Medical News

In the fall of 2021, Tammi Kromenaker started looking for a new home for her North Dakota abortion clinic. For more than 20 years, Red River Women’s Clinic had provided abortion care to the Fargo area, most of that time as the state’s only provider. But now Kromenaker, the practice’s owner and director, was moving it just across the state line to Minnesota. “We had seen the writing on the wall,” she told me. A few months earlier, the Supreme Court had announced that it would take up Dobbs v. Jackson Women’s Health Organization, and North Dakota had a trigger law that would almost completely ban abortion if the justices ruled in favor of Dobbs.

“We closed on a new building at 3 p.m. the day before they overturned Roe,” Kromenaker recalled. Over the next 47 days, with the help of $1 million raised through GoFundMe, she oversaw a frantic move and remodel, sneaking around in a hat and sunglasses to keep the new location a secret; another planned clinic had just been set on fire in Wyoming. Meanwhile, Kromenaker’s clinic sued the state of North Dakota to block the trigger ban.

Last month, a North Dakota judge struck down the state’s abortion ban in response to Red River’s suit. Kromenaker could now return to providing abortions in Fargo, but she told me she has no plans to. That leaves the state with no dedicated abortion providers.

In the aftermath of the Dobbs decision, abortion access has been all but obliterated in 14 states. Perhaps the most obvious consequence is what has happened to brick-and-mortar abortion providers: Clinics have closed, while physicians have fled restrictive states or left medicine altogether. In communities across the country, abortion pills have also been heavily restricted. A push to expand the rights of a fetus has coincided with a rise in pregnancy-related prosecutions, most of which have nothing to do with abortion—210 women were criminally charged in 12 states in the year after Dobbs, the highest number of such cases in a single year since 1973, according to one report.

The backlash has been forceful. Since Dobbs, citizens in six states have voted for ballot measures protecting abortion access. Next month, abortion rights will again be on the ballot, in 10 states. In the first presidential election since Roe was overturned, abortion has become a defining issue. Many Republican politicians, including the party’s presidential nominee, Donald Trump, have attempted to court female voters by wavering on their previous anti-abortion positions. (Trump’s wife, Melania, released a memoir this month, in which she underscored her support for abortion rights.) Meanwhile, Democrats, especially the presidential nominee, Kamala Harris, have campaigned heavily on restoring national reproductive rights. But a Democratic woman in the White House or new federal abortion protections won’t turn back the clock to 2021. Call it the Dobbs legacy, or the Dobbs hangover—the effects of America’s eroded abortion access will linger for years, if not decades.

[Read: Kamala Harris’s biggest advantage]

This summer, on the two-year anniversary of the Dobbs decision, a coalition of groups including Planned Parenthood and the American Civil Liberties Union announced that they were committing $100 million to Abortion Access Now, a campaign to pass federal legislation guaranteeing the right to abortion. Harris has floated one potential path: scrapping the filibuster to push reproductive protections through Congress. (That would probably require Democrats to control both chambers, which does not look likely.) If new federal protections were passed, “you would see overnight relief in a lot of places, depending on the nature of the legislation,” Kimberly Inez McGuire, a co-chair of Abortion Access Now and the executive director of Unite for Reproductive and Gender Equity, told me.

New federal protections, however, wouldn’t instantly undo the tangle of abortion restrictions that some states began enacting even before Dobbs was decided. Reproductive health in America is governed by a complex web of laws, regulations, and court decisions at the local, state, and federal levels. When the Supreme Court ended constitutional protections for abortion on June 24, 2022, trigger laws designed to ban abortion went into effect. By the end of the year, states had enacted 50 new abortion restrictions, many of them resulting in near-total bans. No federal law could immediately undo all of these restrictions at once. Around the country, clinics closed, moved, or quit providing abortions; as of March, the U.S. had 42 fewer clinics than in 2020, according to the Guttmacher Institute, a reproductive-health research and policy group.

With so many barriers in place, some medical providers have decided that living and working in states with restrictions isn’t worth the emotional and professional toll. In one recent study of ob-gyns in Texas, where abortion is banned with few exceptions, 13 percent of respondents said they plan to retire early, 21 percent said they either plan to or have thought about leaving to practice in another state, and 2 percent said they have already left. An analysis by the Association of American Medical Colleges found that applications for ob-gyn residency programs in Alabama, which has a total ban except in cases of “serious health risk” to a pregnant woman, dropped 21.2 percent in the first full cycle after the Dobbs decision.

[From the October 2024 issue: ‘That’s something that you won’t recover from as a doctor’]

None of these policies has reduced the number of abortions performed nationally since Dobbs—in fact, the number has increased—but their consequences have ricocheted far beyond abortion. As obstetricians have fled restrictive states, for example, access to other gynecological care has become strained, too. And this month, Louisiana reclassified the two drugs used in medication abortions as Schedule IV controlled substances, a category typically reserved for drugs with a potential for dependency, such as Xanax and Valium. Mifepristone and misoprostol, which can be prescribed by telehealth, have played a significant role in abortion access since Dobbs. In Louisiana’s bid to further restrict the drugs, the state has potentially limited their use in other routine applications, such as treating miscarriages, inducing labor, and stopping potentially fatal postpartum hemorrhaging.

Even if new federal abortion protections were passed into law tomorrow, restoring nationwide access would still likely take significant time. Clinics, for instance, need real estate and doctors and lots and lots of capital to open or move—that’s partly why, after a 2016 Supreme Court case struck down a Texas law designed to force clinics out of business, the number of providers in the state a year later remained a fraction of what it was before. After Alabama banned abortion in 2022, WAWC Healthcare, in Tuscaloosa, remained open to provide contraception and prenatal care but eventually lost its abortion provider, says Robin Marty, WAWC’s executive director. Such positions might be filled by recent graduates, but the pool of qualified providers in restrictive states will remain small for years thanks to plummeting residency enrollments—most doctors tend to stay in the state where they do their residency.

Recent legal fights in Ohio provide a glimpse of how even sweeping abortion protections don’t automatically undo the effects of restrictions, and could lead to new ones. Last year, Ohio voters approved a constitutional amendment enshrining the right to an abortion. But pro-abortion-rights advocates in the state are still fighting to throw out the state’s six-week ban and a law banning telemedicine in medication abortions, among other restrictions. Meanwhile, a state legislator has introduced a new bill that would withhold state funding from cities and counties that provide funding for local groups that provide abortion-support services such as gas money for patients. The immediate result of any national abortion protection would probably be a protracted legal battle. “Every state has a different assemblage of abortion restrictions,” Inez McGuire said. “A lot of that is going to be fought out through our judicial system. That is a daunting prospect.”

Roe’s downfall also opened up space for anti-abortion activists to renew their battle to recognize the rights of the fetus as a person. In February, when the Alabama Supreme Court found that IVF embryos are legally children, anti-abortion activists widely celebrated the decision as a sign that the country was ready to engage in this debate. As support for fetal rights has grown, pregnant people have found their bodily autonomy curtailed even when they’re not deciding whether to continue a pregnancy: According to the nonprofit group Pregnancy Justice, of the 210 cases of pregnant people who faced criminal charges, just five mentioned abortion. The majority alleged only substance abuse. In one, police charged an overdosing pregnant woman with child neglect after administering Narcan.

[Helen Lewis: The women killed by the Dobbs decision]

Abortion advocates, too, are adjusting to the new reality. Abortion access had been whittled away for decades before Dobbs was decided. But now the constitutional right to an abortion in America is no longer being infringed upon; it just doesn’t exist. Several clinic directors told me that it’s clear to them now that no new law will ever provide unassailable protection. When North Dakota’s ban was struck down by a district court last month, it wasn’t the first time; the same judge blocked a nearly identical abortion ban in 2022, eventually prompting the state legislature to repeal it and pass a new one with minor changes. Just this month, Georgia’s Supreme Court restored a six-week abortion ban that a lower court had overturned while it considers an appeal. “There is no finish line here,” says Katie Quinonez-Alonzo, the executive director of Women’s Health Center, which opened a branch of its West Virginia clinic three and a half hours away in Maryland after Dobbs. “This is work that needs to be done forever.” Kristi Hamrick, the vice president of media and policy for Students for Life of America, told me that the group already has a “Roe 2.0 Rollback plan” in place, ready to deploy at the state and federal levels after the election. “We are prepared legislatively and legally to address the human rights issue of the day, no matter which way the election turns out,” she told me.

Some clinics are tired of fighting. “If you had asked me a few weeks ago, I would have said we were completely ready to go should abortion somehow return to Alabama,” Robin Marty told me. Now she’s not so sure. “We worked in extraordinarily hostile conditions” before Dobbs, Marty said. Clinic staff faced daily protesters, in the parking lot and sometimes even at the back door. Anti-abortion activists filed malpractice complaints against them, reported them to the fire department for allegedly having too many people in the clinic, and alleged health-privacy violations after digging through the clinic’s dumpster and finding a piece of paper from a patient’s file. “Having abortion become illegal and then having it return would be even more dangerous right now. If it comes back, they’re going to be even angrier,” Marty said.

When Red River first opened, in 1998, the threat of extinction was already in the air. The previous director had chosen to name the clinic after a body of water that runs between North Dakota and Minnesota, so that the reference would still make sense on the other side of the state border. When Kromenaker finally made the move, her life became easier virtually overnight, because Minnesota was among the states that had passed abortion protections after Dobbs. “We ended up in a state where providing this care is more straightforward, more patient-centered and with less stigmatizing restrictions,” Kromenaker said. “We would never take a step back and re-inflict those restrictions on ourselves.”

[Read: Abortion pills have changed the post-Roe calculus]

The United States cannot easily go back to the pre-Dobbs status quo. In the past two years, too much has changed—more than 100 new legal provisions, dozens of clinics closed, and a cultural gulf that has grown ever wider. For both abortion-rights supporters and opponents, only one possibility remains: to inhabit the reality we all live in now.

The loaf in my fridge is the furthest thing from Wonder Bread. Each slice is made of organic whole-wheat flour and has four grams of fiber and just two measly grams of added sugar. It’s studded with so many seeds that I’m always worried about them getting stuck in my teeth. The only service this bread can provide is as a hummus sandwich; it tastes too healthy for a grilled cheese, an egg sandwich, or any other handheld creation.

But here’s the thing about my whole-grain, seed-coated loaf of bread: Apparently it counts as an ultra-processed food, just like Twinkies, Coke, and sugary cereals. I was faced with this bread conundrum earlier this month, when I attempted to cut down on ultra-processed foods after hearing so much about their harms. Almost every food is processed in some way—milk is conventionally pasteurized; tomatoes are canned—but ultra-processed foods, or UPFs, are typically made in factories with industrial ingredients, such as emulsifiers and artificial flavors. And they seem to be making us sick. A recent review found “convincing evidence” that ultra-processed-food consumption is tied to type 2 diabetes and fatal heart disease.

According to the rubric created by Carlos Monteiro, the Brazilian epidemiologist who coined ultra-processed foods, my loaf of bread was to be avoided: It was mass-produced, laced with an industrial additive, and sliced. In an email, Monteiro confirmed to me that the bread was a UPF primarily because of the industrial additive: wheat gluten. It’s often used to strengthen dough before it is baked. If you get bread from the grocery store, as I did, it’s almost certainly also a UPF. But perhaps that says more about the perplexing, arbitrary criteria for ultra-processed foods than anything about bread itself.

Exactly what qualifies as an ultra-processed food is not always clear. Monteiro’s rubric, called NOVA, separates foods into four categories. “Unprocessed foods” include raw vegetables and fruits. “Processed culinary ingredients” are things like cooking oils and honey. “Processed foods” are things like canned vegetables. And “ultra-processed foods” include Skittles, fish sticks, and other junk food, as well as infant formula and flavored yogurts. Drawing the line between ultra-processed and processed foods is especially tricky. NOVA doesn’t lay out specific criteria for, say, bread versus soda, but it does have detailed descriptions of how to spot an ultra-processed food, such as foods that include ingredients “never or rarely used in kitchens,” such as high-fructose corn syrup and hydrolyzed proteins.

But even when you read Monteiro’s countless papers outlining the NOVA classification, categorizing food isn’t as simple as you might think. NOVA has called out “pre-sliced bread” as an example of an ultra-processed product, but I couldn’t tell if slicing automatically meant that a food was ultra-processed, or if it was just a signal that a food might be ultra-processed. (With my bread, Monteiro told me that the presence of wheat gluten was “the only marker” of ultra-processing.) But added gluten is hardly the same as hydrolyzed proteins or industrial sweeteners. The fact that a single ingredient—and one as benign as wheat gluten—could lump my bread together with Twinkies made me question the credibility of the entire system.

The attributes to look for in bread, like slicing, felt so arbitrary that I started to wonder if I was applying the criteria incorrectly. Nutritionists I contacted struggled too. Marion Nestle, a professor emeritus of nutrition at NYU who has defended the NOVA system, told me she wasn’t sure whether the bread I was eating qualifies as an ultra-processed food, because, despite having an industrial additive mixed in, it was made mostly from actual whole foods. Even Monteiro seemed confused at first. When I sent him the ingredient list, he initially told me that my loaf was just processed (not ultra-processed), until I asked him specifically about the wheat gluten. He then argued that the bread “is much better than the average ultra-processed bread.” But the idea of UPFs is to try to avoid the category entirely.

Monteiro’s team appears to have long struggled with the bread quandary as well. Nearly every paper they write on the system classifies bread as ultra-processed, but they’ve argued that “bread, even in typically cheapened degraded forms, is relatively innocuous.” In 2015, the team classified “french bread” as “processed,” but “sliced bread” as “ultraprocessed.”

Even if I accepted that my bread was ultra-processed, I still couldn’t understand why it was so bad. Much of the research into the health effects of bread has focused on the nutrients—or lack thereof—in certain products, especially white bread. Mostly, researchers fear that particular additives in bread have not been extensively studied, and that processed bread is easier to chew and swallow, thus prompting people to eat more.

I wasn’t even a week into my attempt to cut out UPFs, and I was already feeling exasperated. The situation was made even worse when I went back to the grocery store in hopes of finding a replacement. At first glance, no bread seemed to fit the bill. Although the Real Bread Campaign, an advocacy group focused on reducing consumption of ultra-processed bread, recommends buying natural sourdough from a local baker, or making it yourself, that’s hardly useful advice for the many Americans who don’t even have easy access to a grocery store, let alone a boulangerie. The NOVA system seems, at first glance, like the world’s simplest diet: All you have to do is avoid certain foods. But when that list gets so broad that you can’t eat a slice of whole-grain bread, it becomes unworkable. The same goes for yogurts and cereals—the majority of which are banned too.

The bread debacle can seem like a straw man designed to make the whole system look pointless and unworkable. Some food scientists have criticized NOVA for being overly broad and unfairly maligning some healthy foods, but those arguments are also made in bad faith by big food companies to defend an industry that has made billions off making people sick. Monteiro told me that zeroing in on a single food “focuses on the trees and loses the forest.” But the entire exercise—the confusing guidelines, and the lack of clear articulation for why certain attributes of foods are worth avoiding—was weighing on me.

This isn’t all NOVA’s fault. The clumsy classifications underscore an even deeper problem with our knowledge—or lack thereof—of UPFs. In short, we don’t know why ultra-processed foods are so bad for us. A recent clinical trial, in which participants ate either ultra-processed or unprocessed diets that were matched for certain key nutrients, found that something beyond the nutrient facts in UPFs makes people eat more and gain weight. What that is remains unclear. Until we understand it, advice on which foods to eat, and which to avoid, will always seem arbitrary and, in the case of bread, a bit silly.

I did eventually find some bread in the supermarket that definitely wasn’t ultra-processed. The loaf, if you could call it that, had been imported from Germany. It had just four ingredients, and it smelled like dead grass. There were no air pockets or delectably crunchy crust. When toasted, it didn’t get crispy; it just got hotter and more pungent. For now, I’m going to stick to my regular old healthy bread.

Ibogaine, a psychedelic compound found in plants native to central Africa, is notorious for the intensity of the trips it induces. Those who consume it are plunged into vivid hallucinations, often preceded by a loud buzzing noise, that last between 24 and 48 hours. In one case report, a 29-year-old woman from Gabon met her dead relatives, and later looked into a mirror and saw a woman crying and holding a baby. A middle-aged American man experienced himself from the perspective of a “Mexican little boy and I’m praying on the side of a road.” When he opened his eyes, one of the people in the room appeared to resemble “a big praying mantis.”

Late last year, Arthur Juliani, a 32-year-old research scientist at the Institute for Advanced Consciousness Studies, was decidedly not taking ibogaine, but was ingesting something similar. He had obtained tabernanthalog, a research molecule designed to mimic ibogaine’s chemical structure and potential effects on neuroplasticity, but not cause any hallucinations. About 45 minutes after he swallowed his dose, Juliani started to feel a kind of “spacious attention,” he told me. On a walk outside, he found that anywhere he looked appeared like a “perfectly framed photograph, distinct and standing on its own.” When he went home for lunch, he ate a bell pepper “in the slowest and most intentional manner I had ever eaten a vegetable in my life.”

Tabernanthalog is part of a wave of drug development that draws inspiration from psychedelics while attempting to remove or refine their trips. Many of the compounds involved are targeted toward some medical purpose; tabernanthalog, for example, is being researched as a treatment for substance-use disorder. Such work has led to debates among psychedelic therapists and researchers about how important a drug experience is for mental-health outcomes. But Juliani’s encounter with tabernanthalog provokes a more complex question: If novel psychedelics and “pseudo-delics” tickle brain receptors in a way that changes people’s subjective experience—perhaps in a manner less intense than traditional psychedelics, and more on par with prescription or over-the-counter drugs—can one confidently say that the people who take them aren’t tripping? As the pursuit of non-hallucinogenic psychedelics advances, the definition of a trip as something induced by a discrete set of substances is set to evolve alongside them.

These days, the hottest new psychedelic drugs might be the ones that feel as close to nothing as possible. In 2022, scientists made a trip-free analogue of LSD to research as an antidepressant. Another is being investigated as a treatment for cluster headaches. This month, the biotech company Bright Minds Biosciences announced that its new compound, which interacts with the same serotonin receptors as psilocybin and LSD but doesn’t cause hallucinations, had a “similar efficacy” to morphine at reducing pain. The federal Defense Advanced Research Projects Agency is developing novel compounds for chronic depression and post-traumatic stress that are not hallucinogenic but are inspired by psychedelic compounds.

These compounds are mostly being tested in research labs and administered in clinical trials, but curious psychonauts have said online that they’ve purchased their own samples to see just how non-hallucinogenic they are. Josh Hardman, the founder of the publication Psychedelic Alpha, collected online reports from a dozen people who claimed to have tried tabernanthalog. Many of the resulting experiences sound trip-like or trip-adjacent. One person said it was “basically the body high of psychedelics without the visuals.” Another said, “Everything had a deeper layer of thinking, almost like I had unlocked a childish part of my mind that I had long forgotten.” (David E. Olson, a biochemist at UC Davis and the co-founder of Delix Therapeutics, the company developing tabernanthalog, said that he considers it dangerous to order drugs made by “clandestine chemists” on the internet because “there is no way to guarantee the identity, purity, or dose of the drug,” and that anecdotal reports can be untrustworthy.)

Defining a psychedelic experience was difficult even before the introduction of these novel compounds. The word comes from the psychiatrist Humphry Osmond, who argued in a 1957 letter to Aldous Huxley that similar effects could arise from drug use, epilepsy, schizophrenia, starvation, vitamin deficiency, yoga practices, and dervish dancing. “It is all one to me,” Osmond wrote. Aidan Lyon, a philosopher at Leiden University in the Netherlands and the author of Psychedelic Experience: Revealing the Mind, has argued that breath work, meditation, and even engaging with a piece of art could count as psychedelic experiences. (In “museum dosing,” people do both: look at art while tripping.)

Peter Sjöstedt-Hughes, a philosopher of mind and metaphysics at the University of Exeter, in the U.K., agrees with Osmond that a trip should be defined by phenomenology, not pharmacology. For example, he told me, “A number of people have tried to define psychedelic as operating on the serotonin receptors, but that immediately can’t be true because it would exclude salvia divinorum”—a hallucinogenic plant in the mint family. Mike Jay, a historian and the author of Psychonauts: Drugs and the Making of the Modern Mind, told me that the effects of a psychedelic analogue may be construed as either trips or side effects, depending on when and how people experience them.

These debates are more than academic. Earlier this year, the FDA rejected an application for a psychedelic drug, MDMA, to be used to assist psychotherapy for PTSD. The biotechnology company Compass Pathways is poised to seek approval for psilocybin as a medication for treatment-resistant depression as soon as 2025. Medical interest in hallucinogenic drugs is currently higher than it’s been in decades, and in order to understand how psychedelic-assisted therapy might help or harm people, researchers are eager to tease apart psychedelic experience from any underlying biological effects. Perhaps certain aspects of a trip could improve or reduce a drug’s efficacy against, say, depression or PTSD; if so, researchers need to be able to measure and define those effects to design successful treatment protocols. The company Mindstate Design Labs even hopes to isolate and enhance the parts of a psychedelic trip that are therapeutically useful. If they’re successful, you could perhaps one day take a pill just for the psychedelic-induced sensation of limitless unity, without the ego loss that sometimes accompanies it.

In a recent Nature Reviews Psychology paper, Johns Hopkins researchers argued that the field needs a new, rigorously validated scale of psychedelic experiences to accurately capture what people go through when they’re tripping. There’s too much variation among the existing measures, David B. Yaden, one of the study’s authors and a co-writer of The Varieties of Spiritual Experience, told me. The 5-Dimensional Altered States of Consciousness Questionnaire scale, for example, includes the measure of “oceanic boundlessness,” but it’s not mentioned in the Inventory of Nonordinary Experiences, which includes visions of ghosts in its rubric.

Non-hallucinogenic, consciousness-altering experiences, like those reported to result from tabernanthalog use, sound far away from such mystical experiences, and more akin to how some people might feel after drinking a glass of wine or a strong cup of coffee. “Many of us are just filling our bodies with substances that cause acute alterations in consciousness of various degrees,” says Chuck Raison, a psychiatry professor at the University of Wisconsin at Madison. Millions of Americans take prescription drugs that affect their psychology, and their numbers are only growing. Psychedelic-inspired drugs might end up resembling many other FDA-approved psychoactive pharmaceuticals, or the wide variety of other things with which humans regularly modify our consciousness, such as supplements, caffeine, alcohol, meditation, exercise, sex, and sleep (or lack thereof).

I told Raison that I’m sensitive to caffeine, and if I drank three cups of coffee, I would likely have an intense physical and mental experience—would that be a trip? The real marker of a trip, he told me, is that it “is different from one’s typical waking awareness in such a way that it produces longer-term changes in perspective or behavior.” After my coffee, I might feel high, he said. “A day later, other than thinking about how odd it was that the coffee hit you so hard, would your life change? The experience would come and go. But psychedelics tend not to do that.” A trip, whatever it is, stays with people. Juliani’s time under the (alleged) influence of tabernanthalog certainly seems to have stayed with him. “I entered into what was clearly an altered state of consciousness, and I stayed there for some number of hours, and I came out of it,” he told me. It was, he added, “a reminder that there isn’t just one kind of consciousness,” but many to inhabit.

In his 1902 book The Varieties of Religious Experience, the psychologist William James wrote that one quality of a truly transformative experience is that it’s ineffable. Sjöstedt-Hughes told me something similar. “One thing that certainly distinguishes psychedelic experience from ordinary states of consciousness is the fact that you can have experiences for which there exist no words,” he said. Researchers will continue trying to break down that ineffability, but in the meantime, Yaden said, identifying a trip might ultimately come down to what he’s called the “orgasm test”: If you have to ask if you had one, you probably didn’t.

Taken on its own, the number is astonishing. According to the CDC, as of August 2023, 40.3 percent of U.S. adults—some 100 million people—met the clinical definition for obesity. But this same estimate, which is based on National Health and Nutrition Examination Survey numbers gathered between 2021 and 2023, also seems remarkably low compared with prior readouts. For the first time in more than a decade, NHANES data hint that our obesity epidemic is no longer growing.

The new estimate is almost two percentage points lower than the government’s previous one, which covered the period from 2017 to 2020 and suggested that 41.9 percent of Americans had obesity. The apparent drop has set off a wave of optimism: A recent editorial in The Washington Post, for instance, celebrated the fact that “the obesity crisis might have plateaued or begun to ease,” and in the Financial Times, the data journalist John Burn-Murdoch used his own analysis of the NHANES data to argue that America is already several years beyond its point of peak obesity. Both outlets suggest that this apparent change in public fortune has resulted from the spread of powerful new drugs for treating diabetes and obesity: Ozempic, Mounjaro, and the rest.

The past few years have certainly brought dramatic changes—historic breakthroughs, even—to the treatment of weight-related chronic illness. GLP-1s seem to be effective at improving people’s health, and they’re clearly capable of causing major weight loss. According to a survey conducted by KFF at the end of April, 6 percent of all American adults are currently on these medications, and as supply shortages ease and drug prices come down, that proportion is likely to increase—by a lot. It only stands to reason that, at some point before too long, their effects will be apparent in our public-health statistics. But are they now, already? For all the expectations that are attached to the present age of GLP-1s, the past should be a source of caution. This is not the first time that obesity’s relentless spread has seemed to be abating, and it’s not the first time that such news has fit into a tidy narrative of progress in public health. And so far, at least, claims of peak obesity, like predictions of “peak oil,” have been prone to falling flat.

Not so long ago, the NHANES data appeared consistent with a different source of hope. Starting back in 2008, analyses began to show, first in children and then in adults, that obesity rates were leveling off. “Americans, at least as a group, may have reached their peak of obesity,” The New York Times asserted in 2010; two years later, NPR reported that “the nation’s obesity epidemic appears to have hit a plateau.”

Then, as now, experts had a convenient story to explain the numbers. Barack Obama’s administration was working to realize his campaign promise that the nation’s excess weight could be reduced, if not erased, by targeting what was by then described as America’s “toxic food environment.” Revised nutrition labels put a spotlight on “added sugars,” new rules for food assistance promoted eating fruits and vegetables, insurers were encouraged to set up wellness programs, and chain restaurants were required to post the caloric content of their meals.

For a time, this new approach—based less on treating individuals than fixing social policy—appeared to be effective. Food manufacturers committed to improving the formulations of their products. Americans stopped drinking so much soda and consuming so much sugar overall. And, sure enough, NHANES data were showing that the number of people with obesity had stabilized. This seemed connected, at the time. “We’ve halted the progress of the obesity epidemic,” William Dietz, an obesity physician-researcher who was then a CDC official, told the Times. Dietz, who had played a central role in creating the idea that obesity was an “epidemic” in the first place, chalked up that achievement to increased awareness of the problem and improvements to school-lunch programs.

Yet this progress turned out to be short-lived. In retrospect, the obesity-rate “plateaus” during those years now appear to be a trend-line blip, if not a statistical mirage. That’s not to say the CDC’s analyses were mistaken. The survey’s error bars were wide, and in those years, any increase in the numbers was not statistically significant. But over time a clear and upward drift became unmistakable. As of 2004, NHANES data showed that about one-third of American adults qualified as having obesity. By 2018, the proportion had moved past 40 percent.

Now Cynthia Ogden, the CDC’s branch chief for NHANES analysis, and her colleagues are reporting another flattening, set against a decades-long increase. Once again the error bars are wide, which is why the CDC’s data brief asserts that the apparent drop in the obesity rate, from 41.9 percent to 40.3 percent, is better understood as a new plateau. “We’re not going up at the same level as we did,” Susan Yanovski, a co-director of the NIH Office of Obesity Research, told me, “but I don’t think we can necessarily say that it’s a real decrease.” In the meantime, the new data clearly show that the rate of severe obesity among U.S. adults has continued to increase.

If we are indeed at a new plateau for Americans generally, then its cause is not yet clear. David Ludwig, an endocrinologist at Boston Children’s Hospital who has been skeptical of earlier “peak obesity” claims, told me that new drugs such as Ozempic certainly should be having some effect by now. “Even if a notable minority is taking the drugs and losing weight, that’s going to alter the shape of the curve, the prevalence rates, and related statistics,” he said. “So it would be surprising, and very depressing, for us not to see any impact of these extremely costly drugs by this point.” Burn-Murdoch, who seems to be working from the same assumption, points out that the recent improvement in obesity numbers looks better among people with college degrees than anyone else. This is just what you might expect, he argues, because the uptake of GLP-1 drugs is generally associated with education.

Yet if the Ozempic effect really were showing up in NHANES data, you’d also expect it to appear first in women, who are much more likely than men to be taking GLP-1s for obesity. This is not borne out in the data: America’s obesity rates appear to have come down (or leveled off) more quickly for men in the past few years. We also don’t know how many Americans were actually taking the drugs at the time of the latest surveys. I asked Ogden when she might expect the drugs to start moving the needle: What proportion of Americans would have to be taking GLP-1s for the national obesity rate to change? “That’s a good question,” she said. “All we can say is what these estimates show us right now, and that we really do need more data to see what’s really happening.”

Yanovski was similarly wary of ascribing any recent changes in the trend to GLP-1s. She suggested that other factors might be at play: fewer people eating out; reduced sugar consumption; shrinkflation in the food industry, which results in smaller average portion sizes. (In principle, COVID might have been a factor too, because the disease is much more deadly for those with severe obesity. In that case, though, you’d expect the number of Americans in that category to have dropped, when in fact it has gone up.) And both Yanovski and Ludwig have long been floating the possibility that, even if the food environment remains as toxic as ever, the effects could start to wane as a function of biology. Almost half the variability in body weight is genetic, Yanovski told me, and that fact in itself could put a ceiling on the long-term trend. “You reach a level in which the population, everybody who is at risk for developing obesity, has already done so,” Ludwig said.

The final possibility is that this new “plateau” will soon reveal itself to be yet another narrow step on a staircase that is always going up—just another artifact of noise, or else a temporary aberration. Having covered these reports for 15 years, I feel safe in saying that some degree of pessimism should be the default setting.

Then again, having covered these reports for 15 years, I’ve never seen an intervention as dramatic as Ozempic, in terms of its power and popularity. Earlier this year, I profiled Barb Herrera, a woman who has had obesity throughout her life, and has tried almost every intervention to reverse it: diets, fen-phen, bariatric surgery. In 2022, her body mass index was measured at 75; after many months of taking GLP-1 drugs, she has lost 255 pounds. If Herrera were included in the next NHANES survey, she’d be recorded with a BMI of less than 28—below the diagnostic threshold for obesity—and classified as “overweight.”

How many other Americans have crossed that line? We’ll soon find out. The next NHANES data surveys are slated to begin in January, Ogden told me, with the first results due back in early 2027, including, this time, information on people’s use of prescription drugs. If the nation has really passed the point of peak obesity—and if the GLP-1 drugs really are responsible—then we’ll know soon enough.

For all the upheaval that followed the overturn of Roe v. Wade, it did not dramatically change the most basic fact about abortions in America: the number. Since 2022, abortions in the United States have held steady—even increased slightly, based on the best of limited data. One major reason? The rise of abortion pills, which are now used in the majority of abortions in America. Every month, thousands of women in states where abortion is banned have been able to discreetly order the pills by mail and take them at home. Even with abortion bans in place, the availability of these pills makes these rules less absolute than the anti-abortion movement would like.

“Abortion pills pose the single greatest threat to unborn children in a post-Roe world,” according to Project 2025, the Heritage Foundation’s conservative policy playbook. They are “death by mail,” according to Students for Life; Kristan Hawkins, the organization’s president, told me that “it’s a travesty what has unfolded under the Biden-Harris FDA.” And the anti-abortion movement is formulating plans to target the pills through a number of legal and political avenues—some of which could apply regardless of who is elected president next month.

Abortion pills had accounted for a steadily growing share of abortions in the U.S. for years, but in 2021, the FDA made them significantly easier to obtain: The pills are actually two different drugs, mifepristone and misoprostol, and the agency nixed a long-standing requirement to prescribe mifepristone only in person. With that, abortion pills became available by mail. The FDA cited COVID-related risks in its 2021 decision, but anti-abortion advocates immediately decried the move—and the policy has remained in place beyond the pandemic. After the overturning of Roe in 2022, 21 states passed new abortion bans or restrictions, but more than a dozen states, including New York and California, took steps to keep abortion pills available by mail, even in restricted states, by passing “shield laws.” These laws explicitly protect doctors, midwives, and nurse practitioners who use telehealth to prescribe the pills by mail across state lines.

Since then, an average of 6,000 to 7,000 people a month living in states with complete or six-week bans have been able to get abortion pills via telehealth, according to data from the Society for Family Planning, which surveys abortion providers in the United States. This number does not include people who had an abortion outside the formal health-care system, for instance by using pills ordered from overseas. And in states where abortion remains legal, the number of abortions—and the proportion involving abortion pills—also rose from 2020 to 2023, according to Guttmacher Institute data. (The number of women traveling to other states for abortions also doubled in this time, which is another reason abortions have not significantly fallen post-Roe.)

“The anti-abortion movement hasn’t quite figured out what to do with this,” says Greer Donley, a law professor at the University of Pittsburgh, who helped draft the nation’s first shield law. The shield laws have not yet been directly challenged in court. And when anti-abortion groups tried to go after the FDA’s original approval of mifepristone via a lawsuit, the Supreme Court dismissed the case this year for lack of standing.

Still, last week, three states—Missouri, Kansas, and Idaho—sought to revive that case, asking courts to reinstate certain restrictions on mifepristone. And although a President Kamala Harris would be likely to stick to the current FDA policy for abortion pills, a Trump administration could change those policies directly. It could, as my colleague Rose Horowitch has reported, curtail access to mifepristone simply by reinstating the in-person requirement for dispensing the drug—or just pull the FDA’s approval of mifepristone altogether. (In August, Donald Trump expressed openness to cracking down on abortion pills; his running mate, J. D. Vance, walked that position back a few days later.) Anti-abortion activists are hoping that Trump will enforce the long-dormant Comstock Act, a 150-year-old anti-obscenity law that bans the mailing of material “intended for producing abortion, or for any indecent or immoral use.” This could criminalize the mailing of abortion pills, even without the passage of a federal abortion ban, though anti-abortion activists have also suggested that Trump keep quiet about Comstock until he wins. (Trump, for his part, refused to share his views on the Comstock Act for months, before finally saying that he would not enforce it.)

Regardless of who becomes president, the anti-abortion movement is devising ways to restrict abortion pills through state governments too. Shield laws, for example, could be directly challenged if a red-state prosecutor goes after a doctor prescribing the pills from a shield-law state. Linda Prine, a doctor with the nonprofit Aid Access, which sends pills to states with abortion bans, told me she no longer leaves her home state of New York. Providers working under shield laws, she said, are all being “super careful.”

Anti-abortion groups could also test the limits of shield laws in more indirect ways. In Texas, says John Seago, the president of Texas Right to Life, pro-abortion groups have put up billboards advertising abortion pills: “You can go to people putting up the billboard. That’s aiding and abetting.” His group has also encouraged Texas lawmakers to introduce new laws that create liability for internet-service providers or credit-card-processing companies involved in abortion-pill transactions.

In Louisiana, where abortion is already banned, a law went into effect this month further restricting both mifepristone and misoprostol as “controlled dangerous substances.” The law is named after a Louisiana woman whose husband secretly slipped misoprostol into her drinks, and anti-abortion activists have used cases like hers to argue that the pills need more regulation. “A faceless, doctorless process to obtain abortion drugs enables abusers to poison or coerce women and girls,” Emily Davis, the vice president of communications for Susan B. Anthony Pro-Life America, said in a statement. But the law is also affecting routine medical care unrelated to abortion: The two drugs are commonly used in miscarriage and postpartum management, and hospitals in Louisiana have been doing timed drills to make sure staff can quickly access the locked closets where the medications now need to be kept.

Anti-abortion groups are also trying creative approaches to regulating abortion pills—such as through environmental regulations. Hawkins told me that Students for Life will be working with state legislatures next year on laws such as those requiring the disposal of fetal tissue from abortions as medical waste. These laws are designed to put the onus on the provider of abortion pills—presumably a doctor operating under a shield law—and states could then go after the provider for environmental-cleanup fees or fines, Kristi Hamrick, the organization’s vice president of media and policy, told me.

The new prevalence of abortion pills has opened up a new frontier, and the political and legal fights ahead may look quite different from those in the past. “We innovate, and we keep coming back. Our work is definitely just beginning,” Hawkins said. Seago, in Texas, told me he does not expect every attempt to restrict abortion pills to work. In the decades before Roe was overturned, he said, states introduced a number of different restrictions to limit access to abortion. Some worked. Some didn’t. With abortion pills, he told me, “we’re not expecting a silver bullet.” But activists like him are demanding that lawmakers try to stop their use nonetheless.

If you had come across the abbreviation GLP-1 a few years ago, chances are you’d have had no idea what it stood for. Intro to Greek lyric poetry? Low-level Great Lakes precipitation? A member of the 1990s rap group Get Low Playaz?

These days, the initialism is much more recognizable. The new blockbuster obesity drugs, made famous by Ozempic, are collectively known as GLP-1 agonists, for the hormone they mimic in the body: glucagon-like peptide 1. It’s impossible to hear about the voraciously in-demand drugs without encountering the term. GLP-1 is mentioned 10 seconds into a Good Morning America segment on Ozempic, and frequently turns up in publications as varied as Good Housekeeping and Rolling Stone.

Now, of course, the wellness industry is trying to get in on the GLP-1 craze. Supplements that are labeled with the term are everywhere. A brand called Supergut, available at chains such as Target and GNC, markets a “GLP-1 Booster” powder. Lemme, a company owned by Kourtney Kardashian, sells a “GLP-1 Daily” pill. These GLP-1 supplements are marketed as an alternative to obesity drugs—even though they have little in common with the drugs. To the wellness industry, GLP-1’s actual significance doesn’t seem to matter nearly as much as its association with thinness. Stripped of all meaning, GLP-1 can be used to sell just about anything.

The obesity-drug boom makes GLP-1 seem almost miraculous. Semaglutide (sold under the brand names Ozempic and Wegovy) and tirzepatide (Mounjaro and Zepbound) are synthetic versions of GLP-1. They can quiet hunger and food cravings, leading to weight loss. Supplements suggest that they can do the same. Pendulum’s GLP-1 Probiotic gives users “the power to boost this powerful hormone.” Calocurb’s GLP-1 Activator offers “natural appetite management support.” GLP-1 Boost Tea, from Happyself, is “inspired by the benefits of Ozempic & Semaglutide.”

Ozempic isn’t the only way to boost GLP-1—the hormone kicks in after every meal. “Eating food will elevate GLP-1,” Richard Bloomer, a supplement expert at the University of Memphis, told me. When food reaches the small intestine, it triggers the release of GLP-1, leading to a feeling of fullness, and stimulates the release of insulin, which lowers blood sugar. GLP-1 supplements claim—correctly!—that a particular blend of nutrients can coax more GLP-1 out of the body. Metabolism Ignite, from a company called Veracity, includes green-coffee-bean extract, which was associated with a small uptick in GLP-1 in one study.

Here’s the catch: GLP-1 supplements are like Ozempic in the way that peewee football is like the NFL. The drugs reach “manyfold higher levels of GLP-1” than any food, Dariush Mozaffarian, a professor at Tufts Friedman School of Nutrition Science and Policy, told me. Consider Lemme’s pills, which contain three plant-derived substances, including a lemon extract. In a 30-person, industry-funded study, lemon extract raised GLP-1 levels by 17 percent after participants took the extract for 12 weeks. In comparison, obesity drugs increase GLP-1 by more than 1,000 percent. The synthetic GLP-1 in obesity drugs lingers in the body for weeks after being injected; meanwhile, GLP-1 produced by the body is degraded within minutes, so hunger quickly returns.

GLP-1 products, for the most part, are just repackaging common supplement ingredients. Some are bacteria-based: Pendulum, whose chief communications officer is the actor Halle Berry, sells a product called GLP-1 Probiotic, not to be confused with pills from a different company, Codeage, called GLP-1 Probiotic+. Other brands that claim to boost GLP-1 are functionally just selling fiber: Supergut’s product, a powder that can be added to drinks or food, contains six grams of probiotic fiber, about the same as a pear.

At best, a GLP-1 supplement might expand on the effects of foods generally considered “good for you,” including unsaturated fats from avocados, nuts, flaxseed, and olive oil; some proteins, such as those from egg whites; and prebiotic fiber from certain legumes, whole grains, and fruits. These have all been shown to raise GLP-1, Mozaffarian told me.

But when one takes these supplements, increasing GLP-1 isn’t really the point. What people actually care about is the secondary effect of having high GLP-1—that is, weight loss. But again, that’s hardly guaranteed. Boosting GLP-1 through a supplement “doesn’t really mean a whole lot, because the half-life is so short—but even if it is elevated, we don’t really know if it’s going to cause any of those beneficial effects,” such as weight loss, Bloomer said. Certainly, consuming fiber helps you feel fuller for longer. But you don’t have to be a nutritionist to know that it won’t slim your waistline like the obesity drugs do.

In that sense, GLP-1 boosters aren’t so different from any old weight-loss supplement already on the market: They don’t reliably hold up to all the breathless marketing. GLP-1 is just the latest addition to the list of health terms that have been absorbed and watered down by the wellness space. Sometimes they’re jammed together on the label of a single product, as if doing so compounds their healthiness. The marketing copy for Pendulum’s GLP-1 Probiotic manages to fit in references to “metabolic health,” the “gut microbiome,” “postbiotics,” and “gut health,” together with the usual jargon related to GLP-1.

If you spend too much time looking at these products, all of these terms start to blur together. Probiotics, electrolytes, protein, adaptogens—does anyone really understand what these words mean, and more important, do they care? Maybe not. But the fact that something sounds healthy makes it good enough to sell products. People may not know what GLP-1 is or does, but it certainly seems like it has something to do with losing weight.

The wellness industry commonly uses sly marketing to sell products of dubious effectiveness, but there’s something especially unnerving about its attempt to move into the obesity-drug space. Demand for Ozempic and its kin is tremendous, but many people can’t access these drugs because of cost and supply issues. For people desperate to get on the drugs, GLP-1 supplements may seem like an easy substitute. They might even be convinced that these supplements are the better option: Supergut, according to its marketing, is “non-pharmaceutical, affordable, convenient, and comes with none of the unpleasant side effects” of the obesity drugs, “offering a sustainable approach to achieve lasting results.” Other brands use phrases such as “hunger quieting” and “curbs cravings,” borrowed directly from the Ozempic playbook. Like the obesity drugs themselves, GLP-1 supplements are meant to be taken continuously; most companies offer monthly subscriptions to their products (a six-month supply of Lemme’s pills, for example, costs $378).

At one point, it seemed as though the new obesity drugs would doom weight-loss supplements for good. The drugs spurred greater and faster weight loss, in a wider range of people, than any other product in history. In response, the supplement industry has rebranded its offerings to mirror the competition, down to the language it uses. GLP-1 supplements don’t even come close to the real thing. But they sure look like it.

As a being whose body contains billions of billions of atoms, I am subject to certain rules. To walk through my front door, I first have to open it. If I throw my jacket onto a chair, it will move in the direction and at the speed with which I tossed it, and stay on the chair until I pick it up again. I can’t affect the movement of a tennis ball in China by bouncing one in New York.

In the quantum world, where physicists study the behaviors of individual atoms and their even smaller parts, these laws do not apply. Particles of matter sometimes act like waves, or move through solid objects. The qualities of one atom can be linked to another’s, even if the two are a great distance apart.

Starting around the turn of the 20th century, physicists began to understand that the behaviors of the tiniest bits of our world couldn’t be explained by the laws of classical physics—the type that governs macroscopic solids, gases, liquids, and the forces that act on them. But as the field has developed, it has taken on another surprising role: as a touchstone in alternative health and wellness spaces, used to justify manifestation, energy healing, and other fringe claims and products. The phenomenon is called “quantum woo,” “quantum mysticism,” or “quantum flapdoodle.” It’s both an incorrect appropriation of scientific ideas and a strangely elegant way to explain the psychological forces that push people toward alternative medicine. Many wellness trends reflect a desire for another, contrarian account of the inner workings of the human body and mind—just what quantum mechanics provides for the inner workings of the physical world. Alongside a pervasive interest in alternative-medicine practices and New Age beliefs, more people could be in danger of getting pulled into the flapdoodle.

The physicist Matthew R. Francis once wrote that “possibly no subject in science has inspired more nonsense than quantum mechanics.” In some cases, quantum terminology is arbitrarily added to health practices to legitimize them, or to indicate that they are mysterious and powerful, says Christopher Ferrie, a physicist at the University of Technology Sydney and the author of Quantum Bullsh*t: How to Ruin Your Life With Advice From Quantum Physics. “Like calling your dishwasher detergent Quantum, it just makes it sound cooler,” Ferrie told me. It’s easy to find a “quantum healer” practicing within a couple of miles of my home. YouTube and Instagram accounts offer advice on learning to quantum leap; you can read books about falling in quantum love. You can even buy a $99 quantum water bottle “charged” with special healing frequencies or a quantum crystal kit that will help you “clear any negative vibrations you have picked up.”

In a 2020 episode of the Netflix show The Goop Lab With Gwyneth Paltrow, an energy practitioner named John Amaral told Paltrow that a pillar of quantum mechanics, the double-slit experiment, shows that “consciousness actually shifts or alters, in some way, shape, or form, physical reality.” What the experiment actually demonstrates is that when photons are shot through two open slits, they can act either as waves or as particles, depending on whether they’re measured. The finding is perplexing—how can matter behave as a wave, and why would recording photons change their behavior? Physicists are still actively working on how and if quantum behaviors might seep into the larger world, but they agree that the human body is a solid thing, and that people don’t act as photons do.

Amaral’s comments are typical of quantum woo in that they apply the uncertain state of subatomic particles to people, and expect humans to act as photons do. “By influencing the frequency of energy in and around your body, you can change your physical reality,” Amaral said on Goop Lab. In The Secret, the best-selling manifesto of manifestation, Rhonda Byrne referenced quantum physics to claim that thoughts and emotions are entangled with outcomes in the exterior world. There are parallels in her description to the quantum theory of entanglement—the idea that pairs of particles can have correlated behaviors even at a distance. In physics, energies and frequencies refer to measurable properties of subatomic particles and waves. In New Age or wellness vernacular, these terms are squishier, usually alluding to ambiguous thought patterns, life forces, or chakras—so immeasurable as to be incontrovertible.

Quantum physics’ close relationship with mystical ideas has on occasion pushed the science forward. In 1975, two students affiliated with the theoretical-physics division of the Lawrence Berkeley Laboratory formed the “Fundamental Fysiks Group,” which frequently connected quantum mechanics to Eastern mysticism, psychedelic-drug experiences, and telepathy. Their explorations into parapsychology, including getting CIA funding to test “remote viewing”—basically whether one person could receive telepathic messages from another—were a bust. But David Kaiser, a quantum physicist at MIT and the author of How the Hippies Saved Physics, told me that the group’s radical questions about the quantum world and its limits “helped nudge the broader community, which then began to take some of these questions more seriously than they had been taken before.” For example, the group’s thought experiment on entanglement led to the “no-cloning theorem,” which states that certain quantum states cannot be copied. This is now important for, among other things, quantum cryptography, which takes advantage of the fact that encrypted messages cannot be copied without also being corrupted.

Crucially, the Fundamental Fysiks Group put its notions to the scientific test, combining Eastern religious or parapsychic ideas with real physics know-how. The quantum wellness and health industry, by contrast, demonstrates a fundamental misunderstanding of what quantum physics is all about. “Quantum mechanics does have many strange and counterintuitive features,” Kaiser said. But quantum states are very delicate, and much different from the ones humans live in. To perform quantum experiments, physicists typically have to put atoms in vacuums or subject them to temperatures near absolute zero. “By the time you get to something that’s a few thousand atoms big, you’re losing the pure quantum essence,” Philip Moriarty, a physicist at the University of Nottingham, in England, told me. “When you get to something as big as a human, there’s no quantum essence left.”

Quantum mechanics arose because classical physics failed to completely describe the microscopic universe around us—because scientists had uncovered experimental situations that defied the physics they knew. It suggested that, underneath the world of cause, effect, and consistency, a secret alternative playbook was hiding in plain sight. Applying that hint of fantasy to the world at human scale has proved too tempting for the wellness marketplace—and many consumers—to resist. Deepak Chopra, a popular alternative-medicine figure and the author of Quantum Healing, declares on his website, “You are a mystery that needs quantum answers.” Many people’s emotions and bodies really do feel like puzzles that we haven’t been given all the pieces to solve, so it’s appealing to think that the missing bits exist somewhere in the quantum realm.

The wellness industry often reflects larger anxieties around health, food, and environmental safety, Adam Aronovich, a medical anthropologist at Universitat Rovira i Virgili, in Spain, told me. It also has a history of using scientific-sounding—but scientifically inscrutable—language to lend itself a patina of legitimacy. Quantum wellness is no exception. Quantum water filters, for example, are enticing “not only because of the quantum mysticism behind it, but because people have real anxieties about microplastics,” Aronovich said. “You don’t have to worry about microplastics in your water if you have enough money to buy this quantum filter that has the approval stamp of Deepak Chopra. It is going to filter away all the bad things in a mystical, magical, unknowable way.”

[From the April 2020 issue: Reiki can’t possibly work. So why does it?]

The quantum world may be all around us, but humans—and our anxieties—inhabit a classical world. Most people are concerned primarily with how to keep our bodies healthy and tend to our emotional states amid social and environmental conditions that make doing so difficult. These problems operate on the macro scale. We can’t rely on single atoms to solve them for us.

These days, you can easily find vapes in flavors that include “Lush Ice,” “Blueberry Banana,” “Mango Lychee,” “Hot Fudge,” and “Fcuking Fab” (whatever that is). No matter which one you choose, it’s almost certainly illegal. The tiny battery-powered devices that produce a mist of nicotine when you inhale, first popularized by Juul, are not outright banned—at least not for adults—but only a few flavored vapes have gotten the FDA authorization required before they hit the market. That hasn’t stopped hundreds of shadowy companies, many based abroad, from effectively hawking contraband. Vapes are sold to Americans online for as little as $5, and are well-stocked in convenience stores, smoke shops, and even vending machines.

With such little oversight, it’s no wonder that about 1.6 million American kids are regularly vaping, leading to panic that they are getting duped into a lifetime of nicotine addiction. The FDA has levied fines, filed lawsuits, and even seized products to keep vapes off of shelves, and the agency has pledged a major escalation in its efforts. Politicians across the political spectrum, including Senators Mitt Romney and Chuck Schumer, have advocated for a vaping crackdown. But not Donald Trump.

In 2020, Trump abruptly abandoned a plan to ban flavored vapes, much to the chagrin of public-health officials. Late last month, Trump posted on Truth Social that, if elected, he would “save Vaping again!” The former president may be a deeply flawed messenger, and the vaping industry hardly deserves any sympathy. Many of these companies flagrantly violate the law and overtly market to kids. Even so, Trump has a point. Vapes—as a replacement for cigarettes, anyway—are actually worth saving.

Trump said in that Truth Social post that vapes have “greatly helped people get off smoking.” It’s easy to dismiss that as spin. After all, he had received a personal visit from the head of the vaping industry’s lobbying group that same day. However, vapes are indeed a revelation for the 28 million adults in the United States who smoke cigarettes. They work as well, or even better, than all of the conventional products designed to help wean people off of cigarettes.

Gum, lozenges, and patches simply deliver nicotine, the addictive chemical that keeps smokers smoking, in a safer way. These so-called nicotine-replacement therapies don’t contain any of the harmful ingredients in tobacco products such as cigarettes. Whenever you might feel an itch to smoke, you can instead use one of these replacements to satiate your craving.

But nicotine-replacement therapies don’t work well. Less than 20 percent of people who try to quit smoking using these therapies in clinical trials are actually successful; one study found they aren’t any better than attempting to quit cold turkey. That’s because, for smokers, nicotine gums and lozenges never deliver anything close to the euphoric feelings of puffing on a cigarette. Your average cigarette is just tobacco leaves wrapped in paper with a filter on the end, but it is exquisitely efficient at delivering nicotine to the body. When burned, tobacco creates nicotine particles that hit receptors in the brain within 10 to 20 seconds. Nicotine-replacement therapies deliver nicotine much more slowly—from minutes to several hours—because the drug is absorbed by the mouth or through the skin.

But you know what can get close to the experience of smoking? Vapes. They generate an aerosol that can reach deep into the lungs, allowing nicotine to hit the bloodstream at a speed that is “almost identical” to cigarettes, Maciej Goniewicz, an expert on nicotine pharmacology at the Roswell Park Comprehensive Cancer Center, told me. Part of what makes vapes so effective is that they look and work like cigarettes. “People who are addicted to smoking are not just physiologically addicted to the nicotine; they’re also behaviorally addicted to the process of smoking,” Ken Warner, an emeritus professor of public health at the University of Michigan, told me.

Vapes even hold their own against the one conventional treatment that’s more effective than the traditional gums and patches: a prescription drug called Chantix. Instead of replacing the nicotine in cigarettes, it blocks the pleasurable effects of nicotine on the brain. According to a recent clinical trial, roughly 40 percent of some 400 people given a vape or Chantix successfully quit smoking after six months. Vaping may be an easier transition for smokers: Chantix isn’t widely used, in large part because of its side effects, which include nausea and vivid dreams. It certainly doesn’t hurt that huffing on a “Fcuking Fab”–flavored gadget can also just be fun. That vapes come in so many flavors is often the reason people start vaping in the first place. It’s not that different from alcohol: Many drinkers would prefer a vodka cranberry over a shot of Tito’s.

Just like how it’s not just heavy drinkers who enjoy a vodka cranberry, the same is true of flavored vapes. The attractiveness of flavors is also why kids gravitate toward them, as do adults who have never smoked. Because kids overwhelmingly use flavors, banning them seems like an easy way to reduce vape use. But if public health is about managing trade-offs, the benefits of vapes seem to outweigh the negatives. Although no kids should be vaping, abusing these products is not deadly like cigarettes are. Amid rising public awareness about the dangers of youth vaping, even FDA’s top tobacco official has acknowledged publicly that youth vaping is no longer the epidemic it was a few years ago.

But there are other caveats to consider when it comes to the anti-smoking potential of vapes. They are regulated as consumer products and not medicines, so they have not gone through the same rigorous approval process that every other anti-smoking drug has gone through. We still don’t know alot about how effective vapes might be to help people quit smoking, or how often smokers need to use them to successfully quit. Because vapes are still relatively new, no one can say definitively that they do not carry some long-term risks we do not know yet. The current Wild West of vapes also adds to the potential pitfalls. Vapes also contain known carcinogens, likely because of the chemicals in e-liquids being heated to high temperatures. Some likely carry higher risks than others because of how little standardization there is in the chemicals used.

All of these risks have made public-health groups understandably reluctant to embrace their use. The FDA acknowledges that vapes are safer than cigarettes, though they do not endorse them as an anti-smoking treatment. Should the agency get its way, the majority of flavored vapes will eventually be off of store shelves. The head of the FDA’s tobacco center has said that “nothing is off the table.”

No matter who wins in November, some of the FDA’s decisions are likely out of the next president’s control: The agency’s decisions on which vapes to green-light doesn’t rest with the commander in chief or the FDA commissioner; rather, they are governed by FDA scientists who are following a legal standard. Still, having a president who embraces vaping could go a long way. Surveys show that a sizable proportion of smokers mistakenly think vapes are more dangerous than cigarettes. That likely keeps many smokers from trying them.

Kamala Harris has not weighed in on vaping since becoming the Democratic nominee. (Her campaign declined to comment on her position. And any single-issue vaping voters out there might do well to reconsider their priorities before voting for Trump.) His stance isn’t exactly academically rigorous, nor is it adequately nuanced. But if Trump acknowledges the benefits of vaping while also condemning the lawlessness of much of the current vaping industry, he could help legitimize a product that has been shunned by most of the medical establishment. For now, few reputable companies are willing to invest in making their own vapes, and few doctors are going to recommend them to patients.

This all might sound like public-health sacrilege. But given that the overwhelming majority of smokers who try to quit each year fail, “anything that we can add to the tool kit as a way that could help people transition away from smoking is something that is worth exploring,” Jamie Hartmann-Boyce, a professor at the University of Massachusetts at Amherst who has studied anti-smoking drugs, told me. You might cringe at the thought of anyone putting something called “Fcuking Fab” into their lungs, but consider that cigarettes still kill nearly 500,000 Americans each year. Vapes are deeply flawed. Unfortunately, so are the alternatives.

The little clump of cells looked almost like a human embryo. Created from stem cells, without eggs, sperm, or a womb, the embryo model had a yolk sac and a proto-placenta, resembling a state that real human embryos reach after approximately 14 days of development. It even secreted hormones that turned a drugstore pregnancy test positive.

To Jacob Hanna’s expert eye, the model wasn’t perfect—more like a rough sketch. It had no chance of developing into an actual baby. But in 2022, when two students burst into his office and dragged him to a microscope to show him the cluster of cells, he knew his team had unlocked a door to understanding a crucial stage of human development. Hanna, a professor at the Weizmann Institute of Science in Israel, also knew that the model would raise some profound ethical questions.

You might recall images of embryonic development from your high-school biology textbook: In a predictable progression, a fertilized egg morphs into a ball of cells, then a bean-shaped blob, and then, ultimately, something that looks like a baby. The truth is, though, that the earliest stages of human development are still very much a mystery. Early-stage embryos are simply too small to observe with ultrasound; at 14 days, they are just barely perceptible to the naked eye. Keeping them alive outside the body for that long is difficult. Whether anyone should is another matter—for decades, scientific policy and regulation has held 14 days as the limit for how long embryos can be cultured in a lab.

Embryo models—that is, embryos created using stem cells—could provide a real alternative for studying some of the hardest problems in human development, unlocking crucial details about, say, what causes miscarriages and developmental disorders. In recent years, Hanna and other scientists have made remarkable progress in cultivating pluripotent stem cells to mimic the structure and function of a real, growing embryo. But as researchers solve technical problems, they are still left with moral ones. When is a copy so good that it’s equivalent to the real thing? And more to the point, when should the lab experiment be treated—legally and ethically—as human?

Around the 14th day of embryonic development, a key stage in human growth called gastrulation kicks off. Cells begin to organize into layers that form the early buds of organs. The primitive streak—a developmental precursor of the spine—shows up. It is also at that point that an embryo can no longer become a twin. “You become an individual,” Jeremy Sugarman, a professor of bioethics and medicine at the Johns Hopkins Berman Institute of Bioethics, told me.

[Read: A woman gave birth from an embryo frozen for 24 years]

The primitive streak is the main rationale behind what is often referred to as the “14-day rule.” Many countries limit the amount of time that a human embryo can be kept alive in a petri dish to 14 days. When a U.K. committee recommended the 14-day limit in the 1980s, IVF, which requires keeping embryos alive until they are either transferred or frozen around day five or six, was still brand-new. The committee reasoned that 14 days was the last point at which an embryo could definitively be considered no more than a collection of cells, without potential individual identity or individual rights; because the central nervous system is formed after the 14-day milestone, they reasoned, there was no chance it could feel pain.

But the recent rise of advanced embryo models has led some groups to start questioning the sanctity of the two-week mark. In 2021, the International Society for Stem Cell Research relaxed its 14-day guideline, saying that research could continue past 14 days depending on ethical review and national regulations. (The organization declined to set a new limit.) In July, U.K. researchers put out a similar set of guidelines specifically for models. Australia’s Embryo Research Licensing Committee, however, recently decided to treat more realistic models like the real deal, prohibiting them from developing past 14 days. In the United States, federal funding of human-embryo research has been prohibited since 1996, but no federal laws govern experiments with either real or model embryos. “The preliminary question is, are they embryos at all?” Hank Greely, a law professor and the director of the Center for Law and the Biosciences at Stanford University, told me. Allow one to develop further, and “maybe it grows a second head. We don’t know.” (Having a second head is not necessarily a reason to disqualify someone from being human.) In the absence of an ethical consensus, Hanna is at work trying to cultivate his models to the equivalent of day 21, roughly the end of gastrulation. So far, he said, he’s managed to grow them to about day 18.

Researchers generally agree that today’s models show little risk of one day becoming walking, talking human beings. Combining sperm and eggs the old-fashioned way is already no guarantee of creating new life; even women in their 20s have only about a 25 percent chance of getting pregnant each month. Making embryos in a lab, sans the usual source material, is considerably harder. Right now, only about 1 percent of embryo models actually become anything that resembles an embryo, according to Hanna. And because scientists don’t have a great idea of what a nine-day-old embryo looks like inside the body, Greely said, they don’t actually know for certain whether the models are developing similarly.

[Read: The most mysterious cells in our bodies don’t belong to us]

And yet, in the past few years, scientists have already accomplished what seemed impossible not so long ago. Both Hanna and Magdalena Żernicka-Goetz, a developmental and stem-cell biologist at the California Institute for Technology and the University of Cambridge, have created models for mice with brains and beating hearts. Scientists and ethicists would be wise to consider what qualifies as human before human embryo models have beating hearts, too. The most important question, some ethicists argue, is not whether researchers can achieve a heartbeat in a petri dish, but whether they can achieve one with a model embryo implanted in a human womb. “It’s no longer so much about how embryos are made or where they come from, but more what they can possibly do,” Insoo Hyun, a bioethicist and the director of life sciences at Boston’s Museum of Science told me. In an experiment published last year, seven-day-old model monkey embryos were successfully implanted in the uterus of three female monkeys. Signs of pregnancy disappeared about a week afterward, but the paper still raised the specter—or perhaps the promise—of a human version of the experiment.

Building more realistic embryo models could have enormous benefits—starting with basic understanding of how embryos grow. A century ago, scientists collected thousands of embryo samples, which were then organized into 23 phases covering the first eight weeks of development. Those snapshots of development, known as the Carnegie stages, still form much of the basis for how early life is described in scientific texts. The problem is, “we don’t know what happens in between,” Hanna said. “To study development, you need the living material. You have to watch it grow.” Until recently, scientists had rarely sustained embryos in the lab past day seven or so, leaving manifold questions about development beyond the first week. Most developmental defects happen in the first trimester of pregnancy; for example, cleft palate, a potentially debilitating birth defect, occurs sometime before week nine for reasons that scientists don’t yet understand. It’s a mystery that more developmental research performed on embryo models could solve, Greely said.

Better understanding the earliest stages of life could yield insights far beyond developmental disorders. It could help reveal why some women frequently miscarry, or have trouble getting pregnant at all. Żernicka-Goetz has grown models to study the amniotic cavity—when it forms improperly, she suspects, pregnancies may fail. Embryo models could also help explain how and why prenatal development is affected by viruses and alcohol—and, crucially, medications. Pregnant people are generally excluded from drug trials because of potential risks to the fetus, which leaves them without access to treatments for new and chronic health conditions. Hanna has started a company that aims, among other things, to test drug safety on embryo models. Hanna told me he also envisions an even more sci-fi future: treating infertility by growing embryo models to day 60, harvesting their ovaries, and then using the eggs for IVF. Because stem cells can be grown from skin cells, such a system could solve the problem of infertility caused by older eggs without the more invasive aspects of IVF, which requires revving the ovaries up with hormones and surgery to retrieve the resulting eggs.

[Read: Christian parents have a blueprint for IVF]

Answering at least some of these questions may not require hyperrealistic models of an embryo. Aryeh Warmflash, a biosciences professor at Rice University, is studying gastrulation, but the cells that form the placenta aren’t relevant to his research questions, so his models leave them out, he told me. “In some sense, the better your model goes, the more you have to worry,” he said. Hyun told me he cautions scientists against making extremely complex models in order to avoid triggering debate, especially in a country already divided by ideas about when life begins. But given all the medical advances that could be achieved by studying realistic models—all the unknowns that are beginning to seem knowable—it’s hard to imagine that everyone will follow his advice.

When Clark Giles first heard about ticks making people allergic to meat, he found the notion so unbelievable, he considered it “hogwash.” Then, in 2022, it happened to him. Following a spate of tick bites, he ate a hamburger and went into sudden anaphylaxis. His lips became numb, his face swollen, and his skin a “red carpet from my knees to my shoulders,” he says. Eventually, Giles—who raises sheep on a homestead in Oklahoma—had to give up eating not just beef but pork, and, yes, even lamb.

From there, his allergy started to manifest in stranger ways. During lambing season, the smell of afterbirth left him with days of brain fog, fatigue, and joint aches. To touch his sheep, he now needs nitrile gloves. To shovel their manure, he now needs a respirator. And Giles doesn’t even have it the worst of people he knows: A friend with the same allergy was getting so sick, he had to give up his sheep altogether.

This unusual allergy is most often caused by the lone-star tick, whose saliva triggers an immune reaction against a molecule, alpha-gal, found in most mammals besides humans. The allergy is also known as alpha-gal syndrome, or AGS. In recent years, the lone-star tick has been creeping northward and westward from its historical range, in the southeastern United States. (Oklahoma is in fact right on the edge; ticks are more prevalent in its east than its west.) Alpha-gal syndrome, too, is suspected to be on the rise. Farmers who spend their days outdoors are particularly exposed to lone-star ticks, and repeated bites may cause more severe reactions. And so, Giles is among a group of farmers who have become, ironically, allergic to the animals that they raise.

There are no official numbers for how many farmers are afflicted with alpha-gal syndrome. But AGS has become prevalent enough, says Charles Green, Virginia’s deputy commissioner of agriculture, that the state farm bureau’s upcoming annual convention is offering an alpha-gal-safe meal option. Green himself developed the allergy after getting tick bites on his family farm. And he isn’t even the only ag commissioner I’ve interviewed with the condition: A couple of years ago, I spoke with the commissioner in North Carolina, a top hog-producing state, who could no longer, as his job usually requires, “eat more barbecue than any human being on the face of the Earth.”

For most people with AGS, just avoiding the meat from mammals is enough. But for those who are more sensitive, anything of mammalian origin is off the table: dairy, wool, gelatin, lanolin, and even more obscure products such as magnesium stearate, a fat derivative often found in pills and drug capsules. And for farmers like Giles, who are extremely sensitive, even the fumes from manure, dander, and amniotic fluid can set off reactions. “It’s so much more far-reaching than just, Don’t eat this. It’s, Don’t touch it. Don’t work with it. Don’t be around it,” says Jenna Olcott, who is no longer able to help out on her family’s small cattle farm in Missouri. Farmers with severe AGS find it difficult, and in some cases impossible, to care for their animals at all.

Sonya Bowes has lost count of the number of tick bites she’s gotten on her tiny farm in rural Kentucky. They’re hard to avoid, she says, when taking care of grazing animals in tall grass. She knew something was wrong when she started experiencing mysterious symptoms around her dairy cows, such as sudden drops in her blood pressure, that turned out to be signs of an allergic reaction. She can no longer milk them without getting sick. When we spoke last week, she had already sold her three cows as well as her rabbits. She’s planning to sell her pigs too, at a probable financial loss, because she cannot care for them anymore. Bowes’s small farm has been her livelihood and her lifelong dream. “It’s just been devastating” to give up on that dream.

Antonia Florence and her husband downsized their cattle farm in Virginia after their allergic reactions became so severe, they lost a calf because they were unable to physically help in the birthing process. “We had to stand back and ask ourselves, ‘Did that calf die because we could not care for it?’” she says. “It wasn’t ethical.” Amniotic fluid from cows is known to contain alpha-gal, and anecdotally, it seems to be a strong trigger of AGS. It is also, however, sometimes simply unavoidable; when a calf gets stuck during birth, a farmer may have to get up to their shoulders inside the mother to help. When Olcott helped her husband pull a stuck calf, she told me, everywhere the fluid splattered on her skin became swollen and red, as if she had been scorched. A case study in Spain has also documented three cattle workers who reacted to touching or even breathing amniotic fluid.

A second factor in the Florences’ decision was that their cattle were also becoming ill—with a different tick-borne illness called theileriosis. This bovine parasite does not affect humans, but managing it requires farmers to get up close with their cattle, which Florence and her husband could no longer do. Together, she told me, these two tick-borne illnesses are killing their farm. Raising cattle isn’t their only source of income, but the couple had put “every evening, every weekend, and every holiday” into the endeavor. Her husband also grew up on this farm, and some of the animals they raised even traced their lineage back to his grandfather’s cows. Unable to fully give up the animals, he still keeps about 10 cattle, but no more mothers or calves. Florence worries about the toll on his health, getting exposed to animals he’s allergic to all the time. He needed a pacemaker recently, and she wonders if it is related to an increased risk of heart disease with AGS.

Alpha-gal syndrome is forcing affected farmers to ask existential questions—not just about their identity as a farmer but about even the long-term viability of their industry. AGS is still unusual enough that it is likely to be underdiagnosed; a survey published in 2023 found that 42 percent of health-care providers had never heard of the syndrome. But as lone-star ticks continue to spread across the country, more and more Americans may eventually find themselves unable to eat beef and pork. (Of course, those opposed to eating animals on ethical and environmental grounds might find cosmic justice in the spread of alpha-gal syndrome. A bioethicist, inspired by the lone-star tick, once proposed decreasing the world’s red-meat consumption by inducing a human immune intolerance to it.)

A few farmers I spoke with have considered switching to raising poultry for other people with AGS, including chicken as well as more exotic species, such as emu and ostrich. The big, flightless birds have red meat that bears a striking resemblance to beef, and they’ve gained popularity in the AGS community. Olcott, in fact, is raising these birds for herself on her family’s cattle farm. They’ve butchered and eaten an ostrich already—“I don’t taste any difference between it and beef”—and still have four emus. She jokes to her husband about switching the whole farm to emus and ostriches, as more sustainable sources of red meat. He isn’t sold yet. But he is much more careful about ticks these days.