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It’s easy to forget that Robert F. Kennedy Jr.’s assault on vaccines—including, most recently, his gutting of the expert committee that guides American vaccine policy—might have been avoided. Four months ago, his nomination for health secretary was in serious jeopardy. The deciding vote seemed to be in the hands of one Republican senator: Bill Cassidy of Louisiana. A physician who gained prominence by vaccinating low-income kids in his home state, Cassidy was wary of the longtime vaccine conspiracist. “I have been struggling with your nomination,” he told Kennedy during his confirmation hearings in January.

Then Cassidy caved.

In the speech he gave on the Senate floor explaining his decision, Cassidy said that he’d vote to confirm Kennedy only because he had extracted a number of concessions from the nominee—chief among them that he would preserve, “without changes,” the very CDC committee Kennedy overhauled this week. Since then, Cassidy has continued to give Kennedy the benefit of the doubt. On Monday, after Kennedy dismissed all 17 members of the vaccine advisory committee, Cassidy posted on X that he was working with Kennedy to prevent the open roles from being filled with “people who know nothing about vaccines except suspicion.”

[Read: The doctor who let RFK Jr. through]

The senator has failed, undeniably and spectacularly. One new appointee, Robert Malone, has repeatedly spread misinformation (or what he prefers to call “scientific dissent”) about vaccines. Another appointee, Vicky Pebsworth, is on the board of an anti-vax nonprofit, the National Vaccine Information Center. Cassidy may keep insisting that he is doing all he can to stand up for vaccines. But he already had his big chance to do so, and he blew it. Now, with the rest of America, he’s watching the nation’s vaccine future take a nosedive.

So far, the senator hasn’t appeared interested in any kind of mea culpa for his faith in Kennedy’s promises. On Thursday, I caught Cassidy as he hurried out of a congressional hearing room. He was still reviewing the appointees, he told me and several other reporters who gathered around him. When I chased after him down the hallway to ask more questions, he told me, “I’ll be putting out statements, and I’ll let those statements stand for themselves.” A member of his staff dismissed me with a curt “Thank you, sir.” Cassidy’s staff has declined repeated requests for an interview with the senator since the confirmation vote in January.

With the exception of Mitch McConnell, every GOP senator voted to confirm Kennedy. They all have to own the health secretary’s actions. But Cassidy seemed to be the Republican most concerned about Kennedy’s nomination, and there was a good reason to think that the doctor would vote his conscience. In 2021, Cassidy was one of seven Senate Republicans who voted to convict Donald Trump on an impeachment charge after the insurrection at the Capitol. But this time, the senator—who is up for reelection next year, facing a more MAGA-friendly challenger—ultimately fell in line.

Cassidy tried to have it both ways: elevating Kennedy to his job while also vowing to constrain him. In casting his confirmation vote, Cassidy implied that the two would be in close communication, and that Kennedy had asked for his input on hiring decisions. The two reportedly had breakfast in March to discuss the health secretary’s plan to dramatically reshape the department. “Senator Cassidy speaks regularly with secretary Kennedy and believes those conversations are much more productive when they’re held in private, not through press headlines,” a spokesperson for Cassidy wrote in an email. (A spokesperson for HHS did not immediately respond to a request for comment.)

At times, it has appeared as though Cassidy’s approach has had some effect on the health secretary. Amid the measles outbreak in Texas earlier this year, Kennedy baselessly questioned the safety of the MMR vaccine. In April, after two unvaccinated children died, Cassidy posted on X: “Everyone should be vaccinated! There is no treatment for measles. No benefit to getting measles. Top health officials should say so unequivocally b/4 another child dies.” Cassidy didn’t call out Kennedy by name, but the health secretary appeared to get the message. Later that day, Kennedy posted that the measles vaccine was the most effective way to stave off illness. (“Completely agree,” Cassidy responded.)

All things considered, that’s a small victory. Despite Kennedy’s claims that he is not an anti-vaxxer, he has enacted a plainly anti-vaccine agenda. Since being confirmed, he has pushed out the FDA’s top vaccine regulator, hired a fellow vaccine skeptic to investigate the purported link between autism and shots, and questioned the safety of childhood vaccinations currently recommended by the CDC. As my colleague Katherine J. Wu wrote this week, “Whether he will admit to it or not, he is serving the most core goal of the anti-vaccine movement—eroding access to, and trust in, immunization.”

[Read: RFK Jr. is barely even pretending anymore]

The reality is that back channels can be only so effective. Cassidy’s main power is to call Kennedy before the Senate health committee, which he chairs, and demand an explanation for Kennedy’s new appointees to the CDC’s vaccine-advisory committee. Cassidy might very well do that. In February, he said that Kennedy would “come before the committee on a quarterly basis, if requested.” Kennedy did appear before Cassidy’s committee last month to answer questions about his efforts to institute mass layoffs at his agency. Some Republicans (and many Democrats) pressed the secretary on those efforts, while others praised them. Cassidy, for his part, expressed concerns about Kennedy’s indiscriminate cutting of research programs, but still, he was largely deferential. “I agree with Secretary Kennedy that HHS needs reform,” Cassidy said.

Even if he had disagreed, an angry exchange between a health secretary and a Senate committee doesn’t guarantee any policy changes. Lawmakers may try to act like government bureaucrats report to them, but they have limited power once a nominee is already in their job. Technically, lawmakers can impeach Cabinet members, but in American history, a sitting Cabinet member has never been impeached and subsequently removed from office. The long and arduous confirmation process is supposed to be the bulwark against potentially dangerous nominees being put in positions of power. Cassidy and most of his Republican colleagues have already decided not to stop Kennedy from overseeing the largest department in the federal government by budget. Now Kennedy is free to do whatever he wants—senators be damned.

Robert Malone has a history of arguing against the data. He has called for an end to the use of mRNA vaccines for COVID despite the well-established fact that they reduce mortality and severe illness. He has promoted discredited COVID treatments such as ivermectin and hydroxychloroquine, dismissing studies that show they are ineffective against the coronavirus. Recently, he called reports about two girls in West Texas dying from the measles “misinformation,” even though the doctors who treated the girls were unequivocal in their conclusion.

Now Malone will have a leading role in shaping America’s vaccine policy. He is one of eight new members of the CDC’s Advisory Committee on Immunization Practices, replacing the 17 former members whom Robert F. Kennedy Jr. relieved of their duties on Monday. The re-formed committee will be responsible for guiding the CDC’s vaccine policy, recommending when and by whom vaccines should be used. The doctors and researchers who make up the new ACIP are all, to some degree, ideological allies of Kennedy, who has spent decades undermining public confidence in vaccines. And Malone arguably has the most extreme views of the group.

Malone, a physician and an infectious-disease researcher, readily acknowledges that he defies mainstream scientific consensus. Just this week, he wrote in his popular Substack newsletter that readers should embrace the anti-vax label, as he has done, and oppose “the madness of the vaccine mania that has swept public health and government.” (This was only a day before Kennedy pledged that the new ACIP members would not be “ideological anti-vaxxers.”)

He is also openly conspiratorial. In his best-selling book, Lies My Gov’t Told Me: And the Better Future Coming, Malone alleges that the Chan Zuckerberg Initiative’s grants to news publications (including The Atlantic) were payments “to smear” vaccine critics, and accuses Anthony Fauci of fearmongering to amass power. Last fall, Malone and his wife, Jill, released a follow-up, PsyWar, making the case that the U.S. government is engaged in a vague but diabolical program of psychological warfare against its own citizens. According to the Malones, the CIA, FBI, and Defense Department, along with a “censorship-industrial complex,” have granted the U.S. government “reality-bending information control capabilities.” (They also claim that “sexual favors are routinely exchanged to seal short-term alliances, both within agencies and between contractors and ‘Govies.’”) They envision this corruption spawning a postapocalyptic future in which guns, ammo, horses, and “a well-developed network of like-minded friends” might be necessary for survival. Malone, who lives on a horse farm in Virginia, appears to be already well prepared.

[Listen: How fragile is our vaccine infrastructure?]

Malone’s rise to contrarian glory began in the summer of 2021, when public-health officials were urging hesitant Americans to roll up their sleeves for the new, mRNA-based COVID-19 vaccines. Back in the 1980s, Malone had conducted research on delivering RNA and DNA into cells, which, he and his co-authors suggested in a 1990 paper, “may provide alternative approaches to vaccine development.” That early work lent credibility to his dire warnings that the COVID shots hadn’t been adequately tested, as perhaps did his grandfatherly beard and professorial demeanor. His popularity grew with appearances on Tucker Carlson’s and Glenn Beck’s shows, where he questioned the safety and effectiveness of the mRNA vaccines while touting—and, critics said, overstating—his own role in the development of the underlying technology. It was Malone’s conspiratorial musings on The Joe Rogan Experience that prompted several famous musicians, including Neil Young and Joni Mitchell, to pull their music from Spotify in protest of the platform’s contract with Rogan. Today, Malone’s newsletter, where he shares his anti-vaccine claims and often praises Kennedy, has more than 350,000 subscribers.

Kennedy and Malone have long been intertwined. Kennedy wrote the foreword to Lies My Gov’t Told Me and wrote an endorsement for PsyWar, alleging that the same techniques that the Malones described shaped public reaction to the assassinations of his father and uncle. Kennedy’s 2021 book, The Real Anthony Fauci—which alleges that the former director of the National Institute of Allergy and Infectious Diseases spread corruption and fraud—is dedicated to Malone, among others. Since Kennedy was appointed as Health and Human Services secretary, many of his allies in the anti-vaccine world have accused him of moderating his views to be more palatable to lawmakers. But among anti-vaccine activists, Malone’s appointment to the advisory board was taken as evidence that Kennedy remains on their side.

Public-health experts, by contrast, are horrified. “I think that the scientific and medical community won’t trust this committee, and for good reason,” Paul Offit, a pediatrician and former member of the advisory group, told me. He’s heard from fellow public-health experts who are considering forming their own committees to weigh the evidence, “because they won’t trust the conclusions of these people.” Sean O’Leary, the American Academy of Pediatrics’ liaison to ACIP, told me he was “deeply concerned” with RFK’s decision to entirely remake the committee. “This maneuver really endangers public health. It endangers children,” he said. He worries that it will lead to disease, suffering, and death among adults and children alike. (Neither Malone nor HHS responded to requests for comment. On X, Malone promised to “do my best to serve with unbiased objectivity and rigor.”)

[Read: RFK Jr. is barely even pretending anymore]

Malone’s appointment is perhaps the strongest sign yet of Kennedy’s willingness to appoint ideological crusaders into powerful government roles. ACIP’s recommendations are nonbinding, but historically, the CDC has almost always hewn to them. The committee’s verdicts will help determine which vaccines insurance companies and the federal government pay for, decisions that will inevitably shape countless Americans’ immunization habits. Malone’s new role requires in-depth, good-faith examinations of scientific evidence. But he has already earned a reputation for rejecting it.

At the core of every joke about Baby Boomers lies a seed of jealousy. Unlike younger generations, they have largely been able to walk a straightforward path toward prosperity, security, and power. They were born in an era of unprecedented economic growth and stability. College was affordable, and they graduated in a thriving job market. They were the first generation to reap the full benefits of a golden age of medical innovations: birth control, robotic surgery, the mapping of the human genome, effective cancer treatments, Ozempic.

But recent policy changes are poised to make life significantly harder for Baby Boomers. “If you’re in your 60s or 70s, what the Trump administration has done means more insecurity for your assets in your 401(k), more insecurity about sources of long-term care, and, for the first time, insecurity about your Social Security benefits,” Teresa Ghilarducci, a labor economist at the New School, told me. “It’s a triple threat.” After more than half a century of aging into political and economic trends that worked to their benefit, the generation has become particularly vulnerable at exactly the wrong moment in history.

Perhaps the biggest threat to Boomers in the second Trump administration is an overhaul of Social Security, which provides benefits to nearly nine out of 10 Americans ages 65 and older. In an emailed statement, Social Security Commissioner Frank Bisignano wrote, “I am fully committed to upholding President Trump’s promise to protect and strengthen Social Security. Beneficiaries can be confident that their benefits are secure.” But in February, DOGE announced plans to cut Social Security staff by about 12 percent and close six of its 10 regional offices; a quarter of the agency’s IT staff has quit or been fired. Social Security’s long-term outlook was already troubled before Trump, and these drastic reductions make the understaffed agency even less equipped to support those who rely on it. Shutting down field offices means seniors can’t get help in person; less staffing means longer wait times when they call and more frequent website crashes. “When you add hurdles, or cause a slowdown in terms of processing claims, you see losses in terms of benefits,” Monique Morrissey, a senior economist at the Economic Policy Institute, told me. In fact, shutdowns of field offices during the first two years of the coronavirus pandemic corresponded with decreased enrollment in both Social Security and Social Security Disability Insurance, which is available to Americans under 65 who can no longer work for physical or mental reasons.

Social Security cuts will most hurt low-income Boomers, who are the likeliest to rely on benefits to cover their whole cost of living. But even those with more financial assets may depend on Social Security as a safety net. “It’s important to understand that many seniors, even upper-income seniors, are just one shock away from falling into poverty,” says Nancy J. Altman, the president of Social Security Works, an organization that advocates for expanding the program. As a whole, seniors have more medical needs and less income than the general population, so they’re much more financially vulnerable. If you’re comfortably middle-class in your early 60s, at the height of your earning potential, that’s no guarantee that you’ll remain comfortably middle-class into your 70s. In the next few years, Boomers who face more medical bills as they stop working might find, for the first time in their life, that they can’t easily afford them.

Middle-income seniors are also likely to feel the impact of a volatile market. “They tend to have modest investments and fixed incomes rather than equities, so the type of wealth that will erode over a high-inflation period,” Laura D. Quinby, who studies benefits and labor markets at the Center for Retirement Research at Boston College, told me. After Trump announced 10 percent tariffs on all imported goods in April, the three major stock indexes dropped 4 percent or more. They’ve since recovered, but the erratic market—whipped around by Trump’s shifting proclamations about tariffs—scares many middle-class Boomers, who are watching their retirement savings shrink.

In the near future, older Americans might find themselves paying more for medical care too. Trump’s “big, beautiful bill,” which has passed in the House but awaits a vote in the Senate, would substantially limit Medicare access for many documented immigrants, including seniors who have paid taxes in the United States for years. The bill would also reduce Medicaid enrollment by about 10.3 million people. Although Medicaid is for people with limited incomes of all ages, it supports many older Americans and pays for more than half of long-term care in the U.S. Most seniors require some sort of nursing home or at-home medical care; one study found that 70 percent of adults who live to 65 will require long-term services and support.

[Read: The GOP’s new Medicaid denialism ]

That support may soon be not only more expensive, but harder to come by. The long-term-care workforce is disproportionately made up of immigrants, so the Trump administration’s immigration crackdown is likely to reduce the number of people available to take care of seniors—and increase how much it costs to hire them. “If you have no money, you’ll be on Medicaid in a nursing home, and that’s that. But if you’re trying to avoid that fate, you’re now going to run through your money more quickly and be more vulnerable,” Morrissey said.

Seniors with some financial security are more likely to live long enough to contend with the diseases of old age, such as Alzheimer’s and dementia. The Trump administration has cut funding for promising research on these diseases. “Going forward, you’ll find less treatments reaching fruition,” Thomas Grabowski, who directs the Memory and Brain Wellness Center at the University of Washington, told me. For now, the UW Memory and Brain Wellness Center, where Grabowski works on therapies for Alzheimer’s, has stopped bringing in new participants; as time goes on, he said, they’ll have to tighten more. (Kush Desai, a White House spokesperson, told me in an email that the cuts to research funded by the National Institutes of Health are “better positioning” the agency “to deliver on medical breakthroughs that actually improve Americans’ health and wellbeing.”)

Changes at the UW Memory and Brain Wellness Center could have dramatic effects on current patients, including Bob Pringle, a 76-year-old who lives in Woodinville, Washington. In April, he started getting infusions of donanemab, an anti-amyloid medication approved by the FDA last year. The drug doesn’t cure Alzheimer’s; it’s designed to slow the disease’s progression, though the utility of donanemab and other Alzheimer’s drugs remains controversial among experts. Pringle, for one, has found donanemab helpful. “With the medication, my decline is a gentle slope, rather than a rapid decline,” says Pringle, whose mother died of Alzheimer’s and whose sister lives in a memory-care facility. “You’re always hopeful that somebody with a bigger brain than you have is working on a cure, and the medication gives us some time until then,” Bob’s wife and caretaker, Tina Pringle, told me. “But right now, because of the funding cuts, our outlook is grim.”

[Read: The NIH’s most reckless cuts yet]

The unknowability of the future has always been a scary part of getting older. The enormous upheaval that the Trump administration has created will only magnify that uncertainty for Boomers. After a historical arc of good fortune, their golden generation has to contend with bad timing.

Younger generations, including my own, shouldn’t gloat, though: Cuts to Social Security and a halt to medical research could well worsen the experience of aging for generations to come. Younger Americans will likely grow old under challenging conditions too. Unlike the Boomers, we’ll have plenty of time to get used to the idea.

When Robert F. Kennedy Jr. accepted his new position as health secretary, he made a big show of distancing himself from his past life. “News reports have claimed that I am anti-vaccine or anti-industry,” Kennedy, who has for decades promoted the debunked notion that vaccines cause autism and has baselessly sown doubt over the ability of the U.S. government to vet shots, said at his confirmation hearing in January. “I am neither. I am pro-safety.”

But for all Kennedy’s talk, this week, he did exactly what a person would do if they were trying to undermine the scientific consensus on vaccination in the United States. He abruptly dismissed the entire expert committee that advises the CDC on its nationwide vaccine recommendations—and began to fill the roster with like-minded people ready to cast doubt on the benefits of vaccination.

Like Kennedy, few of these new appointees to the Advisory Committee on Immunization Practice, or ACIP, have openly embraced the notion that they are anti-vaccine. But among them are individuals who have spoken out against COVID vaccines and policies, claimed vaccine injuries for their own children, and falsely linked COVID shots to deaths—or even baselessly accused those vaccines of “causing a form of acquired immunity deficiency syndrome.”

In January, I wrote that remaking the committee in exactly this way would be an especially harmful blow to Americans’ health: Perhaps more than any other body of experts in the U.S., ACIP guides the nation’s future preparedness against infectious disease. By appointing a committee that is poised to legitimize more of his own radical views, Kennedy is giving his skewed version of scientific reality the government’s imprimatur. Whether he will admit to it or not, he is serving the most core goal of the anti-vaccine movement—eroding access to, and trust in, immunization.

In an emailed statement, Health and Human Services Press Secretary Emily G. Hilliard reiterated that “Secretary Kennedy is not anti-vaccine—he is pro-safety, pro-transparency, and pro-accountability,” and added that his “evidence-based approach puts accountability and radical transparency first, which will restore trust in our public health system.” (Kennedy, notably, promised Senator Bill Cassidy during his confirmation process that he would maintain ACIP, as Cassidy put it, “without changes.”)

Since the 1960s, ACIP has lent government policy on vaccines the clout of scientific evidence. Its mandate is to convene experts across fields such as infectious disease, immunology, pediatrics, vaccinology, and public health to carefully vet the data on immunizations, weigh their risks and benefits, and vote on recommendations that guide the public on how to use them—who should get vaccines, and when. Those guidelines are then passed to the CDC director, who—with only the rarest of exceptions—accepts that advice wholesale.

“These recommendations are what states look to, what providers look to,” Rupali Limaye, an expert in vaccine behavior at the Johns Hopkins Bloomberg School of Public Health, told me. Medicare, for instance, is required to fully cover the vaccines that ACIP recommends; ACIP also determines which vaccines are covered by the Vaccines for Children Program, which provides free vaccines for children whose families cannot afford them. The experts who serve on ACIP have the opportunity, more than just about any of their scientific peers, to translate their vaccine rhetoric into reality.

So far, Kennedy has dismissed the 17 people who were serving on ACIP, and filled eight of the newly open slots. Most of the new nominees have an obvious bone to pick with at least some vaccines, especially COVID shots, and have publicly advocated for limiting their use. Among the new members, for instance, is Robert Malone, a controversial physician who has spoken at anti-vaccine events, where he has denounced COVID vaccines and, without evidence, suggested that they can worsen coronavirus infections. Another appointee is Vicky Pebsworth, who serves on the board of the National Vaccine Information Center, an anti-vaccine nonprofit previously known as Dissatisfied Parents Together. A third, Retsef Levi, a health-care-management expert, called for the administration of COVID vaccines to be halted in 2023, and has questioned the shots’ safety, despite a large body of evidence from clinical trials supporting their continued use. Overall, “this is not a list that would increase confidence in vaccine decisions,” Dorit Reiss, a vaccine-policy expert at UC San Francisco, told me. (None of these new ACIP members returned a request for comment.)

The next ACIP meeting is scheduled for the end of this month—and the agenda includes discussion about anthrax vaccines, chikungunya vaccines, COVID-19 vaccines, cytomegalovirus vaccine, the human-papillomavirus vaccine, influenza vaccines, the Lyme-disease vaccine, meningococcal vaccines, pneumococcal vaccines, and RSV vaccines. That’s a big slate of topics for a brand-new panel of members, Paul Offit, a pediatrician and a vaccine expert who has previously served on ACIP, told me: Depending on how the meeting is structured, and on the input from CDC scientists, these new committee members could substantially alter the guidelines on several immunizations—perhaps so much so that certain shots could stop being recommended to certain groups of Americans. Based on the composition of the committee so far, Offit predicts that the new ACIP will eventually push the CDC away from full-throated endorsement of many of these vaccines.

Even subtle changes in the wording of CDC recommendations—a should swapped for a may—can have big ripple effects, Limaye told me. Insurers, for instance, may be more reluctant to cover vaccines that are not actively endorsed by the CDC; some states—especially those in which vaccines have become a political battleground—may stop mandating those types of shots. If the CDC softens its recommendations, “we will likely see more partisan divides” in who opts for protection nationwide, Jason Schwartz, a vaccine-policy expert at Yale, told me. Pharmaceutical companies may, in turn, cut down production of vaccines that don’t have full CDC backing, perpetuating a cycle of reduced availability and reduced enthusiasm. And primary-care physicians, who look to the CDC’s vaccination schedule as an essential reference, may shift the language they use to describe childhood shots, nudging more parents to simply opt out.

Historically, medical and public-health associations, such as the American Academy of Pediatrics, have aligned their vaccine recommendations with ACIP’s—because those recommendations were all driven by scientific evidence. Now, though, scientific consensus and government position are beginning to diverge: Multiple groups of physicians, scientists, and public-health scholars have issued statements condemning the vaccine decisions of Kennedy and his allies; a number of prominent scientists have now banded together to form a kind of alt-ACIP, dubbing themselves the Vaccine Integrity Project. As the views of fringe vaccine groups become the government’s stance, Americans may soon have to choose between following the science and following what their nation’s leaders say.

Identifying as “anti-vaccine” has historically been taboo: In a nation where most people remain largely in favor of shots, the term is pejorative, an open acknowledgment that one’s views lie outside of the norm. But the more vaccine resistance infiltrates HHS and its advisers, the more what’s considered normal may shift toward Kennedy’s own views on vaccines; ACIP’s reputation for evidence-backed thinking could even gild those views with scientific legitimacy. Assembling one’s own team of friendly experts is an especially effective way to sanewash extremism, Reiss told me, and to overturn the system through what appear to be normal channels. If the nation’s most prominent group of vaccine advisers bends toward anti-vaccine, the term loses its extremist edge—and the scientists who argue, based on sound data, that vaccines are safe and effective risk being labeled anti-government.

Robert F. Kennedy Jr.’s warning about mitochondria slipped in between the anti-vaccine junk science and the excoriation of pharmaceutical drugs as “the No. 3 killer in our country.” He was speaking in 2023 to Joe Rogan, elaborating on the dangers of Wi-Fi—which no high-quality scientific evidence has shown to harm anyone’s health—and arguing that it causes disease by somehow opening the blood-brain barrier, and by degrading victims’ mitochondria.

The mention of mitochondria—the tiny structures that generate energy within our cells—was brief. Two years later, mitochondrial health is poised to become a pillar of the MAHA movement, already showing up in marketing for supplements and on podcasts across the “manosphere.” Casey Means, President Donald Trump’s newest nominee for surgeon general, has singled out the organelle as the main casualty of the modern American health crisis. According to Means (who has an M.D. but no active medical license), most of America’s chronic ailments can be traced to mitochondrial dysfunction. Should she be confirmed to the post of surgeon general, the American public can expect to hear a lot more about mitochondria.

Among scientists, interest and investment in mitochondria have risen notably in the past five years, Kay Macleod, a University of Chicago researcher who studies mitochondria’s role in cancer, told me. Mitochondria, after all, perform a variety of crucial functions in the human body. Beyond powering cells, they can affect gene expression, help certain enzymes function, and modulate cell death, Macleod said.

When mitochondria are defective, people do indeed suffer. Vamsi Mootha, a mitochondrial biologist based at Massachusetts General Hospital and the Broad Institute, told me that rare genetic defects (appearing in about one in 4,300 people) can cause the organelles to malfunction, leading to muscle weakness, heart abnormalities, cognitive disability, and liver and kidney problems. Evidence also suggests that defects in mitochondria directly contribute to symptoms of Parkinson’s disease, and could be both a cause and an effect of type 2 diabetes. Other conditions’ links to mitochondria are blurrier. Researchers see aberrant mitochondria in postmortem biopsies of patients with illnesses such as Alzheimer’s, cancer, and fatty-liver disease, Mootha said; whether those damaged mitochondria cause or result from such conditions is not yet clear.  

But according to Good Energy, the book Means published last year with a top MAHA adviser—her brother, Calley—mitochondrial dysfunction is a veritable plague upon the United States, responsible for both serious illness and everyday malaise. In their view, modern Western diets and lifestyles wreck countless Americans’ metabolic health: Every time you drink unfiltered water or a soda, or feel the stress of mounting phone notifications, you hurt your mitochondria, they say, triggering an immune response that in turn triggers inflammation. (Damaged mitochondria really can cause inflammation, Macleod said.) This chain of events, the Meanses claim, can be blamed for virtually every common chronic health condition: migraines, depression, infertility, heart disease, obesity, cancer, and more. (Casey Means did not respond to requests for comment; reached by email, Calley did not respond to my questions about mitochondria, but noted, “There is significant scientific evidence that healthy food, exercise and sleep have a significant impact on reversing chronic disease.”)

Good Energy follows a typical wellness playbook: using a mixture of valid and dubious research to pin a slew of common health problems on one overlooked element of health—and advertising a cure. Among the culprits for our mitochondrial ravaging, according to the Meanses, are poor sleep, medications, ultraprocessed foods, seed oils, too many calories, and too few vitamins, as well as chronically staying in comfortable ambient temperatures. The Means siblings therefore recommend eschewing refined sugar in favor of leafy greens, avoiding nicotine and alcohol, frequenting saunas and cold plunges, getting seven to eight hours of uninterrupted sleep a night, and cleansing your life of environmental toxins. Some studies indeed suggest that mitochondrial function is linked with sleep and temperature, but they’ve all been conducted on cell cultures, organoids, or mice. According to Macleod, evidence suggests that diet, too, is likely important. But only one lifestyle intervention—exercise—has been definitively shown to improve mitochondrial health in humans.

The Meanses are riding a wave of interest in mitochondrial health in the wellness world. Earlier this year, the longevity influencer Bryan Johnson and the ivermectin enthusiast Mel Gibson both endorsed the dye methylene blue for its power to improve mitochondrial respiration; Kennedy was filmed slipping something that looks a lot like methylene blue into his drink. (Kennedy did not respond to a request for comment; the FDA has approved methylene blue, but only as a treatment for the blood disease methemoglobinemia.) AG1, formerly known as Athletic Greens, formulates its drinkable vitamins for mitochondrial health. Even one laser-light skin treatment promises to “recharge failing mitochondria.” The enzyme CoQ10 is popular right now as a supplement for mitochondrial function, as is NAD, a molecule involved in mitochondria’s production of energy. NAD IV drips are especially beloved by celebrities such as Gwyneth Paltrow, Kendall Jenner, and the Biebers. These supplements are generally thought to be safe, and some preliminary research shows that NAD supplementation could help patients with Parkinson’s or other neurodegenerative diseases, and that CoQ10 could benefit people with mitochondrial disorders. Patients whose symptoms are clearly caused or made worse by deficiencies in a specific vitamin, such as thiamine, can benefit from supplementing those vitamins, Mootha said. But little research explores how these supplements might affect healthy adults.

[Read: The MAHA takeover is complete]

In Good Energy, as well as on her website and in podcast appearances, Casey Means promotes a number of supplements for mitochondrial health. She also recommends that people wear continuous glucose monitors—available from her company, Levels Health, for $184 a month—to help prevent overwhelming their mitochondria with too much glucose. (According to Macleod, glucose levels are only “a very indirect measure” of mitochondrial activity.) As with so many problems that wellness influencers harp on, the supposed solution to this one involves buying products from those exact same people.

At best, all of this attention to mitochondria could lead Americans to healthier habits. Much of the advice in Good Energy echoes health recommendations we’ve all heard for decades; getting regular exercise and plenty of fiber is good guidance, regardless of anyone’s reasons for doing so. Switching out unhealthy habits for healthy ones will likely even improve your mitochondrial health, Jaya Ganesh, a mitochondrial-disease expert at Icahn School of Medicine at Mount Sinai, told me. After all, “if you consistently beat your body up with unhealthy habits, everything is going to fall sick,” Ganesh said.

But the mitochondrial approach to wellness carries risks, too. For patients with genetically caused mitochondrial disease, lifestyle changes might marginally improve some symptoms, Ganesh said, but attempting to cure such conditions with supplements and a healthy diet alone could be dangerous. Means also calls out medications—including antibiotics, chemotherapy, antiretrovirals, statins, and high-blood-pressure drugs—for interfering with mitochondria. Macleod told me that statins really do affect mitochondria, as do some antibiotics. (The latter makes sense: Mitochondria are thought to have evolved from bacteria more than a billion years ago.) That’s no reason, though, to avoid any of these medications if a doctor has determined that you need them.

[Read: America can’t break its wellness habit]

And yet, a whole chapter of Good Energy is dedicated to the idea that readers should mistrust the motives of their doctors, who the authors say profit by keeping Americans sick. The book is less critical of the ways the wellness industry preys on people’s fears. Zooming in on mitochondria might offer a reassuringly specific and seemingly scientific explanation of the many real ills of the U.S. population, but ultimately, Means and MAHA are only helping obscure the big picture.

Updated at 10:26 a.m. on June 9, 2025

Since winning President Donald Trump’s nomination to serve as the director of the National Institutes of Health, Jay Bhattacharya—a health economist and prominent COVID contrarian who advocated for reopening society in the early months of the pandemic—has pledged himself to a culture of dissent. “Dissent is the very essence of science,” Bhattacharya said at his confirmation hearing in March. “I’ll foster a culture where NIH leadership will actively encourage different perspectives and create an environment where scientists, including early-career scientists and scientists that disagree with me, can express disagreement, respectfully.”

Two months into his tenure at the agency, hundreds of NIH officials are taking Bhattacharya at his word.

More than 300 officials, from across all of the NIH’s 27 institutes and centers, have signed and sent a letter to Bhattacharya that condemns the changes that have thrown the agency into chaos in recent months—and calls on their director to reverse some of the most damaging shifts. Since January, the agency has been forced by Trump officials to fire thousands of its workers and rescind or withhold funding from thousands of research projects. Tomorrow, Bhattacharya is set to appear before a Senate appropriations subcommittee to discuss a proposed $18 billion slash to the NIH budget—about 40 percent of the agency’s current allocation.

The letter, titled the Bethesda Declaration (a reference to the NIH’s location in Bethesda, Maryland), is modeled after the Great Barrington Declaration, an open letter published by Bhattacharya and two of his colleagues in October 2020 that criticized “the prevailing COVID-19 policies” and argued that it was safe—even beneficial—for most people to resume life as normal. The approach that the Great Barrington Declaration laid out was, at the time, widely denounced by public-health experts, including the World Health Organization and then–NIH director Francis Collins, as dangerous and scientifically unsound. The allusion in the NIH letter, officials told me, isn’t meant glibly: “We hoped he might see himself in us as we were putting those concerns forward,” Jenna Norton, a program director at the National Institute of Diabetes and Digestive and Kidney Diseases, and one of the letter’s organizers, told me.

None of the NIH officials I spoke with for this story could recall another time in their agency’s history when staff have spoken out so publicly against a director. But none of them could recall, either, ever seeing the NIH so aggressively jolted away from its core mission. “It was time enough for us to speak out,” Sarah Kobrin, a branch chief at the National Cancer Institute, who has signed her name to the letter, told me. To preserve American research, government scientists—typically focused on scrutinizing and funding the projects most likely to advance the public’s health—are now instead trying to persuade their agency’s director to help them win a political fight with the White House.

In an emailed statement, Bhattacharya said, “The Bethesda Declaration has some fundamental misconceptions about the policy directions the NIH has taken in recent months, including the continuing support of the NIH for international collaboration. Nevertheless, respectful dissent in science is productive. We all want the NIH to succeed.” A spokesperson for HHS also defended the policies the letter critiqued, arguing that the NIH is “working to remove ideological influence from the scientific process” and “enhancing the transparency, rigor, and reproducibility of NIH-funded research.”

The agency spends most of its nearly $48 billion budget powering science: It is the world’s single-largest public funder of biomedical research. But since January, the NIH has canceled thousands of grants—originally awarded on the basis of merit—for political reasons: supporting DEI programming, having ties to universities that the administration has accused of anti-Semitism, sending resources to research initiatives in other countries, advancing scientific fields that Trump officials have deemed wasteful.

Prior to 2025, grant cancellations were virtually unheard-of. But one official at the agency, who asked to remain anonymous out of fear of professional repercussions, told me that staff there now spend nearly as much time terminating grants as awarding them. And the few prominent projects that the agency has since been directed to fund appear either to be geared toward confirming the administration’s biases on specific health conditions, or to benefit NIH leaders. “We’re just becoming a weapon of the state,” another official, who signed their name anonymously to the letter, told me. “They’re using grants as a lever to punish institutions and academia, and to censor and stifle science.”

NIH officials have tried to voice their concerns in other ways. At internal meetings, leaders of the agency’s institutes and centers have questioned major grant-making policy shifts. Some prominent officials have resigned. Current and former NIH staffers have been holding weekly vigils in Bethesda, commemorating, in the words of the organizers, “the lives and knowledge lost through NIH cuts.” (Attendees are encouraged to wear black.)

But these efforts have done little to slow the torrent of changes at the agency. Ian Morgan, a postdoctoral fellow at the NIH and one of the letter’s signers, told me that the NIH fellows union, which he is part of, has sent Bhattacharya repeated requests to engage in discussion since his first week at the NIH. “All of those have been ignored,” Morgan said. By formalizing their objections and signing their names to them, officials told me, they hope that Bhattacharya will finally feel compelled to respond. (To add to the public pressure, Jeremy Berg, who led the NIH’s National Institute of General Medical Sciences until 2011, is also organizing a public letter of support for the Bethesda Declaration, in partnership with Stand Up for Science, which has organized rallies in support of research.)

Scientists elsewhere at HHS, which oversees the NIH, have become unusually public in defying political leadership, too. Last month, after Health Secretary Robert F. Kennedy Jr.—in a bizarre departure from precedent—announced on social media that he was sidestepping his own agency, the CDC, and purging COVID shots from the childhood-immunization schedule, CDC officials chose to retain the vaccines in their recommendations, under the condition of shared decision making with a health-care provider.

Many signers of the Bethesda letter are hopeful that Bhattacharya, “as a scientist, has some of the same values as us,” Benjamin Feldman, a staff scientist at the National Institute of Child Health and Human Development, told me. Perhaps, with his academic credentials and commitment to evidence, he’ll be willing to aid in the pushback against the administration’s overall attacks on science, and defend the agency’s ability to power research.

But other officials I spoke with weren’t so optimistic. Many at the NIH now feel they work in a “culture of fear,” Norton said. Since January, NIH officials have told me that they have been screamed at and bullied by HHS personnel pushing for policy changes; some of the NIH leaders who have been most outspoken against leadership have also been forcibly reassigned to irrelevant positions. At one point, Norton said, after she fought for a program focused on researcher diversity, some members of NIH leadership came to her office and cautioned her that they didn’t want to see her on the next list of mass firings. (In conversations with me, all of the named officials I spoke with emphasized that they were speaking in their personal capacity, and not for the NIH.)

Bhattacharya, who took over only two months ago, hasn’t been the Trump appointee driving most of the decisions affecting the NIH—and therefore might not have the power to reverse or overrule them. HHS officials have pressured agency leadership to defy court orders, as I’ve reported; mass cullings of grants have been overseen by DOGE. And as much as Bhattacharya might welcome dissent, he so far seems unmoved by it.

In early May, Berg emailed Bhattacharya to express alarm over the NIH’s severe slowdown in grant making, and to remind him of his responsibilities as director to responsibly shepherd the funds Congress had appropriated to the agency. The next morning, according to the exchange shared with me by Berg, Bhattacharya replied saying that, “contrary to the assertion you make in the letter,” his job was to ensure that the NIH’s money would be spent on projects that advance American health, rather than “on ideological boondoggles and on dangerous research.” And at a recent NIH town hall, Bhattacharya dismissed one staffer’s concerns that the Trump administration was purging the identifying variable of gender from scientific research. (Years of evidence back its use.) He echoed, instead, the Trump talking point that “sex is a very cleanly defined variable,” and argued that gender shouldn’t be included as “a routine question in order to make an ideological point.”

The officials I spoke with had few clear plans for what to do if their letter goes unheeded by leadership. Inside the agency, most see few levers left to pull. At the town hall, Bhattacharya also endorsed the highly contentious notion that human research started the pandemic—and noted that NIH-funded science, specifically, might have been to blame. When dozens of staffers stood and left the auditorium in protest, prompting applause that interrupted Bhattacharya, he simply smiled. “It’s nice to have free speech,” he said, before carrying right on.

After years of trying to improve his hospital in Riverton, Wyoming—first as a doctor, then as a board member and volunteer activist—­Roger Gose was ready to give up.

Gose, a Texas native, had been in Wyoming since 1978, when he saw an ad in a medical journal looking for a small-town internist. Ever since he was a kid, he had wanted to be a community doctor, the kind who made house calls and treated his neighbors from birth into adulthood. He found his calling in Riverton, a town of 10,000 people in one of the state’s poorer counties. For 35 years, he ran a private practice and worked shifts at Riverton Memorial Hospital, even serving for a time as the chief of medicine there. After retiring from his practice in 2012, he joined the hospital board, still eager to do whatever he could to help.

“You want to leave a place better than you found it,” he told me. And for a long time, he felt like he had.

But that was before LifePoint Health, one of the biggest rural-hospital chains in the country, saw his hospital as a distressed asset in need of saving through a ruthless search for efficiencies, and before executives at Apollo Global Management, a private-equity firm whose headquarters looms above the Plaza Hotel in Midtown Manhattan, began calling the shots. That was before Gose realized that, in the private-equity world, a hospital was just another widget, a tool to make money and nothing more.

In late 2018, Gose and a group of his neighbors decided that trying to save their hospital was futile. It had already lost its maternity ward, leaving pregnant people to drive nearly 30 miles to deliver a baby. Data from the Wyoming Department of Health show that the number of air-ambulance flights from the county where Riverton sits to hospitals elsewhere in the state rose from 155 in 2014 to 937 in 2019. By the time I spent several days with Gose and a dozen other Rivertonians in the spring of 2023, they didn’t even have a hospital anymore, they told me; they had a “Band-Aid station.” The only way to ensure that their town had a real hospital, they decided, was to build one themselves.

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The conventional wisdom about rural hospitals in the 21st century is that they are, in a word, screwed. Young people move away; older residents left behind need more expensive care and are less likely than urban and suburban residents to have private insurance, which is more lucrative for providers than Medicare and Medicaid. A 2018 report from the U.S. Government Accountability Office found that twice as many rural hospitals closed from 2013 to 2017 than in the five years prior, and the ones that remained were in much worse financial shape than their nonrural counterparts. Emergency funding during the coronavirus pandemic improved the financial health of rural hospitals, but after that ­funding dried up, many were left facing labor shortages and supply-chain problems that increased prices. House Republicans’ proposed cuts to Medicaid could drive even more hospitals out of business, the American Hospital Association argued in a letter to congressional leaders this April.

The ability to stave off closure has been the chief value proposition that private-equity firms offer to rural hospitals. In my reporting on private equity’s growing dominance in health care, I heard versions of the story that LifePoint and Apollo told Riverton residents again and again: Without us, you will be left with no hospital at all. Yours is running out of money, and our ability to consolidate and find efficiencies across our ever-­growing system is the only thing that can keep it alive. Your community is too small and poor to support an obstetrics department, or general surgery, or mental-health services, so you won’t have those anymore, but isn’t something better than nothing?

Accepting that private equity is the only option for rural hospitals, though, requires accepting that rural Americans deserve less access to care than their urban and suburban counterparts, and that the care they do receive will be measurably worse. A landmark 2023 study found that in the three years after a private-equity acquisition, the rate of serious preventable medical complications increased significantly. (LifePoint hospitals were not included in the study, which focused on acquisitions made before 2018.) Patients were more likely to fall in the hospital and more likely to acquire infections at the site of a surgical incision. The number of central-line infections, which often result from improper insertion or cleaning, rose 38 percent. Though the study didn’t delve into the reasons for the increases, the implication was clear: Focusing on short-­term profits was leading to cost cutting that could be dangerous for patients.

In Riverton, the hospital’s owner was cutting costs aggressively, while also raising prices. In 2014, LifePoint formally merged the hospital with one in wealthier Lander, a town 25 miles away, and renamed them SageWest Riverton and SageWest Lander. In 2017, the year before Apollo bought LifePoint, researchers examined hospital data for 14 individual Wyoming facilities and found that SageWest charged the highest relative prices; data from 2020 show that SageWest maintained the largest price disparity of any general hospital in the state after the Apollo acquisition. (LifePoint referred questions about the Riverton and Lander hospitals to SageWest; SageWest leaders did not respond to several requests for comment.)

At the same time, the Riverton hospital was shrinking. In quick succession, SageWest suspended its obstetrics services, closed its inpatient mental-health unit, and shrank other basic services. By 2022, the last year for which Centers for Medicare and Medicaid Services data are available, SageWest employed 227 people across its two campuses, nearly 40 percent fewer than before the Riverton-Lander merger. According to Gose, the number of physicians based in Riverton had dwindled from 20-something to just seven.

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If they were going to build a new hospital, Gose and his neighbors first needed to know whether it could theoretically be financially viable. By 2018, they had formed a nonprofit, Riverton Medical District, and one of the board members, Vivian Watkins—the former head of commercial lending for U.S. Bank’s 14 branches across Wyoming, and the kind of person who can’t leave the grocery store without stopping four times to ask about someone’s kids or their neighborhood drama—began cold-calling hospital CEOs across Wyoming, looking for advice on where to start. One told her that she should go straight to Stroudwater Associates, a Maine-based consultancy with a specialty in rural-health-care finances.

                       

The Riverton nonprofit was not Stroudwater Associates’ typical client. The company’s chairman, Eric Shell, and his team usually work directly with rural hospitals, or occasionally with a larger chain looking for system-­wide strategic planning. Gose, Watkins, and their allies didn’t have a hospital, didn’t have concrete plans for a hospital, didn’t even have any money for a hospital. Still, Shell was intrigued by the brazenness of what they were dreaming up.

After nearly 30 years working with rural hospitals, Shell believed that rural hospitals could survive, but that too few hospital executives think creatively about solutions. Over and over, he’s seen cuts damage a hospital’s business further: “You win the battle, but you lose the war,” he told me. Instead of cutting costs by “doing more with less” (to use the corporate jargon for layoffs and overworking employees), making rural hospitals run in the 21st century means increasing profits by expanding a hospital’s business.

One of Shell’s go-­to examples is Mahaska Health in Oskaloosa, Iowa, a nonprofit hospital in a city slightly bigger than Riverton. When the pandemic hit in 2020, hospitals across the country were overwhelmed with critically ill COVID patients, but also saw a decline in other types of cases. The result was a huge, unexpected loss of revenue for many hospitals, and a correspondingly huge number of layoffs: 1.4 million health-care workers lost their jobs in April 2020 alone. At Mahaska, though, CEO Kevin DeRonde—­a former NFL linebacker—­ran in the opposite direction: He hired many of the providers who had been laid off from other area hospitals, Shell said. His hospital took a short-­term financial hit, but DeRonde wagered that patient volume would recover once the worst of the pandemic eased up.

The bet paid off. After the drop in 2020, the number of non-­COVID patients skyrocketed. Now many hospitals were understaffed, but not Mahaska. The hospital hadn’t been doing well even before the pandemic, losing more than $5 million in 2017. By 2023, it made $7.5 million in net income, according to Shell and Mahaska Health officials.

Growth, though, is more difficult at hospitals owned by private-equity firms, because of the need to keep shareholders happy through quick returns. “When I look at what they’re doing in Lander and Riverton, I shake my head and say, ‘That’s not the way I’d be running the company,’” Shell told me. “But I’m not running the company, and they’re driven by an external force. If they’re not beating the market rate of compensation for their investors, their investors are going to walk.”

Shell agreed to conduct a feasibility study for Riverton Medical District, and Stroudwater spent months digging into every aspect of Riverton’s economy, population, and existing health-care options. Just 44 percent of Medicare recipients in the area who needed hospital treatment got it at either Riverton or its sister hospital, leaving an opening for a new hospital to quickly capture market share. The presence of the Wind River Reservation, which surrounds Riverton, boosted the financial case: The Eastern Shoshone and Northern Arapaho Tribes, which share the reservation, both provide private insurance to their members. In June 2019, Shell’s firm handed over its report. Its takeaway: The area had the ability to “support a financially viable rural health system with a range of medical, surgical, and specialty services.”

The Riverton Medical District team had the answer they wanted, from a company with real bona fides in the rural health-care world. Gose and Watkins were jubilant. They were going to build a hospital—if they could find the money, that is.

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Friends and neighbors had banded together to cover the $150,000 Stroudwater study, but a whole new hospital was going to cost tens of millions.

Shell didn’t think they could pull it off. He told them so outright. He’s an accountant, which means always assuming the worst. He couldn’t fathom why a bank or a government would give Riverton Medical District a loan, considering the competition risk. The group, though, was unanimous: Shell’s fears weren’t going to stop them. They were the ones who lived there; they were the ones who, in Gose’s words, felt an obligation to leave Riverton better than they found it.

After months of looking into every other source of funding they could think of, Riverton Medical District turned to what the group considered the “lender of last resort”—the U.S. Department of Agriculture, the primary government funder of projects affecting rural Americans. A community hospital in an underserved rural area fit the portfolio, which could qualify Riverton Medical District for low-­interest loans.

Applying for government money, however, required navigating government bureaucracy. In an email exchange that stretched over months, the USDA rural-development regional director for Wyoming, Lorraine Werner, was encouraging but exacting. Every time Werner needed more documents, including a third-­party audit that cost an additional $50,000, the group would scramble to get them to her. Then she would ask for even more. It took Riverton Medical District more than a year to have its application accepted—­not for funding, just for consideration.

Yet somehow, Riverton residents never seemed to grow tired of what looked to many outsiders like a quixotic scheme. To house the hospital, the Eastern Shoshone Tribe agreed to sell eight acres on the north end of town and donated four more acres outright. People kept handing over money, frequently $5 or $10 at a time.

Finally, after an application process that took nearly two years, USDA announced its ruling. The federal government agreed that a new hospital in Riverton could be financially viable, committing to fund the lion’s share of the costs—more than $37 million. It was the largest USDA rural-development loan ever awarded in the state of Wyoming.

The money would fund a hospital offering every routine service Rivertonians had lost. It would have 13 inpatient beds, a full surgical department, two labor-and-delivery rooms, two rooms equipped for intensive care, and space for physical and speech therapy. It would be staffed to perform surgery and deliver babies 24 hours a day. And the building would be designed to accommodate future growth, with the potential to add 11 new patient rooms, additional surgery space, and more parking, board members told me.

In its report, USDA was more bullish than Shell and Stroudwater had been; the agency’s official assessment of the project barely referenced the threat of competition from the existing hospitals. Citing numbers provided by the Riverton Medical District board, USDA found that the hospital could break even with just 30 percent market share, far less than SageWest’s 44 percent.

The Riverton Medical District project, evaluators wrote, had generated a remarkable level of local support; the agency noted donations from individuals and businesses that added up to more than $1 million, and more than 200 letters of support. Several of the letters said that without a new hospital, they would move out of Riverton. Multiple business owners wrote that the lack of a fully functioning hospital left them unable to recruit and retain workers. Most of the USDA report was written in bureaucracy-­speak, but at one point the author slipped into first person: “The applicant started a true grassroots movement to bring back essential services to the community and has exhibited a level of community support, both monetarily and otherwise, that is unseen in my experience.”

In December 2024, just before the soil froze for the season, work crews broke ground on Riverton’s new community hospital. In early June, 400 people turned out for a community celebration, cheering for state-government officials and Riverton Medical District board members and signing a beam that will be installed into the new facility.

Building a new, locally owned hospital isn’t a scalable way to help every community where hospitals owned by private-equity firms are providing less health care. The particular combination of ingredients in Riverton Medical District’s recipe baked into something resembling a miracle. But to Gose’s mind, following Riverton’s example doesn’t require building a community hospital in every rural county in the country. What it requires is people with knowledge of, and investment in, one specific community making decisions for that community—the exact opposite of the private-equity ethos of consolidation at all costs.

“Often you’ll see a lot of people get excited and involved in something for two or three months or six or whatever, but then they get disillusioned and quit,” Gose told me. “And I think that’s what LifePoint thought we were doing. And they underestimated that failure was not an option.”

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This article has been adapted from Megan Greenwell’s forthcoming book, Bad Company: Private Equity and the Death of the American Dream.

Every Monday and Wednesday, students at Channelview High School, outside Houston, are treated to Domino’s for lunch. Delivery drivers from a local branch of the fast-food chain arrive at the school with dozens of pizzas fresh out of the oven, served in Domino’s-branded cardboard boxes. Children can be picky eaters, but few foods are more universally enticing than freshly cooked pizza—let alone from a restaurant students are almost certainly already familiar with. “For kids to be able to see Oh, they’re serving Domino’s, I think it makes a huge difference,” Tanya Edwards, the district’s director of nutrition, told me.

The deliveries are part of Domino’s “Smart Slice” initiative, which sends pizzas to school districts around the country—often at little or no cost to students themselves. “Smart Slice” is part of the national school-lunch program, so taxpayers foot a portion of the bill to guarantee that every kid has lunch to eat. Despite kids’ enthusiasm, you can see the problem: Students munching on free fast food might seem to embody everything wrong with the American diet. If school cafeterias can be thought of as classrooms where kids learn about food, giving them Domino’s would be akin to teaching driver’s-ed students how to drive by letting them play Grand Theft Auto.

The days of school Domino’s—and school pizza in general—are numbered. Health and Human Services Secretary Robert F. Kennedy Jr. and his supporters are on a mission to overhaul school lunch. Late last month, the Trump administration’s Make America Healthy Again Commission released a highly anticipated report on children’s health that pointed to school meals as one venue where ultra-processed foods are offered to kids unabated, contributing to obesity and other kinds of chronic disease. Unless cafeteria workers make school pizza from scratch, nearly every kind contains industrial ingredients that qualify the meal as an ultra-processed food. In effect, ridding school lunch of ultra-processed foods means the end of pizza day as we know it.

Many of the food reforms pushed by RFK Jr.’s movement are popular. Doing away with artificial food dyes, for example, is far more sensible than Kennedy’s conspiracist views about vaccines. But in the case of banning most school pizza, RFK Jr. could be facing a tougher sell. MAHA’s vision for food is about to run headfirst into a bunch of hungry kids in a school cafeteria.

Even though Domino’s school pizza is delivered by Domino’s drivers carrying Domino’s pizza boxes, the company’s Smart Slice is different from what would arrive at your door should you order a pie for dinner tonight. Cafeteria pizza has to abide by nutrition standards for school meals that the Obama administration spearheaded in 2010. The overly cheesy rectangular pizza with a cracker-like crust that you might have eaten in school no longer cuts it. Consider Domino’s Smart Slice pepperoni pizza: It’s made with mostly whole-wheat flour, low-fat cheese, and pepperoni that has half as much sodium than typical Domino’s pepperoni. It’s not a green salad by any means, but school Domino’s is far from the worst thing kids could eat.

Other common cafeteria offerings—such as mini corndogs, mozzarella sticks, and chicken tenders—are also now more nutritious than in decades past. Those standards could still be improved (and we’re still talking about corndogs, mozzarella sticks, and chicken tenders), but they have led companies to sell slightly healthier versions of their foods in schools. Research has shown that, on average, school meals are now the healthiest things kids eat in a day.

In an email, HHS Press Secretary Vianca N. Rodriguez Feliciano said that “while some of these products may technically meet outdated federal guidelines, they are still heavily engineered, nutritionally weak, and designed for corporate profit, not for the health of our kids.” Indeed, school lunch starts to look considerably less healthy if you account for the growing concern over ultra-processed foods. Many school lunches are made in factories with chemicals such as emulsifiers and flavor enhancers you wouldn’t find in a home kitchen. Eating lots of ultra-processed foods is associated with a range of maladies, including Type 2 diabetes and heart disease, though nutritionists are deeply divided on just how much we should be fretting over these industrial ingredients.

To some degree, whether school pizza should be avoided because it’s ultra-processed is beside the point. By allowing Domino’s into school cafeterias, the government also is essentially giving the company carte blanche to advertise its pizza. Serving Smart Slice out of a typical Domino’s box gives “the false impression to children and parents that the less-healthy products served in their restaurants are healthy choices,” Jennifer Harris, a food-marketing expert, told me in an email.

Kennedy has called for schools to serve “real food, whole food, farm-fresh food,” instead of anything ultra-processed. It would, of course, be better for school cafeterias to swap out the pepperoni pizza with salad and chicken breast. But for many kids, school lunch subsidized by the government may be their only real meal of the day. At Channelview, where such a large portion of students are eligible for public assistance that everyone eats for free, simply getting food in kids’ bellies is top of mind. “I can make a fancy little sweet-potato black-bean bowl, but I don’t think my kids are going to eat it,” Tanya Edwards said. “Instead, they are going to go home hungry, and I don’t really know what they have at home.”

The concern isn’t theoretical. Evidence shows that when school meals are too healthy, a sizable portion of kids simply get off the lunch line. In the early 2010s, when the Los Angeles Unified School District overhauled its lunch offerings—an effort that included removing pizza from the menu—schools reported that massive amounts of food were landing in the trash. (The district later brought back pizza, and pepperoni pizza is now the district’s most popular item, a spokesperson said.) Food waste is a perennial issue in school meal programs. A Department of Agriculture study of more than 100 schools found that an average of 31 percent of the vegetables included on observed school lunch trays were wasted. Pizza, however, was among the least wasted food, along with breaded and fried chicken patties and nuggets.

Even advocates for healthier school meals admit that there’s a limit to how much students will tolerate healthier offerings. “We definitely need to harness school food to educate kids about healthy eating, but I don’t think that means no pizza,” Janet Poppendieck, a professor emerita at Hunter College who wrote a book on fixing school meals, told me. “We need to include healthy versions of kids’ favorite foods; otherwise, I don’t think they’ll eat.” In part to ensure that kids actually eat lunch, many school districts seem to have pizza day at least once a week. A spokesperson for Florida’s Hillsborough County Public Schools, the seventh-largest district in the country, told me that its first, second, fifth, and seventh most popular entrees are all in the pizza family (No. 5 is mini calzones; No. 7 is pizza sticks). All told, the district has doled out nearly 3 million servings this school year.

If it wanted to, the Trump administration could simply force kids to suck it up and literally eat their vegetables. Technically the responsibility of overseeing the school-meal program falls to the USDA—which isn’t under Kennedy’s purview—but Secretary of Agriculture Brooke Rollins has signaled that she is onboard with MAHA-ing school lunch. Still, any attempt to enact a ban would likely invite significant backlash. In 2023, when the federal government floated the idea of banning the sale of sugary chocolate milk in elementary and middle schools, many parents flooded the government with complaints. So did some students: Ben, a fourth grader who left only his first name, wrote in an official comment to the USDA that it should abandon the proposal “because students are super MAD.” Members of Congress also put pressure on regulators to stop the reform. The USDA later abandoned the chocolate-milk ban. In 2011, after the Obama administration released its new guidelines for school lunch, Republicans in Congress tried to fight back against healthier pizza by classifying the dish as a vegetable.

It’s no wonder why MAHA has a problem with school pizza. Kennedy has pointed to corporate malfeasance as a leading source of America’s diet problems. You don’t have to be a fan of his to feel uneasy that Domino’s, a fast-food company that sells philly-cheese-steak-loaded tater tots, is participating in a taxpayer-funded program meant to feed kids nutritious meals. But Kennedy’s favored approach to food and, well, everything—big proposals and dramatic overhauls—isn’t well suited to school meals. The health secretary might dream of kids eating from a salad bar stocked with seed-oil-free dressings five days a week, but ending school pizza day won’t automatically make that happen. Telling kids what to eat is one thing; getting them to eat it is another.

Gambling has swallowed American sports culture whole. Until early 2018, sports betting was illegal under federal law; today, it’s legal in 39 states and Washington, D.C. (and easy enough to access through backdoor channels even in the states where it isn’t). During NFL games, gambling commercials air more often than ads for beer. Commentators analyze not just whether a team can win, but if they might win by at least the number of points by which they’re favored on betting apps. Nearly half of men younger than 50 now have an account with an online sports book, and Americans spent about $150 billion on sports wagers last year. I regularly get ads on my phone offering me a complimentary $200 in sports bets, as long as I gamble $5 first.

As betting has overrun American sports, other forms of gambling are also on the rise. According to industry data, American casinos are more popular now than at any point on record. The age of their average patron had been crawling upward for years, but since sports betting was legalized at the federal level, it has plummeted by nearly a decade, to approximately 42. Some signs point to gambling problems increasing, too. No centralized entity tracks gambling addiction, but if its scale comes even close to matching the new scale of sports betting, the United States is unequipped to deal with it.

In its power to ruin and even end lives, gambling addiction is remarkably similar to drug dependency. Imaging studies show that pathological gamblers and people with substance addictions share patterns of brain activity. They are more likely to experience liver disease, heart disease, and sleep deprivation, whether it originates in the anxiety of concealing a gambling addiction or because someone is up wagering on contests, such as cricket and table tennis, that happen in faraway time zones. The best national survey available, which dates to well before the rise of sports betting, found that 2 million to 4 million Americans will experience a gambling disorder at some point in their life; one in six people with a gambling disorder attempts suicide. Even if their death certificate says differently, “I’ve had several patients who died because of the emotional pain from their gambling disorder,” Timothy Fong, a psychiatrist specializing in addiction treatment and a co-director of UCLA’s gambling-studies program, told me.

Fong, like the other researchers I spoke with, said that rapid forms of gambling, especially those that allow you to place multiple bets at one time, tend to be especially addictive. For decades, sports betting mostly involved wagers on who’d win a match, by how much, and total points scored—outcomes resolved over the course of hours. Now apps offer endless in-game bets decided in seconds. Last year, I watched the Super Bowl with a friend who bet on the national anthem lasting less than 90.5 seconds—the smart money, according to the analysts. He lost when Reba McEntire belted the song’s last words twice.

The ability to place one bet after another encourages a hallmark behavior of problem gamblers—when deep in the red, instead of walking away, they bet bigger. “Viewing sports gambling as a way to make money is likely to end badly,” Joshua Grubbs, a gambling researcher at the University of New Mexico, told me. “Gamblers that think that gambling is a way toward economic success or financial payouts almost always have far more problem-gambling symptoms.” And some apps actively blur the already hazy line between betting and other financial activities. For instance, the financial platform Robinhood, where millions of people trade meme stocks and manage their retirement accounts, began offering online sports “events contracts” (a type of investment whose payout depends on traders’ correctly predicting the outcome of a specified event) during March Madness this year through a partnership with the financial exchange Kalshi. (A Robinhood spokesperson told me this “emergent asset class” differs significantly from sports betting because users, not the house, set the prices, and can more easily exit their positions. But the experience of “investing” in an events contract is virtually indistinguishable from betting.) Financial markets have recently started offering services like this even in states where sports betting is illegal. State gambling regulators have called foul, but the federal government has so far made no move to stop the companies. As the courts sort out whether any of this is legal, Robinhood decided to let customers trade on the Indy 500 and the French Open.

Several recent trends suggest that problem gambling might be on the rise in the U.S. Calls to state gambling helplines have increased. (This might be partly explained by advocacy groups marketing their helplines more aggressively than ever; gambling companies also tack the numbers onto their ubiquitous ads.) Fong said that he was recently invited to speak to a consortium of family lawyers, whose divorce clients have started asking, “How do I protect my children from the damage of their father’s gambling?” Researchers and counselors are especially worried about single young men who play in fantasy sports leagues, bet on sports, day trade, and consider gambling a good way to make money. Gamblers Anonymous is rolling out groups for young people. “I’m treating guys who would never be caught dead in a casino,” James Whelan, a clinical psychologist who runs treatment clinics for gambling addiction in Tennessee, told me.

[Read: How casinos enable gambling addicts]

These imperfect proxy measures, along with incomplete data trickling out of a few states, are the best indicators that researchers have about the extent of gambling addiction. Experts are also unsure how long any increase in problem gambling might last: Some studies suggest that the prevalence of gambling problems tends to equalize after a spike, but those findings are usually limited to physical casinos and remain debated within the field. According to researchers I spoke with, no study has established the prevalence of gambling addiction in the U.S. since sports betting became widespread. Federal agencies dedicated to alcoholism and substance abuse allocate billions of research dollars to American universities every year. Yet for decades, the federal government—the largest funder of American research—has earmarked zero dollars for research on gambling activity or addiction specifically, despite collecting millions annually from gambling taxes. (The Substance Abuse and Mental Health Services Administration, which collects national data on behavioral health and funds research into it, declined to comment.)

Gambling-addiction treatment is “50 years behind where we are with drugs or alcohol or any other substance,” Michael Sciandra, the executive director of the Nebraska Council on Problem Gambling, told me. Doctors and therapists, even those who specialize in treating addiction, rarely screen for issues with gambling, he said. Among the handful of dedicated gambling-addiction treatment providers around the country, many deploy cognitive behavioral therapy, which studies suggest can at least temporarily improve patients’ quality of life and reduce the severity of their gambling problem. But discrepancies in treatment approaches and tiny trial sizes make it difficult to say exactly how many patients the therapy helps. Two medications used to treat alcoholism and opioid addiction have also been found to reduce the severity of gambling addiction across a handful of small clinical trials. But the evidence needed for FDA approval would require large and expensive clinical trials that no one seems eager to fund, Marc Potenza, the director of Yale’s Center of Excellence in Gambling Research, told me.

Because the federal government doesn’t fund gambling-addiction treatment, each state decides what resources to make available. A Tennessee caller to the national helpline 1-800-GAMBLER might be put through to their state’s helpline and then connected to the network of government-subsidized clinics Whelan runs across the state. But in states with bare-bones offerings, workers typically refer callers to peer-support groups such as Gamblers Anonymous, or to online resources on budgeting, says Cole Wogoman, a director at the National Council on Problem Gambling, which runs the helpline. Studies have found that each of these strategies is less effective than therapy.

[Charles Fain Lehman: Legalizing sports gambling was a huge mistake]

Texas could be an example of how unprepared the U.S. is to deal with any increase in problem gamblers. The state’s gambling laws are among the strictest in the country, and yet it still sends the second-highest number of callers (behind California) to 1-800-GAMBLER. This November, Texans might vote on a constitutional amendment to allow sports betting. The state of more than 30 million has no funding for gambling treatment and only three certified gambling counselors, according to Carol Ann Maner, who is one of them. The state’s official hub for gambling help, which Maner leads, was founded just this spring.

Once they find the money, Maner and her colleagues plan to finally set up the state’s own helpline. But first, they need to recruit and train more therapists for a job that, thanks to a lack of state and federal funding, might require turning away uninsured clients. That’s a daunting task. Finding the apps Texans can use to get around gambling restrictions is easy.

It was a travesty—two travesties, actually, separate but inextricably linked. In May 1953, Edmund Hillary and Tenzing Norgay became the first people to reach the summit of Mount Everest, a challenge that had killed more than a dozen people in the preceding decades and that scientists had once declared impossible. The catch: They breathed canisters of pure oxygen, an aid that the Everest pioneer George Mallory—one of those who died on the mountain—had once dismissed as “a damnable heresy.”

A month later, a young British medical trainee named Roger Bannister just missed running the first sub-four-minute mile, another long-standing barrier sometimes dubbed “Everest on the track.” But he did it in a race where his training partner let himself be lapped in order to pace Bannister all the way to the finish line, violating rules about fair play due to the advantages of pacing. Bannister’s American rival, Wes Santee, was unimpressed. “Maybe I could run a four-minute mile behind one of my father’s ranch horses,” he said, “if that’s what you want.”

Funny how history repeats itself. Fast-forward to a couple of weeks ago: A controversy erupted in the world of mountaineering, when four British climbers summited Everest just five days after jetting to Nepal from the United Kingdom. To skip the usual weeks or months spent gradually adjusting to high altitude, they paid a reported $153,000 each for a bespoke protocol that included inhaling xenon gas to help them adjust more rapidly. Meanwhile, on the track, Kenya’s three-time Olympic champion, Faith Kipyegon, is preparing for a carefully choreographed, Nike-sponsored attempt to become the first woman to run a mile in under four minutes. It’s slated for June 26 in Paris and will almost certainly violate the same pacing rules that Bannister’s run did.

Both initiatives are, by any measure, remarkable feats of human ingenuity and endurance. They’re also making people very angry.  

The xenon-fueled expedition was organized by an Austrian guide named Lukas Furtenbach, who is known for his tech-focused approach to expeditions. He has previously had clients sleep in altitude tents at home for weeks to pre-acclimatize them to the thin mountain air. What made the new ascent different is that, in addition to sleeping in altitude tents, the four British climbers visited a clinic in Germany where they inhaled xenon gas, whose oxygen-boosting potential has been rumored for years. The World Anti-Doping Agency banned xenon in 2014 after allegations that Russian athletes used it for that year’s Winter Olympics. But subsequent studies on its athletic effects have produced mixed results. Other research in animals has hinted at the possibility that it could offer protection from potentially fatal forms of altitude illness, which can occur when climbers ascend too rapidly. For now, the strongest evidence that it helps high-altitude mountaineers comes from Furtenbach’s own self-experimentation over the past few years.

When news of Furtenbach’s plans emerged earlier this year, the International Climbing and Mountaineering Federation’s medical commission put out a statement arguing that xenon probably doesn’t work and could be dangerous because of its sedative effects. Other critics have pointed out that shorter expeditions mean less paying work for the Sherpa guides in the region. But these criticisms can feel like post hoc justifications for the fact that many mountaineers simply have a gut-level aversion to what seems like a shortcut to the summit. Their objection isn’t to xenon itself but to the idea of making Everest easier.

That’s the same problem many runners have with Kipyegon’s sub-four-minute-mile attempt. Women have made extraordinary progress in the event since Diane Leather notched the first sub-five in 1954, but under conventional racing conditions, no one expects a sub-four anytime soon. Kipyegon is the fastest female miler in history: Her current world record, set in 2023, is 4:07.64, which leaves her more than 50 yards behind four-minute pace—an enormous deficit to overcome in a sport where, at the professional level, progress is measured in fractions of a second. Nike has promised “a holistic system of support that optimizes every aspect of her attempt,” including “footwear, apparel, aerodynamics, physiology and mind science,” but hasn’t revealed any details of what that support might look like. That means critics—and there are many—don’t yet have any specific innovation to object to; they just have the tautological sense that any intervention capable of instantly making a miler 7.7 seconds faster must by definition be unfair. (I reached out to Nike for further specifics about the attempt, but the company declined to comment.)

It’s a safe bet that new shoes will be involved. Kipyegon’s effort, dubbed Breaking4 by Nike, is a sequel to the company’s Breaking2 marathon in 2017, in which Kipyegon’s fellow Kenyan Eliud Kipchoge came within 25 seconds of breaking two hours at a time when the official world record was 2:02:57. Kipchoge’s feat was made possible in part by a new type of running shoe featuring a stiff carbon-fiber plate embedded in a thick and bouncy foam midsole, an innovation that has since revolutionized the sport. But the reason his time didn’t count as a world record was that, like Bannister, he had a squad of pacers who rotated in and out to block the wind for him all the way to the finish line. That’s also likely to be a key for Kipyegon. In fact, scientists published an analysis earlier this year suggesting that a similar drafting approach would be enough to take Kipyegon all the way from 4:07 to 3:59 without any other aids.

Bannister’s paced-time trial in 1953 was ruled ineligible for records because, per the British Amateur Athletic Board, it wasn’t “a bona fide competition according to the rules.” Still, the effort had served its purpose. “Only two painful seconds now separated me from the four-minute mile,” Bannister later wrote, “and I was certain that I could cut down the time.” Sure enough, less than a year later, Bannister entered the history books with a record-legal 3:59.4. Similarly, Kipchoge went on to break two hours in another exhibition race in 2019, and Nike’s official line is that it hopes that feat will pave the way for a record-legal sub-two in the future. (It’s certainly getting closer: The world record now stands at 2:00:35.) In 1978, a quarter century after Hillary and Norgay’s historic ascent, Reinhold Messner and Peter Habeler climbed Everest without supplemental oxygen.

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One view of innovation in sports, advanced by the bioethicist Thomas Murray, is that people’s perceptions are shaped by how new ideas and techniques are introduced. The status quo always seems reasonable: Of course we play tennis with graphite rackets rather than wooden ones, use the head-first Fosbury flop to clear high-jump bars, and climb mountains with the slightly stretchable kernmantle ropes developed in the 1950s. But many of these same innovations seem more troublesome during the transition periods, especially if only some people have access to them.

When Bannister finally broke the four-minute barrier, he was once again paced by his training partners, but only for about the first three-quarters of the race. This form of pacing remained highly controversial, but because none of the pacemakers had deliberately allowed himself to be lapped, the record was allowed to stand. These days, such pacing is so routine that there are runners who make a living doing nothing but pacing races for others, always dropping out before the finish. The full-race pacing that Kipyegon will likely use in Breaking4 remains verboten; the slightly different pacing that leads runners almost all the way through the race but forces them to run the last lap alone is simply business as usual. Oxygen in a can is good; xenon in a can is bad. These are subtle distinctions.

Sports are, in at least some respects, a zero-sum game: When one person wins a race or sets a record, it unavoidably means that someone else doesn’t. Even at the recreational level, if everyone decides to run marathons in carbon-plated shoes that make them five minutes faster, the standards needed to qualify for the Boston Marathon get five minutes faster. “Once an effective technology gets adopted in a sport, it becomes tyrannical,” Murray told me several years ago, when I was writing about athletes experimenting with electric brain stimulation. “You have to use it.” In the ’50s, a version of that rationale seemed to help the British expedition that included Hillary and Norgay overcome the long-standing objections of British climbers to using oxygen—the French had an Everest expedition planned for 1954 and the Swiss for 1955, and both were expected to use oxygen.

Less clear, though, is why this rationale should apply to the modern world of recreational mountaineering in which Furtenbach operates. What does anyone—other than perhaps the climbers themselves, if you think journeys trump destinations—lose when people huff xenon in order to check Everest off their list with maximal efficiency? Maybe they’re making the mountain more crowded, but you could also argue that they’re making it less crowded by getting up and down more quickly. And it’s hard to imagine that Furtenbach’s critics are truly lying awake at night worrying about the long-term health of his clients.

Something else is going on here, and I’d venture that it has to do with human psychology. A Dutch economist named Adriaan Kalwij has a theory that much of modern life is shaped by people’s somewhat pathological tendency to view everything as a competition. “Both by nature and through institutional design, competitions are an integral part of human lives,” Kalwij writes, “from college entrance exams and scholarship applications to jobs, promotions, contracts, and awards.” The same ethos seems to color the way we see dating, leisure travel, hobbies, and so on: There’s no escape from the zero-sum dichotomy of winners and losers.

Kalwij’s smoking gun is a phenomenon that sociologists call the “SES-health gradient,” which refers to the disparities in health between people of high and low socioeconomic status. Despite the rise of welfare supports such as pensions and health care, the SES-health gradient has been widening around the world—even, Kalwij has found, among Olympic athletes. There used to be no difference in longevity among Dutch Olympians based on their occupation. But among the most recent cohort, born between 1920 and 1947, athletes in high-SES jobs, such as lawyers, tend to outlive athletes in low-SES jobs by an average of 11 years. As Kalwij interprets it, making an Olympic team is a life-defining win, but getting stuck in a poorly paying dead-end job is a loss that begets an endless series of other losses: driving a beater, living in a lousy apartment, flying economy. These losses have cumulative psychological and physiological consequences.

Some things in life really are competitions, of course. Track and field is one of them, and so we should police attempts to bend its rules with vigilance. Other things, such as being guided up Everest, are not—or at least they shouldn’t be. The people who seem most upset about the idea of rich bros crushing Everest in a week are those who have climbed it in six or eight or 12 weeks, whose place in the cosmic pecking order has been downgraded by an infinitesimal notch. But I, too, was annoyed when I read about it, despite the fact that I’ve never strapped on a crampon. Their win, in some convoluted way, felt like my loss.

Another detail in Kalwij’s research sticks in my mind. Among American Olympians, silver medalists tend to die a few years earlier than either gold or bronze medalists. Kalwij theorizes that these results, too, are related to people’s outlook. Gold medalists are thrilled to win, and bronze medalists are thrilled to make the podium; silver medalists see themselves as “the No. 1 loser,” as Jerry Seinfeld once put it. With that in mind, I’ve tried to reframe my attitude about the xenon controversy. Let the annual Everest frenzy continue, with or without xenon, and let its allure continue to draw the most hard-edged and deep-pocketed summit baggers. Meanwhile, leave the other, lesser-known mountains for the rest of us to enjoy in tranquility. I’d call that a win.