Medical News

In his run for governor of Maine, Nirav Shah holds standard Democratic positions. He aims, his campaign says, “to fix housing, fund health care, feed kids, and fuel growth, while fighting back against the overreaches of the Trump administration.” But Shah’s background is less conventional: In addition to being a lawyer, he’s an epidemiologist who directed Maine’s CDC during the coronavirus pandemic and was the principal deputy director of the federal CDC until earlier this year. Shah decided to resign from the CDC in part because of Robert F. Kennedy Jr.’s confirmation as the secretary of health and human services. If he wins in 2026—a big if this early in the race—Shah suspects that he might be one of the first, if not the first, top CDC officials to secure such a prominent elected office.

Many science and health professionals have shied away from politics in the past. But as the Trump administration has rescinded its support for scientific research, restricted vaccine access, dismissed expert advisers, attacked doctors and scientists, and worked to curtail health-insurance coverage, researchers and health-care workers have had a surge of interest in running for office. Shaughnessy Naughton, the president of 314 Action, a political-action committee focused on electing Democrats with science backgrounds, told me that since January her team has seen almost 700 applications for candidate guidance, training, or funding, about seven times what the group would expect during an election off year.

Some of that interest has already translated into active campaigns. Candidates running in 2026 elections include a mathematician and a microbiologist, along with multiple pediatricians and former health officials. They are entering crowded races, in which even the primaries are months away. But many of these candidates argue that amid the administration’s attacks, voters will want to support scientifically minded politicians who can help fill the gaps in expertise that the nation’s leaders have left. Several told me that they specifically began their campaigns after Kennedy was confirmed and began to remake U.S. vaccine policy.

The number of candidates with science or health backgrounds is one more indication of how these fields are being forced to reckon with their role in the current political landscape. Plenty of science professionals still argue that their work shouldn’t be political. “Let’s get the politics out of public health,” Daniel Jernigan, who directed the CDC’s center for emerging and zoonotic diseases before resigning in protest of HHS’s approach to health policy, said at a rally in August. At the same time, the Trump administration’s attacks have created a political opening that many health and science experts are taking, even if it means politicizing science further.

Science and health representation in elected office is sparse: Three percent of state legislators are scientists, engineers, or health-care professionals, according to Rutgers University’s Eagleton Institute of Politics. The majority of those politicians are Republicans, Eagleton data show; so are most of the STEM professionals currently in Congress. But as groups, both scientists and, at least in recent years, doctors have leaned liberal, and many of those now motivated to speak out against the Trump administration are Democrats, Kristoffer Shields, the director of Eagleton’s Center on the American Governor, told me. Hawai’i’s Josh Green, the only Democratic physician currently serving in a state governorship, gained prominence during the coronavirus pandemic, when he advanced proactive mitigation measures as lieutenant governor. (This year, Green partnered with 314 Action to launch a $25 million campaign to elect 100 new Democratic physicians to office by 2030; he is up for reelection next year.)

Some science-minded candidates are entering electoral politics for the first time. For New Jersey’s Tina Shah (no relation to Nirav), an ICU physician now running for the U.S. House of Representatives, the push was the Trump administration’s approach to health care: She told me that she now regularly encounters patients who can’t afford medication or who are being denied coverage for important procedures. Others have made bids for public office before, including Abdul El-Sayed, a former health director with an M.D., who ran, unsuccessfully, for the Democratic nomination to Michigan’s governorship in 2018. He feels more confident in his current bid for U.S. Senate because the second Trump administration has made the harms of inaccessible care even more visible. He is gaining some traction: In the most recent quarter, he raised close to $1.8 million, the second-highest amount in his Democratic primary. Tina Shah, meanwhile, has raised more money from donors in a single quarter than any other Democrat in her district.

After the pediatrician Annie Andrews lost a congressional race in 2022, “I had no intention of running again,” she told me—then she changed her mind after watching Kennedy rise to the top of HHS. Andrews is running to unseat Lindsey Graham in the U.S. Senate, but she said she has found success in casting Kennedy—arguably the country’s most polarizing health secretary to date—as an opponent, too: “The more I speak out against the absurdity of RFK Jr. and his recent actions, the more traction I am getting.” For Richard Pan, a pediatrician and former California state senator, Kennedy’s threat is less abstract: When Pan was working on legislation that would make school vaccine exemptions harder to get, Kennedy, one of America’s most prominent anti-vaccine activists, traveled twice to Sacramento to oppose those measures, he told me. Pan’s now running for Congress in part to counteract Kennedy’s anti-vaccine policies at the federal level.

Many of the candidates I spoke with have considered just how much they want to lean into their credentials. For voters worried about health-insurance coverage or the future of research in the United States, scientists, health-care workers, and public-health experts may have particular appeal right now, Shields told me. Still, several of the candidates I spoke with told me they weren’t running “on an explicit science platform,” as Nirav Shah put it. The candidates I interviewed were all critical of Kennedy, but several were reluctant to fixate on him, arguing (as any politician might) that voters care more about changes that directly benefit their community.

In Nirav Shah’s view, behaving as though health and science are severed from politics is “a nonstarter.” As the Trump administration has worked to dismantle its own health agencies, members of Congress have fought to keep some of those agencies’ budgets intact. And as the administration has dismissed expert scientific advisers, state and municipal leaders have stepped in: Fifteen governors, for instance, recently announced the formation of a public-health alliance to dictate policy that diverges from the federal government’s. Although the coalition bills itself as nonpartisan, all of the participating governors are Democrats.

Under Donald Trump’s leadership, polarization around several scientific issues has deepened. The administration argues that research has been corrupted by ideology and claims that it’s restoring “gold-standard science.” Polls suggest that Republicans have been more supportive than Democrats of new restrictions on vaccine recommendations and research-funding cuts. If some Democrats are making an issue of the Trump administration’s record on health and science, so are Republicans. At least one Republican doctor running for the U.S. House has played up his opposition to mRNA vaccines; some members of Congress with health backgrounds who are running for reelection have embraced Trump-administration criticisms of COVID-era policies and gender-affirming care for children.

Several health and science professionals remain skeptical that getting into politics in any way will help their cause. Jernigan, the former CDC official, told me his call to “get the politics out of public health” at the rally meant that, for health policy, politics shouldn’t supersede evidence, not that politics can be fully extracted from public health, he told me. At the same time, he noted that enmeshing science and politics too deeply risks casting evidence and the practice of research as the business of only one political party. “Perhaps we are in a situation where there needs to be a more vocal, assertive public-health voice,” Jernigan told me. “But does it have to translate into political office? I don’t think so.”

And yet, the perception of public-health overreach has been a radicalizing force among Trump supporters; whether through electoral politics or not, any attempt to fight the administration’s actions may bolster its narrative that scientists have been corrupted by liberal ideology. When I asked candidates whether their campaigns might deepen partisan divides in attitudes toward science, many of them skirted the question—and few offered answers when asked how they’d cope with that reality. Instead, candidates told me that they felt fairly boxed in. “Politics came for us,” Andrews said. “You can’t fight bad politics by staying apolitical.”

Donald Trump was giddy. In the Oval Office today, the president announced that he had secured a deal to dramatically slash the price of obesity drugs. Soon, Wegovy and Zepbound will be sold on a new website—dubbed TrumpRx—for only about $250 a month, a fraction of their current retail price of more than $1,000. “Did I do a good job?” Trump asked the assembled reporters. “Do you think Biden could have done this? I don’t think so. ”

In some ways, the announcement heralds a breakthrough in expanding access to some of the nation’s most popular drugs. For years, millions of Americans have been priced out of these medications. Many private insurance plans do not cover these drugs, forcing people who want the weekly injections to pay out of pocket. The same situation has been playing out with Medicaid and Medicare. Only about a dozen states currently cover these obesity drugs for low-income Americans insured through Medicaid. And most seniors have been blocked from accessing the drugs, because Medicare is legally barred from covering weight-loss drugs.

Still, the announcement is more of a step forward than a leap. Both Novo Nordisk and Eli Lilly, the makers of Wegovy and Zepbound, respectively, already sell their drug directly to consumers for $499 a month. And most patients using TrumpRx won’t actually pay $250 for these drugs, at least initially. The price will be closer to $350 (exact costs will vary by dose), although the companies have promised to drop the price over the next two years, administration officials told reporters earlier today. (Novo Nordisk and Eli Lilly declined to comment for this story; the White House did not respond to my email.)

[Read: The obesity-drug revolution is stalling]

Patients are remarkably price sensitive when it comes to their medication—even when those drugs can mean the difference between life and death. A study from 2018 found, for example, that when out-of-pocket costs for cancer drugs were more than $100, a third of patients abandoned those prescriptions at the pharmacy counter. “Even at the lowest prices being offered by drug manufacturers, many people will struggle to pay out of pocket for these products,” Stacie Dusetzina, an expert on drug-pricing policy at Vanderbilt University, told me.

Under Trump’s deal, Medicare will now cover obesity drugs for the first time, allowing seniors to pay no more than $50 a month; the price for those insured by Medicaid will be even less. Even before today’s announcement, though, Medicare could cover the drugs for other conditions that often accompany being overweight, such as diabetes and sleep apnea. The Trump administration is opening up eligibility to those with prediabetes or certain heart conditions, among other comorbidities. Meanwhile, only seniors with severe obesity will be able to access these drugs through Medicare solely because of their weight. Overall, the Trump administration anticipates that roughly 10 percent of Medicare enrollees will be eligible to access these drugs following the announcement. It’s still unclear exactly what will happen with Medicaid. Coverage decisions ultimately rest not with the White House, but with the states.

What all of this means is that the biggest winners of today’s announcement might be the patients who are so desperate to access these drugs that they are willing to pay out of pocket. That’s only a small subset of patients. (A Novo Nordisk spokesperson told me before today’s announcement that roughly 10 percent of patients currently pay its discounted cash price for Wegovy.) How much someone with insurance pays for these drugs depends on their health plan; Eli Lilly notes on its website that through private insurance, people can pay as little as $25 a month.

Another factor is at play. Soon, patients may not be clamoring for Wegovy or Zepbound like they were before. America is about to enter a new era of GLP-1 drugs: Eli Lilly is expected to imminently submit an application to the FDA requesting approval to sell a new GLP-1 pill for weight loss. Novo Nordisk’s application for an oral pill is already pending before the FDA. As part of the deal with the government to cut prices, both companies were awarded vouchers that speed up the FDA’s review of their drugs. The announcement includes a commitment from both companies to sell the starting dose of new oral GLP-1 drugs for about $150; the higher doses for Eli Lilly’s drug will be capped at $399. (It’s still unclear how much Novo Nordisk will charge for higher doses of its oral drug.) Eli Lilly is similarly developing a new injectable GLP-1, retatrutide, that appears to be even more effective than the current drugs on the market—and which the company confirmed is not currently included in its agreement with the White House.

In his announcement, Trump gave himself credit for driving a hard bargain with drugmakers. “You think it was easy dealing with these people?” he said today. “It wasn’t.” But these companies are getting something in return. Both Eli Lilly and Novo Nordisk have made billions charging as much for these drugs as the market will allow. They’re on the cusp of brand-new drugs that are sure to be profitable.

Millions of the poorest Americans are stuck in food-stamp limbo. They still do not know when their benefits will arrive—or if they will at all.

In the past few days, the government shutdown has thrown the food-stamp program, formally known as SNAP, into chaos. On Friday, after the Trump administration said that SNAP was on the verge of running out of money, a federal judge ordered the White House to tap into a reserve of funds and pay out billions of dollars in benefits. Then, yesterday, the administration said that it had the funds to provide people on food stamps with only half of their monthly allotment of benefits. To make matters even more confusing, President Donald Trump today appeared to contradict his own Justice Department: SNAP benefits, he posted on Truth Social, “will be given only when the Radical Left Democrats open up government.”

White House Press Secretary Karoline Leavitt later appeared to walk back the president’s post. The administration is “fully complying” with the court order, she said. (When reached for comment, the White House pointed me back to Leavitt’s press briefing.) If the administration makes good on its promise, Americans still might not get their benefits for quite some time. In a legal filing, the administration said that it may take some states several months—yes, months—to get the benefits released, despite the fact that the judge ordered the benefits to be released by tomorrow.

None of this is normal. Food-stamp benefits have never been cut like this in the current program’s more-than-60-year history. “It is a significant inflection point in the program’s history,” Christopher Bosso, a political scientist at Northeastern University who wrote a book on SNAP, told me. “Where we go from here is anyone’s guess.”

This dustup likely means that some of the nation’s most vulnerable will end up going hungry, at least temporarily. In 2023, 5 percent of U.S. households qualified as very food insecure, meaning that at least one household member’s “normal eating patterns” were disrupted because of a lack of food. Even in cases where immediate hunger isn’t a risk, the delay in getting food-stamp money will create stress for Americans who rely on the program. SNAP provides low-income Americans with a monthly stipend loaded onto prepaid cards that they can use to buy groceries, and government data on SNAP transactions show that roughly 40 percent of households have less than $1 left at the end of the month.

[Read: America’s grocery lifeline is fraying]

These are signs that once the funds are released—assuming they are—many Americans will still struggle to make due on half of their usual food-stamp budget. The average SNAP household with children receives $574 a month, meaning that those households will now receive less than $300 in food stamps for the entire month. The Department of Agriculture, meanwhile, estimates that it costs nearly $1,000 a month to feed a family of four a “nutritious, practical, cost-effective diet.” In such a situation, SNAP beneficiaries are likely to gravitate toward the cheapest, most calorie-dense foods they can find.

Facing hunger, “your body is hardwired to go find food, whatever food you can find, regardless of whether it’s nutritious and regardless of whether it’s safe,” Hilary Seligman, a professor at UC San Francisco who researches food insecurity, told me. In the era before food stamps, that meant making decisions that now seem unconscionable: A 1954 survey of pregnant Black women in Louisiana found that 38 percent were eating laundry starch to satiate their hunger; 25 percent reported eating clay. In present-day America, the poor are likely to turn to ultra-processed foods. Packaged snacks full of industrial additives are ubiquitous and cheap: A bunch of kale is much more perishable than a bag of Doritos. An artisanal loaf of bread will set you back more than Wonder Bread. At my local grocery store, a pound of ground beef costs nearly $8, but a frozen entrée of six Salisbury steaks with gravy can be purchased for only $5. Ultra-processed foods cost just 55 cents per 100 calories, compared with $1.45 for unprocessed foods, according to a recent study.

These same ultra-processed foods have been targeted by the Trump administration and particularly by Robert F. Kennedy Jr., the secretary of Health and Human Services. He has pointed to junk food as a major contributor to America’s chronic-disease problem and has declared emphatically that food-stamp recipients should not be able to use government funds to buy soda. Several states will be testing a ban on the purchase of soft drinks and other sugary foods with food stamps starting next year.

The reasons ultra-processed foods are so troublesome are also the reasons they may, in this situation, provide a lifeline until SNAP benefits are fully restored. Yes, soft drinks might not do much to help a family stave off hunger, but faced with all of this uncertainty about if and when their benefits will come, SNAP households are going to be stocking up on the cheapest food they can rely on, even if they know it’s unhealthy. Now more than ever, healthy foods are a luxury in the United States.

My patient’s lungs were filled with blood, and he lay intubated in an ICU bed. His kidneys were failing, too. The cause of his illness was not a mystery: He had been previously diagnosed with an autoimmune disease that, in many cases, leads to severe organ damage, and he clearly needed the same treatment he’d received before, a drug that suppresses the immune system. With it, he started to improve in days.

At a follow-up visit, I suggested re-dosing the medication in a few months, to prevent future episodes of life-threatening inflammation. That word caught his attention. “What caused it?” he asked. “The inflammation, I mean.”

He and his wife exchanged uncertain glances as I explained that doctors don’t know what sets off most autoimmune inflammatory diseases: It’s likely a complex interplay between genetics, environment, and bad luck. But we do know how to treat them. At the next visit, his wife asked me about the potential causes of chronic inflammation that she’d read about online—tick bites, heavy-metal exposures, nutritional deficiencies—as well as anti-inflammatory treatments including herbal supplements, acupuncture, and energy healing. I began to worry that framing the conversation around inflammation—a word that clearly meant one thing to me and quite another to this couple—had been a mistake.

Doctors caring for patients with autoimmune diseases have long thought of inflammation in precise terms: Cells of the immune system lodge in tissues and release messenger molecules, called cytokines, that rev up the body’s response to a perceived insult. In recent years, scientists have been able to identify many cytokines and create targeted therapies for a host of disabling, sometimes fatal, diseases.

At the same time, popular culture has latched on to the concept of inflammation and made it a catch-all term for “something amiss in the body”—a bête noire for wellness gurus, health influencers, and the “Make America Healthy Again” movement. A YouTube or TikTok search for chronic inflammation might lead to Josh Farris, also known as “The Gut Guy,” who argues that rubber-soled shoes prevent us from connecting to the earth and force the body to steal energy from other cells, causing “an inflammation loop cycle.” The MAHA report, which the White House released in May, suggests that ultra-processed foods and the overuse of medications may be contributing to chronic inflammation in children. Even as conventional treatments for autoimmune diseases have become more effective than ever, alternative treatments, including nutritional supplements, breathing exercises, hyperbaric oxygen chambers, and cold plunges in frigid water, have proliferated.  

Andrew Weil is perhaps the person most responsible for inserting the phrase anti-inflammatory into the American lexicon. Weil, a Harvard Medical School graduate who completed his internship before deciding to explore nontraditional medical practices, told me that his views on inflammation are simple and have not changed over the decades. According to Weil, acute inflammation is a natural, protective response to injury or infection and is an important part of healing. Chronic inflammation is a low-level, persistent activation of the immune system that can damage the body over time and is linked to ailments such as cardiovascular disease, neurodegenerative diseases, cancer, and autoimmune conditions. Weil argues that following his anti-inflammatory food pyramid and taking up practices such as meditation, yoga, and tai chi can help prevent and treat these diseases of chronic inflammation.

To support his claims, Weil cites population studies showing that people who maintain a diet high in fruits, vegetables, and whole grains have lower rates of heart disease, diabetes, and some cancers than those who don’t consume these products. He also points to studies showing that certain foods and spices, including turmeric and ginger, can inhibit key regulators of the immune system, reducing cytokine production. When I asked Weil about proof that these interventions work, based on randomized clinical trials, he told me that he believes such studies are not necessary when an intervention is unlikely to cause harm. “I grade evidence on a sliding scale,” he said.

Weil’s anti-inflammatory message has germinated across the internet in tweets, podcasts, and YouTube Shorts. The result is a hodgepodge of myths and theories about how to address the issue that go well beyond advice to just eat well and meditate. Juice cleanses are fashionable in certain anti-inflammatory circles, even though they can cause electrolyte imbalances. A popular notion on TikTok is that hidden parasites are a common cause of chronic inflammation and that ingesting wormwood—a bitter herb that can lead to liver injury—will rid the body of this problem. Other videos encourage viewers to ingest water laced with borax, a powdery substance found in laundry detergent, in order to reduce inflammation and joint pain.  

Most claims made by health gurus and social-media influencers are exaggerated. “If it sounds too good to be true, it is,” Richard Panush, a rheumatologist and emeritus professor at the University of Southern California, who has studied alternative therapies for autoimmune diseases, told me. Some of their recommendations are outright dangerous. Still, these ideas are clearly enticing to patients feeling beaten down by chronic disease. One recent study showed that, among people with an autoimmune condition, more than 80 percent have tried some form of complementary and alternative medicine. In my experience, most patients gravitate toward interventions on the milder end of the spectrum, such as acupuncture and herbal remedies, but even these can be problematic if taken to the extreme. One patient of mine told me that, at a certain point, he was consuming 60 supplements a day, putting him at risk of adverse interactions with his prescription medications.  

In decades past, alternative therapies may not have seemed so outlandish compared with conventional therapies, which often had significant side effects and limited efficacy. Now, though, doctors like me can prescribe treatments that turn many debilitating diseases into manageable conditions. People with rheumatoid arthritis can be treated with one or two medications and expect to experience disability-free lives with few to no symptoms. Surgeons used to routinely remove the colons of individuals with ulcerative colitis, but an injection or infusion of medication every few weeks can put those patients in remission. The key to these advances has been the development of certain biologics that target key pathways in the immune system and selectively block the activity of pro-inflammatory cytokines. Dozens of FDA-approved biologics are now available to patients for diseases including psoriasis, Crohn’s, and multiple sclerosis. The future is even more promising with therapies like CAR T cells, which are genetically modified “living drugs” that have had remarkable success in clinical trials, particularly for lupus.

This is not to say that conventional therapies come without costs. Using a medication meant to suppress the immune system has an inherent trade-off: Autoimmunity may be better controlled, but the risk of infection increases. The list price for some biologics can reach $7,000 a month, and patients receiving infusible medications must arrange travel plans around the timing of their therapy.

Alternative health might be appealing for another reason. Because doctors cannot give a simple explanation as to why most autoimmune conditions developed in the first place, patients may look elsewhere for insights and solutions. Some autoimmune diseases also can remit on their own for reasons that remain unclear, implying that not every patient may require lifelong therapy.

For doctors, though, taking the wait-and-watch approach feels risky when the stakes are high: Not treating a disease, in the hopes that it’ll resolve naturally, could leave someone with, say, joint erosions or renal failure. “I frequently tell patients, ‘I’m overtreating you’ because we can’t predict if your disease will cause irreversible damage,” Philip Seo, a rheumatologist at Johns Hopkins University, told me. “We can’t go back in time.”

Conversations with patients about if and when to start medication have always been complex, but online lore about inflammation, coupled with declining confidence in doctors since the coronavirus pandemic, have made such discussions more fraught. “It comes down to trust,” Panush, the rheumatologist who researches alternative therapies, told me, “which I’m afraid doctors are losing from patients who have adopted a different belief system than their own.”

I saw that happen with my own ICU patient, whose condition had been so dire. He and his family were willing to accept immune-suppressing therapy when he was critically ill, but his calculus changed once he was doing better. I tried to provide clear recommendations while making him and his wife feel heard, but it seemed like we were talking past each other. Eventually, he stopped showing up for appointments. I called multiple times to check in, but there was no answer. A year later, I learned that he had died. His obituary didn’t mention his autoimmune disease, the most likely cause of his death. Instead, it said he had died from agricultural and industrial pollution.

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

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

[Read: Revenge of the COVID contrarians]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[Read: Ozempic or bust]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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