they lose 15 or 20 percent of their weight, which is one reason doctors see a market for more potent drugs. Many people who are morbidly obese need to shed a higher percentage of weight to achieve certain health goals, which is why some undergo bariatric surgery, even with all of its associated risks. Of course, people who are less obese might not benefit from losing a lot of weight. “Not all of our patients need 20 percent, 25 percent, 30 percent weight loss,” Timothy Garvey, an endocrinologist and professor at the University of Alabama at Birmingham who has led trials of amylin drugs, told me. “In fact, it’s unhealthy for many people, and it’s way beyond what we need to improve health.”

Doctors often consider body mass index (the imperfect but broadly used measure based on someone’s weight and height) to judge if someone is over- or underweight: A BMI of less than 18.5 is considered underweight. If someone’s weight loss causes their BMI to fall below that in a clinical trial, the person generally has to leave the experiment. But social pressures to lose weight can be tremendous, and GLP-1 drugs are already available at online pharmacies, where physician oversight is less rigorous. Some doctors worry that if more potent combination drugs come along—at the same time that generic GLP-1 drugs are available—people might take their weight loss too far.

Since GLP-1 drugs have been widely available, people have used them not just to tend to their health but also to modify their appearance. Christoffer Clemmensen, an obesity researcher at the University of Copenhagen, drew a parallel between the excessive use of weight-loss medications and inappropriate uses of anabolic steroids to bulk up muscles. Without support from a doctor or other medical professionals, people using these drugs, or even more effective ones, could lose significant muscle mass, Michael Lyon, the medical director of the Obesity Medicine and Diabetes Institute in a suburb of Vancouver, British Columbia, told me. In some rare cases, people’s weight loss on GLP-1 drugs doesn’t level off. “They just keep losing and keep losing,” Garvey said. “You are losing bone; you’re losing muscle.” Already, people who want to lose weight have some of the most powerful tools ever available. In the next year, they’ll likely have even more options.

Last week, the two top officials at the National Institutes of Health—the world’s largest public funder of biomedical research—debuted a new plan to help Americans weather the next pandemic: getting everyone to eat better and exercise.

The standard pandemic-preparedness playbook “has failed catastrophically,” NIH Director Jay Bhattacharya and NIH Principal Deputy Director Matthew J. Memoli wrote in City Journal, a magazine and website published by the Manhattan Institute for Policy Research, a conservative think tank. The pair argue that finding and studying pathogens that could cause outbreaks, then stockpiling vaccines against them, is a waste of money. Instead, they say, the United States should encourage people to improve their baseline health—“whether simply by stopping smoking, controlling hypertension or diabetes, or getting up and walking more.”

On its own, Bhattacharya and Memoli’s apparently serious suggestion that just being in better shape will carry the U.S. through an infectious crisis is reckless, experts told me—especially if it’s executed at the expense of other public-health responses. In an email, Andrew Nixon, the director of communications at the Department of Health and Human Services—which oversees the NIH—wrote that the agency “supports a comprehensive approach to pandemic preparedness that recognizes the importance of both biomedical tools and the factors individuals can control.” But more broadly, Bhattacharya and Memoli’s proposal reflects the spread of a dangerous philosophy that Robert F. Kennedy Jr., the secretary of HHS, has been pushing for years: a dismissal of germ theory, or the notion that infectious microbes are responsible for many of the diseases that plague humankind.

In his 2021 book, The Real Anthony Fauci: Bill Gates, Big Pharma, and the Global War on Democracy and Public Health, Kennedy, a longtime anti-vaccine activist, argues that modern scientists have blamed too much of infectious disease on pathogens, which he suggests are rarely problematic, unless the immune system has been compromised by poor nutrition, toxins, and other environmental stressors. He credits sanitation and nutrition for driving declines in infectious-disease deaths during the 20th century; vaccination, he has baselessly claimed, was largely ineffective and unnecessary. In his view, germs don’t pose a substantial threat to people who have done the work of “fortifying the immune system”—essentially, those who have taken their health into their own hands.

In terms of general health, most Americans would benefit from improvements in diet and exercise. A strong emphasis on both has been core to the Make America Healthy Again movement, and in one important aspect, Kennedy and his allies are correct: The immune system, like other bodily systems, is sensitive to nutritional status, and when people are dealing with chronic health issues, they often fare less well against infectious threats, Melinda Beck, a nutrition and infectious-disease researcher who recently retired from the University of North Carolina, told me. Conditions such as obesity and diabetes, for instance, raise the risk of severe COVID and flu; malnutrition exacerbates the course of diseases such as tuberculosis and measles.

But applied to widespread infectious outbreaks, the MAHA prescription is still deeply flawed. Being generally healthy doesn’t guarantee survival, or even better outcomes against infectious diseases—especially when an entire population encounters a pathogen against which it has no immunity. Although some evidence suggests that the 1918 flu pandemic strongly affected certain groups of people who were less healthy at baseline—including undernourished World War I soldiers—“relatively healthy people, as far as we could understand, were the main victims,” Naomi Rogers, a historian of medicine at Yale, told me. Smallpox, too, infected and killed indiscriminately. HIV has devastated many communities of young, healthy people.

In his book, Kennedy relies heavily on the term miasma theory as a shorthand for preventing disease “through nutrition and by reducing exposures to environmental toxins and stresses.” He’s employing that phrase incorrectly: Historically, at least, miasma theory referred to the notion that epidemics are caused by bad air—such as toxic emanations from corpses and trash—and was the predominant way of describing disease transmission until scientists found definitive proof of infectious microbes in the late 19th century. But his choice of words is also revealing. In pitting his ideas against germ theory, he plays on a centuries-old tension between lifestyle and microbes as roots of illness.

In its early days, germ theory struggled to gain traction even among physicians, many of whom dismissed the idea as simplistic, Nancy Tomes, a historian at Stony Brook University, told me. After the idea became foundational to medicine, scientists still had to work to convince some members of the public that microbes could fell healthy people, too. In the early days of polio vaccination, when the virus still ran rampant in the U.S., some vaccine-skeptical Americans insisted that children were falling seriously ill primarily because their parents weren’t managing their kids’ nutrition well and “had disrupted the child’s internal health,” Rogers told me.

Over time, as pharmaceutical companies made global businesses out of selling antibiotics, vaccines, and antivirals, the products became a symbol, for some people, of how germ theory had taken over medicine. Accepting vaccines came to represent trust in scientific expertise, Rogers said; misgivings about the industry, in contrast, might translate into rejecting those offerings. In that skeptical slice of the American public and amid the rise of alternative-wellness practitioners, Kennedy has found purchase for his ideas about nutrition as a cure-all.

Since taking over as health secretary, he has on occasion made that distrust in germ theory national policy. In his book, he wrote that “when a starving African child succumbs to measles, the miasmist attributes the death to malnutrition; germ theory proponents (a.k.a. virologists) blame the virus.” Earlier this year, when measles raged through undervaccinated regions of West Texas, the secretary acted out his own miasmist theory of the outbreak, urging Americans to rely on vitamin-A supplementation as a first-line defense, even though deficiency of that vitamin is rare here.

But germ theory is key to understanding why outbreaks become pandemics—not because people’s general health is wanting, but because a pathogen is so unfamiliar to so many people’s immune systems at once that it is able to spread unchecked. Pandemics then end because enough people acquire sufficient immunity to that pathogen. Vaccination, when available, remains the safest way to gain that immunity—and, unlike lifestyle choices, it can represent a near-universal strategy to shore up defenses against disease. Not all of the risk factors that worsen disease severity are tunable by simply eating better or working out more. For COVID and many other respiratory diseases, for instance, old age and pregnancy remain some of the biggest risk factors. Genetic predispositions to certain medical conditions, or structural barriers to changing health habits—not just lack of willpower—can make people vulnerable to disease, too.

In their article, Bhattacharya and Memoli purport to be arguing against specific strategies of pandemic preparedness, most prominently the controversial type of gain-of-function research that can involve altering the disease-causing traits of pathogens, and has been restricted by the Trump administration. But the pair also mischaracterize the country’s current approach to pandemics, which, in addition to calling for virus research and vaccine development, prioritizes measures such as surveillance, international partnerships, and improved health-care capacity, Nahid Bhadelia, the director of the Center on Emerging Infectious Diseases at Boston University, told me. And Bhattacharya and Memoli’s alternative approach cuts against the most basic logic of public health—that the clearest way to help keep a whole population healthy is to offer protections that work on a societal level and that will reach as many people as possible. Fixating on personal nutrition and exercise regimens as pandemic preparedness would leave many people entirely unprotected. At the same time, “we’re basically setting up society to blame someone” in the event that they fall ill, Jennifer Nuzzo, the director of the pandemic center at the Brown University School of Public Health, told me.

Kennedy’s book bemoans that the “warring philosophies” of miasma and germ theory have become a zero-sum game. And yet, at HHS, he and his officials are presenting outbreak preparedness—and the rest of public health—as exactly that: The country should worry about environment or pathogens; it should be either pushing people to eat better or stockpiling vaccines. Over email, Nixon told me that “encouraging healthier habits is one way to strengthen resilience alongside vaccines, treatments, and diagnostics developed through NIH-funded research.” But this year, under pressure from the Trump administration, the NIH has cut funding to hundreds of vaccine- and infectious-disease focused research projects; elsewhere at HHS, officials canceled nearly half a billion dollars’ worth of contracts geared toward developing mRNA vaccines.

The reality is that both environment and pathogens often influence the outcome of disease, and both should be addressed. Today’s public-health establishment might not subscribe to the 19th-century version of miasma theory, but the idea that environmental and social factors shape people’s health is still core to the field. “They’re saying you can only do one thing at a time,” Bhadelia told me. “I don’t think we have to.”

Three years ago, America was in the midst of an infant-formula crisis. Abbott, one of the world’s biggest formula producers, had issued a nationwide recall after two children who consumed its products died of Cronobacter, a bacterial infection that can lead to complications such as meningitis. Because Abbott produced about 40 percent of the U.S. supply of infant formula, the recall contributed to a monthslong nationwide shortage stemming partially from pandemic-related supply-chain issues.

Federal investigators suspected that the outbreak originated in an Abbott factory in Michigan. FDA inspectors found that the plant had a leaky roof, standing water, and colonies of bacteria. Abbott has denied that its plant was the source of illness, and its products were never definitively linked to the outbreak. Nevertheless, the incident led to congressional hearings, a consent decree for Abbott, and assurances from FDA officials that the agency would more closely police formula manufacturers so that a situation like this would never happen again.

And yet, it has. Twenty-three infants have fallen ill in recent months from infant botulism after drinking powdered formula from ByHeart, a high-end brand whose stated goal is to “make the best formula on earth.” Infant botulism can cause muscle weakness, difficulty breathing, and, if untreated, death. One child was on a feeding tube for four weeks, according to Bill Marler, a food-safety attorney who filed a lawsuit last week on behalf of the child’s family. Last Tuesday, ByHeart issued a nationwide recall for all of its products.

In response to detailed questions, a spokesperson for ByHeart told me that the company is focusing on “implementing the recall as quickly as possible and supporting the FDA’s investigation into the source of the outbreak.” The company wrote in a November 8 update to customers that “there is no confirmed link between ByHeart’s infant formula and infant botulism.”

Infant formula is perhaps the most highly regulated sector in the U.S. food industry, because the slightest lapse can cause serious harm. Nothing about formula itself is inherently unsafe; it’s essentially milk protein fortified with key vitamins and minerals. But microbes that most adults can ingest without incident—including the ones that caused the 2021–22 outbreak and today’s—can cause life-threatening complications for babies, because the newborn immune system isn’t developed enough to fight them off. The FDA inspects infant-formula plants at least once a year. (Regulators inspect facilities for other foods they deem at high risk of contamination only every three years, unless they’re alerted of a potential problem.)

Missteps in manufacturing happen, but most of the time, they are caught before they end up making kids sick. At least five other infant-formula recalls have occurred because of potential contamination since Abbott’s in 2022. It’s impossible to say that no children got sick from those incidents—parents may simply have not reported their kids’ illness—but in recalling the products quickly, the companies might have prevented major problems.

Although many smaller formula brands use a third-party manufacturer, ByHeart operates its own facilities, so the current outbreak appears to be contained to only its products. And unlike Abbott, ByHeart’s market share is too small—about 1 percent, per the FDA—to meaningfully affect the national supply. Infant botulism is less deadly than Cronobacter, and the condition is rare. The medical literature documents only a few cases that have been tied to infant formula prior to the current outbreak. In 2021, just 181 cases were confirmed in the United States overall.

[Read: The ominous rise of toddler milk]

Even so, ByHeart’s customers are clearly distressed. On the company Facebook page, parents—some of whom have fed their children the affected products—are venting their anger at the company. “I have yet to sleep in peace since we heard about this,” wrote one mother, who says she fed her three-week-old the formula before the recall. Others are frustrated that they purchased an expensive formula only to throw it all away. (Prior to the recall, ByHeart sold its powdered formula for about $1.75 an ounce; at Target, Abbott’s Similac Advance formula costs about $1.30 an ounce.) ByHeart told me in a statement that “we express our deepest sympathy to the affected families” and that the company is “working as quickly and diligently as we can to respond to each inquiry we receive.”

Experts I spoke with were adamant that food manufacturers bear most of the blame for foodborne outbreaks—after all, they produced the unsafe food. “It is the responsibility of a food company, whether they’re making baby formula or Pop-Tarts or selling romaine, to ensure that their food is safe,” Sandra Eskin, the CEO of the advocacy group Stop Foodborne Illness, told me. But regulators often share some culpability. In the 2021–22 outbreak, a whistleblower alerted the FDA to alleged rule-breaking, including falsification of records and the release of untested formula into the market, but regulators failed to follow up on the complaint until 15 months later. Abbott said in a statement on its website that the whistleblower “was dismissed due to serious violations of Abbott’s food safety policies, and after dismissal, through their attorney, made evolving, new and escalating allegations to multiple authorities.” Although the company has acknowledged that the plant at issue did test positive for certain bacteria, a spokesperson reiterated the company’s defense to me that it was never proved that the bacteria in its facility made it into formula.

As for the current outbreak, it’s too early to pinpoint exactly what went wrong. The affected powdered ByHeart formula must be rehydrated, so the bacterial spores that cause infant botulism—which are relatively common—could have contaminated the formula when parents were preparing it for their babies. But experts told me that that explanation is unlikely because so many children have now gotten sick from the same formula; nearly two dozen families would have had to make the same mistake around the same time. Plus, the FDA found manufacturing deficiencies at ByHeart’s Iowa facility—one of the two linked to the current outbreak—when it was last inspected in February, Emily Hilliard, a Department of Health and Human Services spokesperson, told me. (She declined to say what those deficiencies were.) The ByHeart spokesperson, when asked about the issues identified in February, said that “addressing observations and updating regulators is a continuous and routine process that is inherent in maintaining compliance and meeting the highest safety and quality standards.”

[Read: What parents did before baby formula]

In 2023, the company received a formal warning letter after the FDA found that the company did not have proper systems in place to make sure that formula was not contaminated at its since-closed facility in Reading, Pennsylvania. Months later, that facility was cited by the FDA for having mold in a water tank and thousands of dead insects on the premises, according to The New York Times.

The spokesperson for ByHeart told me that all of the issues in the 2023 warning letter have been resolved. But the FDA’s allegations against the company typify what food-safety experts and former FDA officials have described to me as ByHeart’s cavalier approach to food safety. “There’s a lot of red flags about the way ByHeart is managing this outbreak, which tells me they don’t have an experienced food-safety team at the helm,” Sarah Sorscher, the director of regulatory affairs at the Center for Science in the Public Interest, told me.

The company has, for example, downplayed findings by officials at the California Department of Public Health, who tested an open canister of ByHeart formula acquired from an infant-botulism patient and found the bacteria that causes infant botulism. After California alerted the public to these findings on November 8, the company announced a recall and put out a statement claiming that it was taking the results “very seriously”—but then questioned the state’s methodology in the next sentence.

In an open letter posted on the company’s website, ByHeart also noted that formula companies are not required to test for the bacteria that causes infant botulism. Frank Yiannas, a former deputy commissioner for food policy at the FDA, told me that the response was “not a really good answer,” because companies—particularly those in an industry like infant formula—should be doing their own analyses of hazards and risks, regardless of what is mandated by law. When California’s officials found the bacteria in that can of baby formula, the state’s public-health officer urged parents to “stop using ByHeart formula immediately.” The company, however, initially responded by recalling just two batches of its formula. (In the days since, the company has issued a nationwide recall to include all of its products.)

[Read: We’ve never been good at feeding babies]

In the coming weeks or months, regulators may find—as they did with Abbott—sanitation issues at ByHeart’s facilities. Or perhaps the evidence will indicate that the company acted responsibly and just got hit with a black-swan event. Whichever way the situation goes, it’s a reminder of how easily the baby-formula industry can crack, even when it’s supposed to be bulletproof.

Russell Brand had found his people, that much was clear. Last Saturday, in front of 800 fans in a hotel ballroom in Austin, the comedian doled out praise for Robert F. Kennedy Jr. (whom he called “Great Brother Kennedy”), disdain for the medical establishment (“flat-out evil”), and gratitude for Jesus Christ (“Thank God we have a forgiving God that died for us”). He also told a bunch of dick jokes and, later, called me a Nazi.

After the show, I’d asked Brand for an interview, and he told me that the media are “Luciferian,” and that reporters are Nazis. “Do you really think that?” I asked him. “You’re more like an individual Nazi,” he said, seemingly a concession that I was just following orders. (I didn’t get the interview.)

Brand and his fans had gathered for the annual conference of Children’s Health Defense, the anti-vaccine nonprofit founded in 2018 by the current secretary of Health and Human Services. Kennedy wasn’t there, but the movement’s other headliners were. Brand—who is awaiting trial for rape and sexual assault in the U.K. and has pleaded not guilty—was onstage with Kennedy’s wife, Cheryl Hines, to promote her memoir. Her publisher, Tony Lyons, was there in his role as president of MAHA Action, a nonprofit that holds weekly Zoom calls to galvanize support for Kennedy’s agenda. Also on the scene were Andrew Wakefield, who’s infamous for his discredited 1998 Lancet study on the measles-mumps-rubella vaccine and autism, along with newer adherents such as Bret Weinstein, the evolutionary biologist, COVID-vaccine critic, and podcast host.

Everyone I spoke with at the conference shared a distrust of vaccines and a sense that, after they’d spent years on the fringes of scientific discourse, Kennedy’s rise to power had given them the legitimacy they once lacked. (The theme of the event was “Moment of Truth.”) As Polly Tommey, the program director of the organization’s video-and-audio operation, told the audience: “We never thought Bobby would be health secretary—I mean, come on! We’re in the best place we’ve been for ages!” But what should have been a victory lap at times felt like an attempt to rally the troops, or at least reassure them.

Kennedy’s tenure has been turbulent. In less than a year, he’s sent mixed signals about the benefits of vaccination during a measles outbreak, fired all of the CDC’s outside vaccine advisers and replaced them with his allies, axed the director of the CDC just weeks after she took the job, and stoked fears about prenatal Tylenol use as a cause of autism despite recent conflicting evidence. A string of top CDC officials, including the chief science officer, has resigned, and those who remain say morale has never been lower.

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

But the Kennedy faithful don’t care about the health secretary flouting institutional norms or sidelining subject-matter experts, because they view HHS, and the CDC in particular, as either useless or corrupt. In fact, some at the conference worried that Kennedy is not acting with enough urgency. (In an email, the HHS spokesperson Emily Hilliard wrote that Kennedy “remains committed to ensuring that all Americans have access to accurate, evidence-based information about vaccines.”)

They want Kennedy to investigate their belief that the government supposedly colluded with Big Pharma to hide the harms of vaccination. In a session on Saturday afternoon, former Republican Representative Dave Weldon, whose nomination to become CDC director was withdrawn in March amid outcry over his criticism of immunizations, called for the creation of an independent body to investigate vaccine-safety data and report only to Kennedy and President Donald Trump. “If it’s in the hands of the CDC, you’ll never get the answers you need,” he told the crowd. During a session titled “The Enduring Nightmare of COVID mRNA Technology,” Sherri Tenpenny, a veteran anti-vaccine activist who once said that one goal of COVID vaccination was to turn people into “transhumanist cyborgs,” called for the mRNA-based vaccines to be taken off the market: “It’s just the next level of atrocity of how they want to damage us and make us customers for life.” Mark Gorton, the founder of LimeWire who is now president of the MAHA Institute, a think tank, favors stopping routine shots altogether until they’ve undergone further testing. “The medical establishment will scream that plagues will sweep across the land,” he said from the stage. “We need to counter that their plague of vaccine poisoning is already amongst us.”

[Read: The neo-anti-vaxxers are in power now]

Other attendees were frank about their attempts to personally influence Kennedy. Steve Kirsch, a former tech executive turned anti-vaccine activist, told me at the conference that he texts directly with the health secretary. After getting vaccinated against COVID, Kirsch became convinced that the shot was unsafe and began campaigning against it. He said he later took a supplement marketed to remove spike proteins from the body, which he now blames for causing him to go blind in one eye. Kirsch told me he recently sent Kennedy some data from the Czech Republic that he believes prove that COVID shots increase mortality rates. (Multiple studies have shown that the vaccines reduce mortality rates, particularly in those over 60.) He is frustrated that he hasn’t heard back yet. “Kennedy’s taking baby steps, and that’s a big problem,” Kirsch told me. (When I asked Hilliard about Kennedy’s correspondence with Kirsch, she did not provide an answer.)

Although the MAHA merch table sold hats with slogans such as RAW MILK IS MILK and MAKE FRYING OIL TALLOW AGAIN, the attire of conference-goers was mostly vaccine-themed: One popular T-shirt featured an illustration of a syringe with the message COME AND MAKE ME. Mary Holland, the chief executive officer of Children’s Health Defense, began the conference by listing some of the environmental triggers that she believes cause chronic childhood disease, including stress, ultra-processed food, and electromagnetic radiation; attendees were asked to switch their phones to airplane mode out of consideration for those sensitive to Wi-Fi. But as she told the crowd, “It is in large part—predominantly—the vaccines.” Gorton agreed. “There’s been a lot of progress in terms of the MAHA movement, but if you look at real, meaningful changes in the health system, they’re trivial,” he said. He characterized the general feeling about the progress that’s been made since Kennedy became secretary as “mixed.”

The forces aligned against Kennedy, everyone at the conference seemed to agree, are formidable. Leslie Manookian, the president of the Health Freedom Defense Fund and the author of a recently passed Idaho law that makes vaccine mandates illegal, railed against the “pit of vipers” that Kennedy must deal with in Washington. In a session titled “Sustaining the Promise of Freedom Through Action,” the crowd applauded when Joseph Ladapo, Florida’s surgeon general, announced that the reporters from The Atlantic and The Washington Post in the room “represent forces who are working toward the enslavement of humanity”—though he allowed that he had “nothing against them.” (As The Atlantic’s editor in chief, Jeffrey Goldberg, told the Post, “In fact, The Atlantic is not working towards the enslavement of humanity, but I appreciate his concern.”) Ladapo spent most of his speech expounding on his experience with psychotherapy and his relationship with his wife. The day after Brand declined to speak with me and called me a Nazi, Alex Jones posted a two-hour interview in which a bathrobe-clad Brand dismissed the allegations against him as a “governmental and media operation.”

Several speakers counseled patience in the face of such powerful enemies, encouraging attendees to keep their faith in Kennedy. Wakefield (who received a hero’s welcome himself) insisted that Kennedy was on the right path: “We need, collectively, to give Bobby Kennedy—a very, very brave and smart man—the support he needs to get through the next round.” Del Bigtree, who served as communications director for Kennedy’s presidential campaign and identified himself as a lifelong Democrat, emphasized the importance of Republicans doing well in next year’s midterms so that Kennedy can continue to carry out the “Make America Healthy Again” agenda.

[Read: RFK Jr.’s victory lap]

Kennedy may not have gone far enough yet in realizing the goals of the so-called medical-freedom movement, Bigtree said, but given enough time and popular support, he still might: “We’ve got to hold it together so that Bobby can just work.”

Photographs by Alana Paterson

The police came at dawn. Karen Espersen watched them drive into the valley: more than 40 cruisers in a line. They were on a mission from the government. All of her ostriches must die.

Karen and her business partner, Dave Bilinski, were standing in the outdoor pens of their farm in the mountains of Canada’s West Kootenay. The fate of their flock had been taken up by right-wing media, and had become another front in a spiritual war. An angry group of their supporters, with signs and walkie-talkies, gathered on the property. They’d set up a barricade to slow the cops’ advance: several logs laid across the dirt near the turnoff from the highway. 

The activists had been camping out for months; their numbers sometimes reached into the hundreds. They knew the government was saying that the ostriches had bird flu, but they were convinced that this was cover for some other, bigger scheme. The feds were conspiring with the United Nations and Big Pharma, they said. Small farmers’ rights were being trampled. But Dave and Karen’s birds had other, more powerful friends. Robert F. Kennedy Jr. was making calls to Canadian officials; Dr. Oz had offered to evacuate the ostriches to his ranch in Florida. 

Canada “respects and has considered the input of United States officials,” the nation’s deputy chief veterinary officer had said. But rules were rules, and birds were birds—even if they were the size of refrigerators. And so a convoy of police had been sent to occupy the farm. Law-enforcement drones were flying overhead. The electricity was cut off. 

The farm’s supporters had already threatened local businesses that were renting equipment to the cops, saying they would shoot employees. Then someone claimed that they’d placed a bomb somewhere on the property.

At 7 a.m., while the police were stuck behind the logs near the highway, a man slipped out of sight, donned a balaclava, and grabbed a jerrican of fuel. He crept over to the next-door neighbor’s house and doused its front with gasoline. Not more than 50 yards away, a group of ostrich activists stood around a bonfire, streaming from their phones as they sang “The Battle Hymn of the Republic.” When the neighbor came outside and tried to chase the would-be arsonist away, her screams for help were broadcast live on social media, above the sound of “Glory, glory, hallelujah.” 

For decades, Karen and Dave had been raising hundreds of ostriches on a 58-acre plot in the small town of Edgewood, British Columbia. They’d earned a living from the meat and hide and feathers, and from a moisturizing lotion that they made from rendered ostrich fat. They’d also welcomed tourists to the property, bused in through the Monashee Mountains on a farm safari. But in mid-December of last year, the flock at Universal Ostrich Farms was overtaken by disease. The young birds in particular were having trouble breathing. Mucus leaked from eyes and beaks. Some were clearly feverish: They were roosting in puddles, even in the cold.

Over the next few weeks, the birds began to die, one by one, and then in groups. Dave hauled their carcasses across the property and buried them in 10-foot holes. The vet was out of town, so Karen did her best to nurse the sick. But more than 20 died, so many that they didn’t fit into the pits. Dave had to stash the rest beneath a tarp.

Locals noticed what was going on; you could see ravens feeding on the carnage from the highway. On December 28, someone notified the sick-bird hotline set up by the Canadian Food Inspection Agency, which monitors and manages agricultural diseases. Now the government was asking questions. Was there standing water on the property? Were the ostriches outdoors? Had Dave been aware of any wild birds nearby?

In fact there was some standing water, and the ostriches were never not outdoors, and lots of wild ducks had alighted in their pond and now were poking in the flock’s straw bedding and leaving droppings by the food bowls. To the CFIA, it sounded like a recipe for bird flu. A pair of government inspectors showed up two days later, in masks and Tyvek suits, and swabbed a couple of the carcasses. Their test results came back on New Year’s Eve: The birds were positive for the “H5” part of H5N1, the deadly strain of avian influenza that has raged through North America in recent years. According to the Canadian authorities, and in keeping with the nation’s agricultural-trade agreements, the outbreak had to be stamped out. The birds would have to die. 

An ostrich is of course a grand and silly thing: more than six feet tall with giant eyes, a 350-pound sedan on muscled stilts. It chirps and booms and honks and grunts. It wags its tail and pulls the threads from your sweater. Some ostriches on Dave and Karen’s farm had names: Barney, Peter, Q-Tip, Sarah. One looked so much like Dave himself, with bushy white eyebrows, that it shared his name. Karen used to keep an ostrich as a pet—a Somali blue, the smaller kind—and she called it Newman because it liked to hop up on her couch and watch Seinfeld on TV. Her son remembers riding Newman like a pony.

Now Dave and Karen’s flock of charismatic megapoultry was a threat to public health. They tried to bargain with the government. They said the illness was subsiding. They argued that their older birds had never even gotten sick and might already be immune. They noted that the compensation they would receive for a cull—up to $3,000 per animal—wouldn’t be enough to cover their losses. And then Karen started spinning out a stranger story. Universal Ostrich Farms wasn’t just a farm, she told the CFIA; it was the site of cutting-edge research. She and Dave were working on a novel class of ostrich-based pharmaceuticals—medicines that could one day help rid the world of many different ills, including cholera, obesity, and COVID. The drugs might even put an end to bird flu itself.

H5N1 doesn’t pose a major threat to human beings—or, one should say, it doesn’t yet. The virus has not adapted to our airways. But a current strain has already made the jump from birds to dairy cattle, and more than 70 people in North America have contracted it through exposure to infected animals. Most human cases have been very mild. But around the time that Dave and Karen’s ostriches were getting sick, a teenage girl in their province was rushed to a pediatric ICU with failing lungs and kidneys. She had bird flu and nearly died.

Dave and Karen maintained that their birds were not a danger but a cure. Now that the survivors had been exposed to bird flu, Karen told the government by email, they’d be laying eggs that were full of bird-flu antibodies. That could be the key to something extraordinary: If those ostrich antibodies were extracted and sprinkled into feeders, she said, then wild ducks might inhale them and develop their own immunity. Treat enough birds this way, and the entire epidemic could be stopped. 

Karen’s plan did not impress the experts at the CFIA, and to be clear: It isn’t sound. Extensive tests have not been run to show that ostrich antibodies protect other animals when they’re eaten or inhaled. Even if the antibodies were effective in some way, to stop the spread of H5N1 you’d have to load enough of them in feeders to shield the 2.6 billion migratory birds that cross the border into Canada each year. And CFIA scientists found no reason to believe that Dave and Karen’s ostriches would be a special source of antibodies, an agency spokesperson told me. The farm’s request for an exemption was denied.

But Karen’s email wasn’t entirely deluded, not in every detail. She and Dave had been in touch with Yasuhiro Tsukamoto, a scientist and the president of Kyoto Prefectural University, who has for years been pushing the idea that ostriches, and their powerful immune system, could be the basis for an industry in biomedicine—that the birds’ enormous eggs are factories for mass-producing antibodies in response to almost any pathogen. A single ostrich hen can make about a cup of these a year, Tsukamoto says, which might in turn be layered onto ventilation screens, painted into face masks, or used in ointments, sprays, and pills. A few such products have already been marketed in Japan, among them a soy sauce with ostrich antibodies for E. coli and a cosmetic line with ostrich antibodies for the germs that can lead to pimples.

Dave and Karen first learned about Tsukamoto’s work in March 2020, when he was inoculating ostriches with SARS-CoV-2 antigens. They did the same and hoped to sell their antibodies to a company producing masks. But they couldn’t land the deal, and ended up with freezers full of SARS-CoV-2-resistant egg yolks. A few years later, they’d moved on to something bigger: an ostrich diet pill, made from antibodies for the enzymes that digest sugar and starch. This could be a natural rival for Ozempic, they believed, sold as “OstriTrim.”

In November 2024, just around the time when all those wild ducks began to settle in their pond, Dave and Karen were finishing their business plan. They would partner with Tsukamoto’s licensee in North America, a company called Ostrich Pharma USA, and begin inoculating birds in early March. After that, the money would start pouring in. Within five years, the farmers’ business plan predicted, they’d clear $2 billion in annual sales.

But then an ostrich got a bloody nose and another one began to wheeze, and more were plopping down in icy water.

Katie Pasitney, Karen’s oldest child, grew up among the ostriches. She describes them as her family. So when Katie heard that the CFIA had ordered their destruction, she set out to raise hell. The birds themselves—those “big, beautiful babies,” she calls them—were natural mascots for a social-media campaign. In one early plea for help on Facebook, Katie put up a picture of a favorite ostrich from the farm. “Meet Sarah ♥️,” Katie wrote atop the post. “PLEASE HELP SAVE ME BEFORE I’M KILLED BEFORE FEB 1ST.”

By the end of January, Sarah’s fate had been taken up by right-wing media and online activists. Supporters began to gather at the farm. They built a campsite in the freezing cold and posted signs for Katie’s website, saveourostriches.com. People stopped by for the day and never left. A field kitchen was set up, porta-potties were installed, and volunteers were given jobs. They put up pictures of the ostriches, or wore them on their shirts and hats. At least one walked around in a full-body, feathered suit. At times there were 200 people in the field, just across the road from the ostrich pens. 

The group was there to save the animals, but by and large, they weren’t PETA types. They knew Universal Ostrich Farms had long been in the killing business; in the mess tent, supporters were not averse to eating meat. They were less concerned with harm to living things than with the threat to human liberty. These were freedom activists—people who had joined the convoy protests that swept through Canada in 2022 to oppose vaccine mandates. What brought them back together in the valley of the ostriches was a trailing fury over government intrusion, and suspicion about the aims of public health.

In the front room of her mother’s house, Katie set up a makeshift media center, with seven laptops on the table and cords everywhere. A handwritten ON AIR sign was posted whenever she was being interviewed live. Reporters started showing up in person, too. In one conversation after another, Katie and the farmers argued that the virus had already run its course. By their accounting, the 69th and final bird had died from the disease on January 14. The remaining ostriches were healthy, they insisted, and their location was remote—85 miles from the nearest city. What benefit would come from killing them?

Meanwhile, Dave and Karen brought their case to court and won a stay of execution for the birds until they finished their appeal. As winter turned to spring, the conflict reached a stalemate. The CFIA announced that no more inspectors would be coming to the farm, because of the risk of infection by the birds, and of interference by the protesters. Its staffers were getting threats by phone and email.

Then one night at the end of March, someone showed up with a gun. The birds were sleeping in their pens, some with upright necks, in the ostrich way. In the hours before sunrise, Katie and the farmers said, one was shot just below the ear. Dave and Karen found the carcass in the morning, lying in a pool of blood. The assassinated bird was Sarah, the one from Katie’s Facebook post. 

A couple of days later, one of the farm’s supporters posted a musical tribute to the fallen ostrich on social media, called “Feathers of Resistance (Sarah’s Song).”

Out in the fields ’neath Edgewood skies,
She walked with grace with ancient eyes.

Not just a hen but hope in stride,
Her blood held truth they tried to hide.

“A sniper’s bullet ended her life, but not her story,” the poster wrote.

After Sarah’s death, a deeper sense of dread overtook the valley. The farm began to fortify. Trip lines were laid around the ostrich pens and hooked up to bear bangers to scare away intruders. Supporters equipped themselves with walkie-talkies. And Dave and Karen started sleeping in the ostrich pens. 

Katie’s interviews and Facebook streams grew more conspiratorial. The supporters had been seeing government drones flying overhead at night, she told a podcast host in May. Karen, too, was obsessing over hidden plots. The farm’s website had malfunctioned in December, out of nowhere, even though she was sure that she’d set up the domain to auto-renew. Could it have been a government-associated hack? Could all of this have been a plan to stop her antibody business—to “squish our science,” as she later put it to me? Could it be that certain institutions were trying to hide the fact that H5N1 bird flu wasn’t really all that dangerous? 

Two months after the shooting, a second bird was murdered in its pen. Karen said she heard a drone flying overhead between 1 and 2 a.m., and then she saw an “Army-sized” device flying overhead, as big as the hood of a vehicle. Some folks from the encampment said they saw it too, while sitting by the fire. There was a silent flash of light, and moments later, Karen found one of the biggest roosters on the farm, an ostrich called Joey, with a hole through its head. This time the wound was vertical, starting near the crown and ending 18 inches down the neck. The drone may have been equipped with a gun, Karen told me. Maybe a silencer, too. Dave wondered if it might have been a laser. 

John Catsimatidis, a billionaire supermarket magnate and New York City radio personality, took a particular interest in the story of the ostriches. Toward the end of April, he invited a special guest onto the air: his old friend Bobby Kennedy. The secretary of Health and Human Services had come to talk about his plan for fighting autism, but near the end of the segment, Catsimatidis grabbed the chance to bring up the “awstriches,” as he calls them in his thick New York City accent. “Mr. Secretary, one last thing,” he said. There were these special birds in Canada, with a “natural healing process,” and now they were in danger because Big Pharma wanted them dead.

“I support you 100 percent,” Kennedy responded. “I’m horrified by the idea that they’re going to kill these animals.”

The cause was a natural fit for Kennedy. The anti-vaccine organization that he once chaired, Children’s Health Defense, had already aired an interview with Katie on its video channel in March. And Kennedy himself has often railed against government overreach in efforts to control potential outbreaks. Earlier that spring, Kennedy had declared that the U.S. and Canada’s policy of stamping out H5N1-infected chickens should be stopped. The survivors—the ones with naturally acquired immunity—could be used to repopulate poultry farms with hardier stock, he said. (Experts warn about the dangers of letting the virus spread unchecked; vaccinating poultry makes a lot more sense, two bird-flu scientists told me.) Kennedy also seems to have an affinity for large, flightless birds. He has kept at least one emu as a pet on his property in California.

One late night in May, Katie awoke to a call. At first she was confused, she said, but then she heard Kennedy’s raspy voice; the secretary was on the line with Catsimatidis. Some days later, as the sun set across the Monashees, Katie stood among the farm’s supporters in the field and choked back sobs as she prepared to read from a letter that Kennedy had written to her government. “We are respectfully requesting CFIA to consider not culling the entire flock of ostriches at Universal Ostrich Farm,” it said. The letter was signed at the bottom by three of the most important public-health officials in America: not just Kennedy but also FDA Commissioner Marty Makary and National Institutes of Health Director Jay Bhattacharya. (HHS did not respond to questions for this story.)

Katie’s “Save the Ostriches” campaign had until this point attracted hippies, libertarians, and anti-vaxxers, as well as local politicians in her province. Now it had the U.S. government.

I arrived in Edgewood a few weeks later, having come along the same twisting highway that the CFIA inspectors had used when they first drove out to test the ostriches almost six months earlier. As I pulled into the driveway, I could see the birds peering at my rental car from inside their large enclosures. 

I checked in with a volunteer in a makeshift booth, and he handed me an Ostrich Sheriffs sticker. A Canadian flag hung from the fence at the edge of the encampment, along with handmade posters: STOP the MURDER of 399 OSTRICHES. Save Ostrich Science (S.O.S.). If your child got sick in your family, would you kill the whole family?

Jim Kerr, an ostrich-farm supporter with a long beard, took me on a tour of the premises. Kerr is known among right-wing activists in Canada for his livestreamed protest videos, and for the soap-bubble-blowing art car that he drives to freedom convoys. Kerr explained that the supporters had an action plan for when the feds arrived. Dave and Karen would go into the pens and stand among the birds. Volunteers would block the road and send up drones to document everything that happened. They’d had a dry run just a few weeks before I came, when someone thought they saw a line of SUVs, all white, coming down the road. The sentries notified the camp; barricades went up; three women lay down on the highway. It turned out to be a false alarm. 

When I sat down with the farmers in the kitchen, Karen put out plates of sandwiches and cookies, and then she, Dave, and Katie launched into the story that they’d told so many times before, to politicians and supporters and the press. Katie, in particular, sometimes seemed to speak about the farm on autopilot, winding back to certain formulations about “giving small farmers a seat at the table” and the need to protect the “future of farming.” But still her voice would catch and the tears would flow, even in what must have been her thousandth telling. 

Her connections with right-wing and extremist figures were expanding. She told me that she would soon be headed to a “Truth Movement” conference down in West Palm Beach, where she would share a stage with several noted anti-vaxxers, as well as Enrique Tarrio, the former Proud Boys leader. And she let me scroll through a run of texts that she’d received in recent weeks from Mehmet Oz, who, like Kennedy, had gotten drawn in to her cause by Catsimatidis. Oz, the celebrity doctor who is currently the head of the U.S. Centers for Medicare and Medicaid Services, had suggested that he could bring the ostriches to Florida, but that wasn’t possible on account of the cull order. “I have spread the word widely and cannot understand why they cannot let me take these beautiful birds,” he wrote to Katie in one message. (Oz did not respond to a request for comment.) 

Again and again, the farmers said the Canadian government’s response to their outbreak made no sense. Plainly they were right in some particulars. Why couldn’t the CFIA just test the birds again, to see if the virus was still present? The government had claimed that this was impossible, that its inspectors would have no way to gather swabs from several hundred dangerous animals that can run at the speed of a moped, without handling facilities of any kind on-site. But I’d heard otherwise from independent experts. Adriaan Olivier, an ostrich-industry veterinarian in South Africa, told me that high-volume testing could be done. South Africa has been dealing with bird-flu outbreaks on ostrich farms for years, he said, and could manage the screening of even several hundred adults in one day.

Then again, I could also see—really, anyone could see—that Dave and Karen had been flouting basic rules of biosafety on the farm. At first, they hadn’t told the government that their birds were sick. And their “quarantine” was barely that. The same farm dogs that nosed around my feet inside the kitchen were also running in and out of ostrich pens. After Dave and Karen fed the birds, they sprayed each other down with disinfectant, but they didn’t change their clothes or remove their shoes. And the volunteers were clearly handling the eggs and feathers.

Those who had been around the farm the longest hadn’t simply been exposed to H5N1—they’d been infected. The farmers mentioned this offhandedly. Not long before my visit, Katie had tested positive for H5N1-specific antibodies. Dave and Karen had also turned up positive, as had one of their earliest supporters, a woman who’d arrived at the farm in January. No one could remember having any symptoms, though, and Katie wasn’t willing to concede that she or any of the others had caught the virus from the ostriches. 

The conversation circled back to the phone call from December that had prompted the government’s investigation—the tip-off to the sick-bird hotline. The farmers said it must have come from the woman who lives next door, Lois Wood. If it hadn’t been for her, none of this would have happened.

I spoke with Lois, a 72-year-old widow and volunteer firefighter, by phone a few days later. She lives just up the road from the ostrich farm. She can see the pens from her front yard. She said the situation had gotten out of hand. For months, the activists had been tormenting her: shining headlights in her yard, yelling out her name, tailing her when she was on her way to fire practice. “Finally—finally—somebody wants to hear the other side,” she told me. 

Lois claimed that she never reported the sick birds to the CFIA: She’d tried to call, but no one answered, and she didn’t leave a message. But everyone could tell that the ostriches were dying, she said, and the CFIA was right to get involved.

Elsewhere in the town of Edgewood, the fight to save the ostriches has brought out skeptics of the cause. Jim McFarlane, a local cattle rancher who has known Dave since they were kids, told me that, like Lois, he’d had enough. Dave has been “a total fucking bullshitter all his life,” he said. He asked me what I thought about the story of the murdered ostriches—the ones that supposedly were shot in the head in the middle of the night. “I mean, come on,” Jim said. “I’m a hunter, and you’re going to go out there in the middle of the night and shoot at a little fucking ostrich head when you’ve got a 300-, 400-pound body there?”

It’s true: An ostrich head is like a Q-tip protruding from a very large piñata. The idea of aiming for it, at least while sneaking in the dark, seemed preposterous. Yet Dave and Karen insisted that not one but two birds had been killed like this. Jim thinks that Dave and Karen might have killed the birds, that maybe they were trying to draw attention to the farm for the sake of more donations. Lois had another theory: What if the birds were still sick? What if the outbreak hadn’t ended, and the farmers didn’t want the government to know? (Both ostrich murders are still under investigation, according to the Royal Canadian Mounted Police. When I brought the claim to Dave that he’d shot the birds himself, he told me, “That’s insane.”)

The matter of the ostrich shootings is one of many that’s been taken up by a local Facebook group, “Edgewood—Uncensored,” in which a group of grumpy neighbors and others in British Columbia debate the ostrich farm and what they deem to be its hidden motives. They obsess over every open question and apparent inconsistency, such as who really called the CFIA about the sick ostriches, and how many birds were really in those pens. Some even wondered if the so-called standoff was a piece of theater, concocted by the government and its contacts in Big Pharma. Maybe no one ever really planned to cull the birds. After all, hadn’t Dave and Karen been involved in biotech? Hadn’t they injected ostriches with COVID?

If Katie, Dave, and Karen had built their movement from the bricks of outrage and suspicion, then those bricks were also being hurled against their walls. Paranoia had sustained them to this point, but paranoia was a force that they couldn’t quite control. 

I drove out to the farm again in late September. The line of police cruisers had snaked into the valley just a few days earlier, and I could see the marks of occupation. The property was divided at the edge of Langille Road. Yellow tape stretched across the northern side, at the entrance to the pens, and officers were taking shifts on guard. Just across from them, the farm’s supporters had put up a set of wooden bleachers so they could try to watch and record everything that happened. An inscription had been carved into the top row: In Appreciation: Robert F. Kennedy, Jr. Some of the birds had been dedicated too: There was now an ostrich Charlie Kirk, an ostrich Dr. Oz, an ostrich Donald Trump.

I’d arrived at a moment of uneasy calm. Not so long before, every sign had suggested that the standoff was about to end. After many hours’ worth of yelling and negotiations, the police had seized the pens; Karen and Katie were driven off in handcuffs, and briefly held. The CFIA had put up a wall of hay bales in the field, presumably to hem in the flock and hide the coming slaughter. But hours later, just as Dave and Karen were finishing a group prayer, their lawyer called to say that the Supreme Court of Canada had intervened. The justices were considering whether they would hear the case, and that meant the ostriches would not be killed just yet. Everyone agreed that this intervention was divine. 

Now the camp was far more crowded than it had been in June. No one took my name and phone number, or handed me a badge, when I arrived. Near one corner of the pens, I met a man named Thomas, who was taking footage of the Mounties with a camcorder. “I hate cops,” he said. “If one of those guys got a bullet to the head, I wouldn’t shed a tear.” Thomas told me that he’d been incarcerated for assault and fraud, but that his days as a criminal were over. “I don’t condone violence,” he said, “but I’ve started to think some violence might be necessary when there’s no other way to make people pay attention.”

Over at the house, Dave and Karen were meeting with the police department’s liaisons. Dave looked as though he hadn’t slept for days. His ears were bloody from the ostrich pecks that he’d sustained during his vigil in the pens. When I asked him what he’d do if the cull was carried out, he cried into his hand. If the ostriches were killed, Dave and Karen would have nothing left. They may no longer be eligible for compensation for the loss of the birds, according to the CFIA rules. They also owe tens of thousands of dollars to the government in fines and legal expenses. In the meantime, they’d been deprived of revenue for months, and the farm had already been facing heavy debts when all of this started. “There’s no recovery from this,” their lawyer, Umar Sheikh, told me.

Next door, in the grass outside Lois’s double-wide trailer, the smell of gasoline still lingered. When she came outside to say hello, I saw that she had bruises on both arms, cuts on her face, and a black eye. She’d only stopped the would-be arsonist by chance, she said: She’d come out to feed one of her cats and there he was, reaching into his pocket, as if to grab a lighter. She’d lunged at him, bit him on the elbow, and kicked him in the groin. Then he punched her in the face and fled. The police identified their suspect by the tooth marks on his arm. 

The man was a freedom-convoy veteran, Karen’s son told me, who’d warned the others in the group that he planned to go to jail before this all was over. Both Katie and her mother claimed, at least at first, that the attempted arson never really happened—that the whole thing was a setup by the members of the local “hate group” who had criticized the farm online.

I asked Lois if she felt unsafe. She told me that she’d gone to stay with a friend on the night after the attack, but had come back to the farm to tend to her cats and her tomatoes. She said that there were a lot of cops around for protection, but also that she didn’t see herself as having many options. “People say, ‘Well, you should do a civil suit against them for slander, libel, whatever, harassment,’” she told me. “I say, ‘I could not bear to do that. Can you imagine going up against Katie? You wouldn’t win.’” 

Moving out of Edgewood didn’t seem to be an option, either. Lois’s property, her 120 acres in the valley, was all she had, and who would ever buy it now? She was living on the site of a bird-flu quarantine. Fair or not, she was just as trapped as Dave and Karen. “I keep thinking it’s going to be over,” she said. And then it never is.

An end did come at last, six weeks later. On November 6, the Supreme Court decided not to hear the farmers’ case. The Notice of Requirement to Dispose of Animals issued by the CFIA more than 10 months earlier was reinstated for the final time. Shortly after nightfall, once the police had cut their floodlights and sealed off Langille Road, gunshots started ringing out behind the hay bales. At first there were a dozen, then many dozens more, as hired marksmen fired on the flock from platforms.

Katie squatted at the border of the pens, pulling at the fence and screaming, “Make it stop.” Karen stood beside the line of officers who blocked the road. “They’re killing my babies,” she said.

By the next morning, the cull was over. All of the ostriches—314 of them, by the government’s final count—were dead.

It was gray and it was cold in the valley. Autumn had returned: one full cycle of the seasons from the day Dave and Karen’s birds first began to falter in the slush. Waves of wild ducks were passing overhead once more. Since the start of fall, the bird-flu virus has again been spilling over into poultry flocks in North America. Another 8 million birds have been killed on U.S. farms in recent months, and 3 million more in Canada.

While construction vehicles shoveled up the ostrich carcasses and dumped them into trucks, the farm’s supporters gathered for a vigil, in person and online. It had been 297 days, they claimed, since any of the birds were sick. Whether this was true no longer mattered. The outbreak on the Universal Ostrich Farms had reached its end; yet even now, no one could agree about the nature of the threat. Had the poultry been a risk to public health? What about the farmers, who never thought the rules applied to them? And what about the government, which chose annihilation over compromise? Any middle ground was now awash with blood. Some kind of danger had been present in those pens; that was clear enough. Now that danger is stamped out.

Load up on linguine and stock up on spaghetti. In the new year, high-quality pasta may be a lot harder to come by in American stores. Several weeks ago, the U.S. Commerce Department announced that, starting in January, most pasta imported from Italy could be subject to a preliminary 92 percent tariff—on top of the 15 percent blanket duty on goods from the European Union. Outraged Italian pasta manufacturers are threatening to pull their products from American shelves.

The proposed tariff, the result of a year-long investigation into the pasta industry, targets 13 Italian companies that have allegedly undercut U.S. manufacturers by selling underpriced pasta. Pasta tensions between the United States and Italy have been simmering since the 1990s, but this new proposal has turned up the heat. White House Press Secretary Kush Desai told me that some of the companies “screwed up” their initial response to the probe by providing the U.S. government with incomplete data, but if they comply going forward, the Commerce Department may yet recalculate its tariff. The pastifici insist that they’re being unfairly targeted, and an Italian agricultural industry group has said they won’t give in to pressure. That could leave American noodle connoisseurs in an impastable situation.

The affected companies, which include La Molisana, Pasta Garofalo, and Rummo, manufacture the usual penne and rigatoni as well as fancier shapes: tubular bucatini, spiraling elicoidali, and delicate rings of anelli siciliani. Notably, all of them specialize in “bronze-cut” pasta. This term refers to the tool, known as a die, used to extrude the pasta dough into shapes. Using a bronze die gives the pasta a slightly sandpapery texture, which clings better to sauce and results in a more satisfying bite. (Indeed, I have tasted bronze-cut pappardelle, and it is spectacular.) Bronze-cut pasta imbues the water in which it is boiled with extra starch, and ladling some of that water back into the pan while mixing pasta and sauce—nonnegotiable for pasta enthusiasts—creates a silky dish, the chef J. Kenji López-Alt told me.

Most of the pasta made and sold in America is not bronze-cut, but extruded using plastic molds coated with Teflon, according to Tom Sheridan, president of sales and international development at the U.S.-based Kensington Food Company, which makes bronze-cut pasta. A pasta die is about the size of a car tire, dotted with 40 to 60 inserts that extrude the dough, Scott Ketchum, a co-founder of the American bronze-cut-pasta brand Sfoglini, told me. Bronze inserts aren’t as durable as plastic ones, so they need to be replaced more often. Ketchum said that he spends roughly $4,000 every two years to buy new inserts from Italy. Each shape requires a different insert, Tony Adams, the owner of Mill Valley Pasta, told me. And a major downside of making more textured pasta is that it produces huge amounts of pasta dust, necessitating even more equipment and labor to clean up the machinery, according to Dan Pashman, who hosts the Sporkful podcast and created his own pasta shape that launched with Sfoglini in 2021. Teflon pasta is cheaper to make because the dough simply glides out of the die, resulting in a faster and more streamlined process—and pasta that is gummier and less adherent to sauce.

These days, the average American is likely more concerned with price than the mouthfeel of their macaroni. Still, over roughly the past decade, demand for better-quality pasta has grown. Barilla, known in the United States for its inexpensive American-made products, launched its Al Bronzo line of imported Italian pasta in 2022. Even midrange stores such as Target and Wegmans sell their own bronze-cut pasta. House-brand pastas are usually imported from Italy, so they too may be affected by tariffs, Ketchum said.

[From the July 1986 issue: Pasta]

Bronze-cut pasta’s popularity is growing in part because Americans are becoming more savvy about their food. “Pretty much all the pasta was Teflon” until people started learning that there were tastier alternatives, Pashman told me. Recently, the appetite for bronze-cut pasta has also been whetted by health fears. In wellness circles, Teflon is basically synonymous with poison because it comes from a family of chemicals, called PFAS, that have been linked to certain cancers and reproductive issues. On TikTok, lifestyle influencers encourage viewers to seek out bronze-cut pasta because it is supposedly healthier than its Teflon-extruded kin.

The concerns are largely a nonissue. Teflon cookware can release harmful chemicals when it’s overheated, but extruding pasta is a room-temperature affair, Sheridan told me. Teflon bits could flake off into the pasta, but the health effects of this are unclear, and the company that makes Teflon maintains that those particles are inert. As I have written previously, the health consequences of using PFAS-coated cookware are generally not well studied.

If the pasta tariff goes into effect, bronze-cut pasta will almost certainly be rarer on U.S. shelves. More than half of America’s pasta imports—much of which is bronze-cut—come from Italy. Historically, and even more so now, companies don’t have much incentive to start making it domestically: “It’s gonna cost you a quarter of a million dollars or more to get into the game,” Sheridan said. Bronze-cut-pasta equipment from an Italian company called Fava Storci, which he called the Ferrari of pasta machinery, can cost upwards of $500,000. Such machines are hard to come by in the U.S., so they’re usually imported from Europe—and subject to their own tariffs.

[Read: A great way to get Americans to eat worse]

If the pastifici accept the Trump administration’s proposed tariffs, Americans who are fussy about their pasta—for culinary or health reasons—may soon have to make tough decisions: stomach another meal of slippery, Teflon-extruded penne, or pay extra for ridged radiatori? The alternative—that bronze-cut noodles simply won’t be available—is scarier still. After a decade of growing accustomed to the chewy, high-friction delight of bronze-cut shapes, many American foodies may find that they can’t get their teeth on them at all.

Last Thursday, in lieu of my afternoon coffee, I placed a sticker on the inside of my wrist. It was transparent, about the size of a dime, and printed with a line drawing of a lightning bolt—which, I hoped, represented the power about to be zapped into my radial vein. The patch had, after all, come in a box labeled Energy Boost.

So-called wellness patches have recently flooded big-box stores, promising to curb anxiety, induce calm, boost libido, or dose children with omega-3s. Their active ingredients are virtually indistinguishable from those of the many oral supplements already hawked by the wellness industry. Whether the skin is a better route for supplements than the stomach isn’t entirely clear. But the appeal of wellness patches seems to have less to do with their effects and more to do with how they look.

Wellness patches are generally pitched as an easier, safer way to take supplements. The website for The What Supp Co., a British brand that launched in the United States this year, describes its products as “super convenient” because users don’t have to take a pill or mix a drink—plus, they’re extra portable. That brand, like many patch sellers, laments the filler ingredients (such as corn starch and gelatin) that can show up in oral supplements, plus their digestive side effects; patches, it says, come with no such risks. The slogan for Kind Patches, which rolled out across Walmart locations last month, is “No pills. No sugar. No nonsense.” Half Past 8, a patch company that launched last week, says that its products sidestep the crash and comedown associated with some pills and gummies by offering a slow drip of wellness. Some brands also advertise that, unlike a pill, you can take a patch off when you’ve had enough. But that cuts both ways: I put another patch on my wrist yesterday morning, and it had fallen off by the time I got to the office.

Most of the products are labeled as remedies for common complaints. Stickers from The Good Patch include Nite Nite for better sleep, Think for boosting focus, and Rescue for hangovers. Several brands sell patches that purport to mimic the appetite-reducing effects of GLP-1 drugs; you can buy them on the fast-fashion website Shein. And whereas traditional oral supplements tend to be marketed as vectors for specific compounds, leaving users to mastermind their perfect mix, patches are usually cocktails that advertise their active ingredients less prominently. Putting on The Friendly Patch Co.’s Relax and Let Go sticker really is easier than consuming supplemental forms of its seven key components, which include the herb ashwagandha, the neurotransmitter GABA, and magnesium. (Neither The Good Patch nor The Friendly Patch Co. responded to a request for comment.)

[Read: The return of snake oil]

Whether those ingredients will actually help you chill out is an open question, as is whether they can pass from a sticker into the bloodstream. The whole point of skin is to keep most things out of the body, and although some compounds are known to pass through the skin—nicotine and birth-control patches have been used for decades—little is known about the permeability of the many ingredients used in wellness patches. Some basic principles are well established: For compounds to pass through the skin, they need to be both tiny and fat-soluble; caffeine and vitamins A, D, E, and K all meet those criteria, says Jordan Glenn, the head of science at SuppCo, an app that helps supplement users optimize their intake.

But other common wellness ingredients—such as coenzyme Q10, vitamin B12, folic acid, and zinc—require extra processing to permeate the body’s exterior, Glenn told me. My lightning patch was made by Barrière, whose co-founder Cleo Davis-Urman told me that the company uses a process called micronization to break down large molecules into particles small enough to enter the bloodstream. Micronization is a real technique used for pharmaceutical drugs, transdermal or otherwise, so it’s certainly possible that it could help big compounds pass through the skin. Yet this assurance, together with claims that patches offer a gentler and more sustained release than oral supplements, simply isn’t backed up by independent research; Meto Pierce, a co-founder and the CEO of Half Past 8, told me that the industry is “still developing in terms of published data.” “There might be claims of skin patches being more effective or more consistent, but we can just ignore that at this point because there’s no proof,” Elise Zheng, a health-technology researcher at Columbia University, told me. Dietary supplements aren’t regulated for safety or effectiveness by the FDA, and patches can’t even be regulated as dietary supplements, because they’re not ingestible.

[Read: Everything is a multivitamin]

Wellness patches seem most useful for people who are already supplement enthusiasts—not only because they’ve already bought into the idea that ashwagandha works but because they take so many oral supplements that their mouth needs a break. “Pill fatigue” is a common complaint among the wellness set, Glenn said, though patch users notably still need to remember to apply their supplements. (Glenn also pointed out that patches might be more convenient for people who have digestive problems or difficulty swallowing.)

An hour after I put on my sticker last week, I thought I felt marginally less groggy than usual. Maybe micronization really did make its B12 and folate particles tiny enough to seep into my skin. Or maybe the source of my energy was the sunny 15-minute walk I’d taken to acquire the sticker. By far the most noticeable impact of my thunderbolt was that I kept admiring it, as if it were a tattoo I’d gotten on a whim.

Wellness patches are meant to be seen, as their fun colors and designs suggest. Ads for Kind Patches show wrists adorned with pepperoni-size stickers whose color matches their claim: Dream patches are a dusty blue, Energy is electric yellow, and Period Patches are, of course, bright red. The What Supp Co.’s patches are shaped like a w and come in lavender (for chilling out), kelly green (for detoxing), and pink (for beautifying). “We want the experience to feel joyful and intuitive, not clinical,” Ivana Hjörne, the founder of Kind Patches, told me. Kelly Gilbert, the founder of The What Supp Co., suggested that a patch on your skin could remind you to make other healthy choices throughout the day. It’s also free advertising for the company. Davis-Urman, Barrière’s founder, told me that with patches, customers are “elevated to brand ambassadors, because the product sparks conversation.”

Before the rise of social media, personal wellness was a more private endeavor. These days, people post their run stats, sleep scores, and workout selfies; they wear fitness trackers and brand-name athleisure to the gym. This shift has reordered the priorities of personal health. It’s not just about taking care of yourself; it’s about taking care of yourself in a visible and socially sanctioned way, Marianne Clark, a sociologist at Acadia University who studies wellness culture, told me.

[Read: The perilous spread of the wellness craze]

Accordingly, wellness has also become a notably aesthetic pursuit—it’s no surprise that you can find patches to release skin-firming collagen or strengthen hair and nails. Conspicuous consumption has been part of the beauty industry since at least the 1920s, when Chanel No. 5 first hit shelves and became synonymous with wealth and luxury. (Wellness patches, too, don’t come cheap: My pack of 36 was $15, and other brands charge significantly more.) Social media has made the labor of beauty all the more visible. The online beauty community is rife with selfies glamorizing branded sheet masks and under-eye depuffing patches, photos called “shelfies” that showcase collections of expensive cosmetics, and images of celebrities sporting pimple patches in public. Brightly colored vitamin stickers similarly glorify the work of wellness. Not all wellness patches are beauty products, but many are meant to enhance appearance nevertheless.

By 11 p.m. last Thursday, seven hours into the eight that my sticker journey was supposed to last, I was not sure whether I was less tired than usual. (Davis-Urman assured me that, although the effects of the patch differ for everyone, “cellular-level benefits” were occurring whether or not I felt them.) But I did get a tiny hit of dopamine when my husband noticed it and said, “Cute tattoo.” My lightning bolt also nudged me toward self-reflection, a pillar of modern wellness. Whenever I glanced at it, I asked myself: How do you feel? The answer was the same every time: Tired.