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But it starts an ocean away, during the Crimean War, 169 years ago.

Almost as soon as the phrase was coined, its definition was broadened to become shorthand for the British military more generally, particularly its courage in the face of long odds or superior numbers.

“Between the law-abiding elements of society and the criminals that prey upon them,” Mr. Parker said, “stands a thin blue line of defense — your police officer.” The police, in his vision, weren’t just protecting public safety; they were combating the decline of Western civilization, the rise of Communism, the moral laxity of postwar America, the decay of the nuclear family, and so on.

Like other mash-ups of identity flags with the American flag, the thin blue line flag is a rallying point for a marginalized identity, a way to lay claim to the American birthright, a demand for long-denied respect

Mr. Parker’s vision went beyond policing as a profession. In 1965, he told a civil rights commission investigating the Watts riots that “the police of this country, in my opinion, are the most downtrodden, oppressed, dislocated minority in America.” This belief, a half-century later, would animate an identity politics that blurred the blue line.

Blue Lives Matter is not just an expression of support and solidarity for the police, but a response to and rejection of Black Lives Matter. It suggests that it is not Black people whose lives are undervalued by society, but police officers.

Blue Lives Matter is a movement that belies the simplicity of its name: It can certainly mean that the police deserve respect for doing a critical and dangerous job. But it can also mean that overzealous racial politics have inverted the criminal justice system, punishing the peacekeepers, coddling the criminals and turning those who carry a badge into the most embattled and victimized group in the nation. Blue Lives Matter transformed policing into a tribal affiliation.

As the L.G.B.T. American flag does, it exploits a visual pun, but much less playfully: The blue line divides America against itself.

The thin blue line would become the dominant metaphor for the police. In 1981, President Ronald Reagan said the thin blue line held back “a jungle which threatens to reclaim this clearing we call civilization”; in 1993, President Bill Clinton called it “nothing less than our buffer against chaos, against the worst impulses of this society.”

This blossoming identity was an opportunity for any politician bold enough to take it. While trust in the police was dropping among Black and Hispanic Americans, it actually was rising for white Americans

Donald Trump was particularly well suited to take advantage of the rise of policing as identity politics. His entrance onto the political scene in the 1980s was his call for the reinstatement of the death penalty and less oversight of police.

The Trump campaign cast the Democrats as enemies of law and order who sought to incubate riots in American cities and chaos at the border.

Mr. Trump claimed that while the Democratic ticket stood with “rioters and vandals,” he stood with “the heroes of law enforcement.”

After Mr. Trump’s prophecy came true and the soft coup of representative democracy denied him a second term, when his supporters rallied for one last stand on the grassy field in front of the Capitol, it was inevitable that they would see themselves as bearing the mantle of law and order, a thin blue line smashing through a thin blue line.

In the aftermath of Jan. 6, when the nation saw that flag held aloft by the rioters who attacked the Metropolitan Police officer Michael Fanone (he says they literally beat him with it), the thin blue line flag has become increasingly controversial among police officers. In 2023, the Los Angeles Police Department banned its public display on the job. In an email explaining his decision to his officers, Chief Michel Moore lamented that “extremist groups” had “hijacked” the flag.

there is no debate. There’s a trade-off. But once you make identity a core qualification, you’re opening up a whole world of racist anti-racism.

Most Americans believe in individual merit, and advancement regardless of identity. Harvard and our new elite believe that our society is so structured as an enduring “white supremacy” that merit can only be considered after you have accounted for the effects of “intersectional oppression.”

each moment of truth puts a crack in the stifling, authoritarian edifice of DEI. We can bring this corruption to light. We can hold them to account. I’m certainly more hopeful about the future of liberal society now than I was a month ago.

the only way to cover it all up, of course, is to abolish testing students entirely (which is what so many elite colleges and universities are now doing) or to give all students an A or an A-, making any distinctions of excellence irrelevant.

When push comes to shove, when there is a finite number of places available, you’re in a zero-sum predicament. You have to pick between a smarter student of the wrong race and a weaker student of the right race. In the end at Harvard, being in the right race — not merit — determines your chances.

The more people see this for the systemic racism it is, the sooner we can throw this neo-Marxist cuckoo out of the liberal nest, and return to the airing of all ideas, regardless of the subject matter or the identity of the students

That’s how you can claim, as Gay does, that “diversity” and “excellence” go hand in hand, when obviously, at some point they can and do conflict.

The response to all this from the CRT crowd has been to insist — ever more strongly — that Gay is simply and only a victim of racism, or, in woke terminology, a victim of misogynoir. The fact that a white female university president at those same hearings lost her job before Gay did — and without any plagiarism questions — doesn’t count.

In the Congressional hearings, moreover, she showed little gravitas, grace, or ability to think on her feet. She has largely hidden from public view since the plagiarism revelations — not a good instinct for a leader of a huge, public-facing institution like Harvard. She is, quite obviously, a run-of-the-mill woke academic, who was promoted at breakneck speed because of her race and sex, and found herself quickly out of her depth.

When you look instead at what she has done as an administrator, which is where she has been focused more recently, you see it has almost all been about hiring on the basis of sex and race, persecuting heretical members of racial minorities, and removing paintings of dead white dudes. She is, at least, consistent.

And let’s be honest: we can all see with our own eyes that subordinating merit to race and sex is how Gay got her position. Her work, beyond the sloppy dime-store plagiarism, would be underwhelming for an average member of any faculty in the country. But for a Harvard president, it’s astonishingly mid

For instance, when a Harvard scholar such as Steven Pinker speaks of “disempowering D.E.I.” as a necessary reform in American higher education, he’s not opposing diversity itself. Pinker is liberal, donates substantially to the Democratic Party and “loathes” Donald Trump. The objections he raises are shared by a substantial number of Americans across the political spectrum.

, the problem with D.E.I. isn’t with diversity, equity, or inclusion — all vital values.

First, it is a moral necessity for colleges to be concerned about hateful discourse, including hateful language directed at members of historically marginalized groups. Moreover, colleges that receive federal funds have a legal obligation

I’ll share with you three pervasive examples

In the name of D.E.I., all too many institutions have violated their constitutional commitments to free speech, due process and equal protection of the law.

Yet that is no justification for hundreds of universities to pass and maintain draconian speech codes on campus, creating a system of unconstitutional censorship that has been struck down again and again and again in federal court. Nor is it a justification for discriminating against faculty members for their political views or for compelling them to speak in support of D.E.I.

There is a better way to achieve greater diversity, equity, inclusion and related goals. Universities can welcome students from all walks of life without unlawfully censoring speech. They can respond to campus sexual violence without violating students’ rights to due process. They can diversify the student body without discriminating on the basis of race

Second, there is a moral imperative to respond to sexual misconduct on campus.

that is no justification for replacing one tilted playing field with another. Compelled in part by constitutionally problematic guidance from the Obama administration, hundreds of universities adopted sexual misconduct policies that strip the most basic due process protections from accused students. The result has been systematic injustice

The due process problem was so profound that in 2019 a state appellate court in California — hardly a bastion of right-wing jurisprudence — ruled that “fundamental fairness” entitles an accused student to cross-examine witnesses in front of a neutral adjudicator.

Third, it is urgently necessary to address racial disparities in campus admissions and faculty hiring — but, again, not at the expense of the Constitution.

it is difficult to ignore the overwhelming evidence that Harvard attempted to achieve greater diversity in part by systematically downranking Asian applicants on subjective grounds, judging them deficient in traits such as “positive personality,” likability, courage, kindness and being “widely respected.” That’s not inclusion; it’s discrimination.

Our nation has inflicted horrific injustices on vulnerable communities. And while the precise nature of the injustice has varied — whether it was slavery, Jim Crow, internment or the brutal conquest of Native American lands — there was always a consistent theme: the comprehensive denial of constitutional rights.

But one does not correct the consequences of those terrible constitutional violations by inflicting a new set of violations on different American communities in a different American era. A consistent defense of the Constitution is good for us all,

The danger posed by D.E.I. resides primarily not in these virtuous ends, but in the unconstitutional means chosen to advance them.

Virtuous goals should not be accomplished by illiberal means.

it is not just that Europeans spend a few extra weeks on the beach. The typical working day in Britain, France and Germany is half an hour shorter than in America, according to the International Labour Organisation.

which is the better way of living—with more money or more free time? The reality is that it is difficult for people to choose

Those in America work according to American schedules; those in Europe conform to European norms.

the more fruitful question is why Americans put in longer hours

The answer leads to a curious new observation: that remote work is making America’s office drones a little more European, albeit with a puritanical twist.

A first guess suggests that culture might account for the variation in work hours. Maybe Europeans enjoy their leisure more. They are spoilt for choice about how to spend time off

As for Americans, surveys indicate that they view hard work as intrinsically worthwhile. “Rugged individualism” is, after all, what built the country.

the difficulty with chalking up the difference to culture is that until the early 1970s many Europeans worked more

American working hours are basically the same now as back then. The big change is that Europeans now toil less. Hours are down a whopping 30% in Germany over the past half-century. Something beyond culture—a slow-moving, ill-defined variable—is at play.

Edward Prescott, an American economist, came to a provocative conclusion, arguing that the key was taxation

Until the early 1970s tax levels were similar in America and Europe, and so were hours worked. By the early 1990s Europe’s taxes had become more burdensome and, in Prescott’s view, its employees less motivated

A substantial gap persists today: American tax revenue is 28% of GDP, compared with 40% or so in Europe.

A recent study by Jósef Sigurdsson of Stockholm University examined how Icelandic workers responded to a one-year income-tax holiday in 1987, when the country overhauled its tax system. Although people with more flexibility—especially younger ones in part-time jobs—did indeed put in more hours, the overall increase in work was modest relative to that implied by Prescott’s model.

Regulation seems to matter more.

European rules give workers power, from generous parental-leave policies to stricter laws on firing staff. Many European countries try to put caps on working tim

most research agrees that they have reduced work hours.

Another important relationship is that, as people get richer, they typically want to work less

A recent paper by the IMF shows a remarkably strong link between GDP per person and hours worked in Europe. People in richer countries, such as the Netherlands, generally work less than those in poorer countries, such as Bulgaria.

Americans are wealthier than most Europeans, so why do they still work more?

Perhaps leisure is a collective-action problem. Americans may want to ask their bosses for longer holidays but are worried about being seen as slackers

A paper in 2005 by Alberto Alesina of Harvard University and colleagues argued that Europe’s stronger unions had in effect solved this collective-action problem by fighting for paid vacations, which ended up enshrined in law.

Europe’s well-regulated leisure time may then beget more leisure because it is more socially acceptable, and the market responds by supplying more good ways not to work. It is a virtuous cycle of lovely cafés.

One fascinating new development is a discrepancy in the rise of remote work

In 2023 the Global Survey of Working Arrangements found that full-time employees in America work from home 1.4 days a week, while those in Europe do so for 0.8 days

a striking result: Europeans and Americans now spend almost exactly the same amount of time in the office, with 1,320 hours a year for the former and 1,304 for the latter.

In other words, the extra 15% of work done by Americans annually is now from the comfort of their own homes—or occasionally on the beach, perhaps even one in Europe. Americans do still work harder, but rather more enjoyably than in the past

The answer to both lies in one word: satiety. It’s a concept that we don’t use much in everyday life but that we’ve all experienced at some point. It describes the sensation of having had enough and not wanting any more.

The primary reason we have gained weight at a pace unprecedented in human history is that our diets have radically changed in ways that have deeply undermined our ability to feel sated

The evidence is clear that the kind of food my father grew up eating quickly makes you feel full. But the kind of food I grew up eating, much of which is made in factories, often with artificial chemicals, left me feeling empty and as if I had a hole in my stomach

In a recent study of what American children eat, ultraprocessed food was found to make up 67 percent of their daily diet. This kind of food makes you want to eat more and more. Satiety comes late, if at all.

After he moved in 2000 to the United States in his 20s, he gained 30 pounds in two years. He began to wonder if the American diet has some kind of strange effect on our brains and our cravings, so he designed an experiment to test it.

He and his colleague Paul Johnson raised a group of rats in a cage and gave them an abundant supply of healthy, balanced rat chow made out of the kind of food rats had been eating for a very long time. The rats would eat it when they were hungry, and then they seemed to feel sated and stopped. They did not become fat.

then Dr. Kenny and his colleague exposed the rats to an American diet: fried bacon, Snickers bars, cheesecake and other treats. They went crazy for it. The rats would hurl themselves into the cheesecake, gorge themselves and emerge with their faces and whiskers totally slicked with it. They quickly lost almost all interest in the healthy food, and the restraint they used to show around healthy food disappeared. Within six weeks, their obesity rates soared.

They took all the processed food away and gave the rats their old healthy diet. Dr. Kenny was confident that they would eat more of it, proving that processed food had expanded their appetites. But something stranger happened. It was as though the rats no longer recognized healthy food as food at all, and they barely ate it. Only when they were starving did they reluctantly start to consume it again.

Drugs like Ozempic work precisely by making us feel full.

processed and ultraprocessed food create a raging hole of hunger, and these treatments can repair that hole

the drugs are “an artificial solution to an artificial problem.”

Yet we have reacted to this crisis largely caused by the food industry as if it were caused only by individual moral dereliction

Why do we turn our anger inward and not outward at the main cause of the crisis? And by extension, why do we seek to shame people taking Ozempic but not those who, say, take drugs to lower their blood pressure?

The first is the belief that obesity is a sin.

The second idea is that we are all in a competition when it comes to weight. Ours is a society full of people fighting against the forces in our food that are making us fatter.

Looked at in this way, people on Ozempic can resemble cyclists like Lance Armstrong who used performance-enhancing drugs.

We can’t find our way to a sane, nontoxic conversation about obesity or Ozempic until we bring these rarely spoken thoughts into the open and reckon with them

remember the competition isn’t between you and your neighbor who’s on weight-loss drugs. It’s between you and a food industry constantly designing new ways to undermine your satiety.

Reducing or reversing obesity hugely boosts health, on average: We know from years of studying bariatric surgery that it slashes the risks of cancer, heart disease and diabetes-related death. Early indications are that the new anti-obesity drugs are moving people in a similar radically healthier direction,

But these drugs may increase the risk for thyroid cancer.

Do we want these weight loss drugs to be another opportunity to tear one another down? Or do we want to realize that the food industry has profoundly altered the appetites of us all — leaving us trapped in the same cage, scrambling to find a way out?

The ordinary fixes—the kind that draw on people’s will, and require eating less and moving more—rarely have a large or lasting effect. Indeed, America itself has suffered through a long, maddening history of failed attempts to change its habits on a national scale: a yo-yo diet of well-intentioned treatments, policies, and other social interventions that only ever lead us back to where we started

Through it all, obesity rates keep going up; the diabetes epidemic keeps worsening.

The most recent miracle, for Barb as well as for the nation, has come in the form of injectable drugs. In early 2021, the Danish pharmaceutical company Novo Nordisk published a clinical trial showing remarkable results for semaglutide, now sold under the trade names Wegovy and Ozempic.

Patients in the study who’d had injections of the drug lost, on average, close to 15 percent of their body weight—more than had ever been achieved with any other drug in a study of that size. Wadden knew immediately that this would be “an incredible revolution in the treatment of obesity.”

Many more drugs are now racing through development: survodutide, pemvidutide, retatrutide. (Among specialists, that last one has produced the most excitement: An early trial found an average weight loss of 24 percent in one group of participants.

In the United States, an estimated 189 million adults are classified as having obesity or being overweight

The drugs don’t work for everyone. Their major side effects—nausea, vomiting, and diarrhea—can be too intense for many patients. Others don’t end up losing any weight

For the time being, just 25 percent of private insurers offer the relevant coverage, and the cost of treatment—about $1,000 a month—has been prohibitive for many Americans.

The drugs have already been approved not just for people with diabetes or obesity, but for anyone who has a BMI of more than 27 and an associated health condition, such as high blood pressure or cholesterol. By those criteria, more than 140 million American adults already qualify

if this story goes the way it’s gone for other “risk factor” drugs such as statins and antihypertensives, then the threshold for prescriptions will be lowered over time, inching further toward the weight range we now describe as “normal.”

How you view that prospect will depend on your attitudes about obesity, and your tolerance for risk

The first GLP-1 drug to receive FDA approval, exenatide, has been used as a diabetes treatment for more than 20 years. No long-term harms have been identified—but then again, that drug’s long-term effects have been studied carefully only across a span of seven years

the data so far look very good. “These are now being used, literally, in hundreds of thousands of people across the world,” she told me, and although some studies have suggested that GLP-1 drugs may cause inflammation of the pancreas, or even tumor growth, these concerns have not borne out.

adolescents are injecting newer versions of these drugs, and may continue to do so every week for 50 years or more. What might happen over all that time?

“All of us, in the back of our minds, always wonder, Will something show up?  ” Although no serious problems have yet emerged, she said, “you wonder, and you worry.”

in light of what we’ve been through, it’s hard to see what other choices still remain. For 40 years, we’ve tried to curb the spread of obesity and its related ailments, and for 40 years, we’ve failed. We don’t know how to fix the problem. We don’t even understand what’s really causing it. Now, again, we have a new approach. This time around, the fix had better work.

The fen-phen revolution arrived at a crucial turning point for Wadden’s field, and indeed for his career. By then he’d spent almost 15 years at the leading edge of research into dietary interventions, seeing how much weight a person might lose through careful cutting of their calories.

But that sort of diet science—and the diet culture that it helped support—had lately come into a state of ruin. Americans were fatter than they’d ever been, and they were giving up on losing weight. According to one industry group, the total number of dieters in the country declined by more than 25 percent from 1986 to 1991.

Rejecting diet culture became something of a feminist cause. “A growing number of women are joining in an anti-diet movement,” The New York Times reported in 1992. “They are forming support groups and ceasing to diet with a resolve similar to that of secretaries who 20 years ago stopped getting coffee for their bosses.

Now Wadden and other obesity researchers were reaching a consensus that behavioral interventions might produce in the very best scenario an average lasting weight loss of just 5 to 10 percent

National surveys completed in 1994 showed that the adult obesity rate had surged by more than half since 1980, while the proportion of children classified as overweight had doubled. The need for weight control in America had never seemed so great, even as the chances of achieving it were never perceived to be so small.

Wadden wasn’t terribly concerned, because no one in his study had reported any heart symptoms. But ultrasounds revealed that nearly one-third of them had some degree of leakage in their heart valves. His “cure for obesity” was in fact a source of harm.

In December 1994, the Times ran an editorial on what was understood to be a pivotal discovery: A genetic basis for obesity had finally been found. Researchers at Rockefeller University were investigating a molecule, later named leptin, that gets secreted from fat cells and travels to the brain, and that causes feelings of satiety. Lab mice with mutations in the leptin gene—importantly, a gene also found in humans—overeat until they’re three times the size of other mice. “The finding holds out the dazzling hope,”

In April 1996, the doctors recommended yes: Dexfenfluramine was approved—and became an instant blockbuster. Patients received prescriptions by the hundreds of thousands every month. Sketchy wellness clinics—call toll-free, 1-888-4FEN-FEN—helped meet demand. Then, as now, experts voiced concerns about access. Then, as now, they worried that people who didn’t really need the drugs were lining up to take them. By the end of the year, sales of “fen” alone had surpassed $300 million.

It was nothing less than an awakening, for doctors and their patients alike. Now a patient could be treated for excess weight in the same way they might be treated for diabetes or hypertension—with a drug they’d have to take for the rest of their life.

the article heralded a “new understanding of obesity as a chronic disease rather than a failure of willpower.”

News had just come out that, at the Mayo Clinic in Minnesota, two dozen women taking fen-phen—including six who were, like Barb, in their 30s—had developed cardiac conditions. A few had needed surgery, and on the operating table, doctors discovered that their heart valves were covered with a waxy plaque.

Americans had been prescribed regular fenfluramine since 1973, and the newer drug, dexfenfluramine, had been available in France since 1985. Experts took comfort in this history. Using language that is familiar from today’s assurances regarding semaglutide and other GLP-1 drugs, they pointed out that millions were already on the medication. “It is highly unlikely that there is anything significant in toxicity to the drug that hasn’t been picked up with this kind of experience,” an FDA official named James Bilstad would later say in a Time cover story headlined “The Hot New Diet Pill.

“I know I can’t get any more,” she told Williams. “I have to use up what I have. And then I don’t know what I’m going to do after that. That’s the problem—and that is what scares me to death.” Telling people to lose weight the “natural way,” she told another guest, who was suggesting that people with obesity need only go on low-carb diets, is like “asking a person with a thyroid condition to just stop their medication.”

She’d gone off the fen-phen and had rapidly regained weight. “The voices returned and came back in a furor I’d never heard before,” Barb later wrote on her blog. “It was as if they were so angry at being silenced for so long, they were going to tell me 19 months’ worth of what they wanted me to hear. I was forced to listen. And I ate. And I ate. And ate.”

For Barb, rapid weight loss has brought on a different metaphysical confusion. When she looks in the mirror, she sometimes sees her shape as it was two years ago. In certain corners of the internet, this is known as “phantom fat syndrome,” but Barb dislikes that term. She thinks it should be called “body integration syndrome,” stemming from a disconnect between your “larger-body memory” and “smaller-body reality.

In 2003, the U.S. surgeon general declared obesity “the terror within, a threat that is every bit as real to America as the weapons of mass destruction”; a few months later, Eric Finkelstein, an economist who studies the social costs of obesity, put out an influential paper finding that excess weight was associated with up to $79 billion in health-care spending in 1998, of which roughly half was paid by Medicare and Medicaid. (Later he’d conclude that the number had nearly doubled in a decade.

In 2004, Finkelstein attended an Action on Obesity summit hosted by the Mayo Clinic, at which numerous social interventions were proposed, including calorie labeling in workplace cafeterias and mandatory gym class for children of all grades.

he message at their core, that soda was a form of poison like tobacco, spread. In San Francisco and New York, public-service campaigns showed images of soda bottles pouring out a stream of glistening, blood-streaked fat. Michelle Obama led an effort to depict water—plain old water—as something “cool” to drink.

Soon, the federal government took up many of the ideas that Brownell had helped popularize. Barack Obama had promised while campaigning for president that if America’s obesity trends could be reversed, the Medicare system alone would save “a trillion dollars.” By fighting fat, he implied, his ambitious plan for health-care reform would pay for itself. Once he was in office, his administration pulled every policy lever it could.

Michelle Obama helped guide these efforts, working with marketing experts to develop ways of nudging kids toward better diets and pledging to eliminate “food deserts,” or neighborhoods that lacked convenient access to healthy, affordable food. She was relentless in her public messaging; she planted an organic garden at the White House and promoted her signature “Let’s Move!” campaign around the country.

An all-out war on soda would come to stand in for these broad efforts. Nutrition studies found that half of all Americans were drinking sugar-sweetened beverages every day, and that consumption of these accounted for one-third of the added sugar in adults’ diets. Studies turned up links between people’s soft-drink consumption and their risks for type 2 diabetes and obesity. A new strand of research hinted that “liquid calories” in particular were dangerous to health.

when their field lost faith in low-calorie diets as a source of lasting weight loss, the two friends went in opposite directions. Wadden looked for ways to fix a person’s chemistry, so he turned to pharmaceuticals. Brownell had come to see obesity as a product of our toxic food environment: He meant to fix the world to which a person’s chemistry responded, so he started getting into policy.

The social engineering worked. Slowly but surely, Americans’ lamented lifestyle began to shift. From 2001 to 2018, added-sugar intake dropped by about one-fifth among children, teens, and young adults. From the late 1970s through the early 2000s, the obesity rate among American children had roughly tripled; then, suddenly, it flattened out.

although the obesity rate among adults was still increasing, its climb seemed slower than before. Americans’ long-standing tendency to eat ever-bigger portions also seemed to be abating.

sugary drinks—liquid candy, pretty much—were always going to be a soft target for the nanny state. Fixing the food environment in deeper ways proved much harder. “The tobacco playbook pretty much only works for soda, because that’s the closest analogy we have as a food item,

that tobacco playbook doesn’t work to increase consumption of fruits and vegetables, he said. It doesn’t work to increase consumption of beans. It doesn’t work to make people eat more nuts or seeds or extra-virgin olive oil.

Careful research in the past decade has shown that many of the Obama-era social fixes did little to alter behavior or improve our health. Putting calorie labels on menus seemed to prompt at most a small decline in the amount of food people ate. Employer-based wellness programs (which are still offered by 80 percent of large companies) were shown to have zero tangible effects. Health-care spending, in general, kept going up.

From the mid-1990s to the mid-2000s, the proportion of adults who said they’d experienced discrimination on account of their height or weight increased by two-thirds, going up to 12 percent. Puhl and others started citing evidence that this form of discrimination wasn’t merely a source of psychic harm, but also of obesity itself. Studies found that the experience of weight discrimination is associated with overeating, and with the risk of weight gain over time.

obesity rates resumed their ascent. Today, 20 percent of American children have obesity. For all the policy nudges and the sensible revisions to nutrition standards, food companies remain as unfettered as they were in the 1990s, Kelly Brownell told me. “Is there anything the industry can’t do now that it was doing then?” he asked. “The answer really is no. And so we have a very predictable set of outcomes.”

she started to rebound. The openings into her gastric pouch—the section of her stomach that wasn’t bypassed—stretched back to something like their former size. And Barb found ways to “eat around” the surgery, as doctors say, by taking food throughout the day in smaller portions

Bariatric surgeries can be highly effective for some people and nearly useless for others. Long-term studies have found that 30 percent of those who receive the same procedure Barb did regain at least one-quarter of what they lost within two years of reaching their weight nadir; more than half regain that much within five years.

if the effects of Barb’s surgery were quickly wearing off, its side effects were not: She now had iron, calcium, and B12 deficiencies resulting from the changes to her gut. She looked into getting a revision of the surgery—a redo, more or less—but insurance wouldn’t cover it

She found that every health concern she brought to doctors might be taken as a referendum, in some way, on her body size. “If I stubbed my toe or whatever, they’d just say ‘Lose weight.’ ” She began to notice all the times she’d be in a waiting room and find that every chair had arms. She realized that if she was having a surgical procedure, she’d need to buy herself a plus-size gown—or else submit to being covered with a bedsheet when the nurses realized that nothing else would fit.

Barb grew angrier and more direct about her needs—You’ll have to find me a different chair, she started saying to receptionists. Many others shared her rage. Activists had long decried the cruel treatment of people with obesity: The National Association to Advance Fat Acceptance had existed, for example, in one form or another, since 1969; the Council on Size & Weight Discrimination had been incorporated in 1991. But in the early 2000s, the ideas behind this movement began to wend their way deeper into academia, and they soon gained some purchase with the public.

“Our public-health efforts to address obesity have failed,” Eric Finkelstein, the economist, told me.

Others attacked the very premise of a “healthy weight”: People do not have any fundamental need, they argued, morally or medically, to strive for smaller bodies as an end in itself. They called for resistance to the ideology of anti-fatness, with its profit-making arms in health care and consumer goods. The Association for Size Diversity and Health formed in 2003; a year later, dozens of scholars working on weight-related topics joined together to create the academic field of fat studies.

As the size-diversity movement grew, its values were taken up—or co-opted—by Big Business. Dove had recently launched its “Campaign for Real Beauty,” which included plus-size women. (Ad Age later named it the best ad campaign of the 21st century.) People started talking about “fat shaming” as something to avoid

By 2001, Bacon, who uses they/them pronouns, had received their Ph.D. and finished a rough draft of a book, Health at Every Size, which drew inspiration from a broader movement by that name among health-care practitioners

But something shifted in the ensuing years. In 2007, Bacon got a different response, and the book was published. Health at Every Size became a point of entry for a generation of young activists and, for a time, helped shape Americans’ understanding of obesity.

Some experts were rethinking their advice on food and diet. At UC Davis, a physiologist named Lindo Bacon who had struggled to overcome an eating disorder had been studying the effects of “intuitive eating,” which aims to promote healthy, sustainable behavior without fixating on what you weigh or how you look

The heightened sensitivity started showing up in survey data, too. In 2010, fewer than half of U.S. adults expressed support for giving people with obesity the same legal protections from discrimination offered to people with disabilities. In 2015, that rate had risen to three-quarters.

In Bacon’s view, the 2000s and 2010s were glory years. “People came together and they realized that they’re not alone, and they can start to be critical of the ideas that they’ve been taught,” Bacon told me. “We were on this marvelous path of gaining more credibility for the whole Health at Every Size movement, and more awareness.”

that sense of unity proved short-lived; the movement soon began to splinter. Black women have the highest rates of obesity, and disproportionately high rates of associated health conditions. Yet according to Fatima Cody Stanford, an obesity-medicine physician at Harvard Medical School, Black patients with obesity get lower-quality care than white patients with obesity.

That system was exactly what Bacon and the Health at Every Size movement had set out to reform. The problem, as they saw it, was not so much that Black people lacked access to obesity medicine, but that, as Bacon and the Black sociologist Sabrina Strings argued in a 2020 article, Black women have been “specifically targeted” for weight loss, which Bacon and Strings saw as a form of racism

But members of the fat-acceptance movement pointed out that their own most visible leaders, including Bacon, were overwhelmingly white. “White female dietitians have helped steal and monetize the body positive movement,” Marquisele Mercedes, a Black activist and public-health Ph.D. student, wrote in September 2020. “And I’m sick of it.”

Tensions over who had the standing to speak, and on which topics, boiled over. In 2022, following allegations that Bacon had been exploitative and condescending toward Black colleagues, the Association for Size Diversity and Health expelled them from its ranks and barred them from attending its events.

As the movement succumbed to in-fighting, its momentum with the public stalled. If attitudes about fatness among the general public had changed during the 2000s and 2010s, it was only to a point. The idea that some people can indeed be “fit but fat,” though backed up by research, has always been a tough sell.

Although Americans had become less inclined to say they valued thinness, measures of their implicit attitudes seemed fairly stable. Outside of a few cities such as San Francisco and Madison, Wisconsin, new body-size-discrimination laws were never passed.

In the meantime, thinness was coming back into fashion

In the spring of 2022, Kim Kardashian—whose “curvy” physique has been a media and popular obsession—boasted about crash-dieting in advance of the Met Gala. A year later, the model and influencer Felicity Hayward warned Vogue Business that “plus-size representation has gone backwards.” In March of this year, the singer Lizzo, whose body pride has long been central to her public persona, told The New York Times that she’s been trying to lose weight. “I’m not going to lie and say I love my body every day,” she said.

Among the many other dramatic effects of the GLP-1 drugs, they may well have released a store of pent-up social pressure to lose weight.

If ever there was a time to debate that impulse, and to question its origins and effects, it would be now. But Puhl told me that no one can even agree on which words are inoffensive. The medical field still uses obesity, as a description of a diagnosable disease. But many activists despise that phrase—some spell it with an asterisk in place of the e—and propose instead to reclaim fat.

Everyone seems to agree on the most important, central fact: that we should be doing everything we can to limit weight stigma. But that hasn’t been enough to stop the arguing.

Things feel surreal these days to just about anyone who has spent years thinking about obesity. At 71, after more than four decades in the field, Thomas Wadden now works part-time, seeing patients just a few days a week. But the arrival of the GLP-1 drugs has kept him hanging on for a few more years, he said. “It’s too much of an exciting period to leave obesity research right now.”

When everyone is on semaglutide or tirzepatide, will the soft-drink companies—Brownell’s nemeses for so many years—feel as if a burden has been lifted? “My guess is the food industry is probably really happy to see these drugs come along,” he said. They’ll find a way to reach the people who are taking GLP‑1s, with foods and beverages in smaller portions, maybe. At the same time, the pressures to cut back on where and how they sell their products will abate.

the triumph in obesity treatment only highlights the abiding mystery of why Americans are still getting fatter, even now

Perhaps one can lay the blame on “ultraprocessed” foods, he said. Maybe it’s a related problem with our microbiomes. Or it could be that obesity, once it takes hold within a population, tends to reproduce itself through interactions between a mother and a fetus. Others have pointed to increasing screen time, how much sleep we get, which chemicals are in the products that we use, and which pills we happen to take for our many other maladies.

“The GLP-1s are just a perfect example of how poorly we understand obesity,” Mozaffarian told me. “Any explanation of why they cause weight loss is all post-hoc hand-waving now, because we have no idea. We have no idea why they really work and people are losing weight.”

The new drugs—and the “new understanding of obesity” that they have supposedly occasioned—could end up changing people’s attitudes toward body size. But in what ways

When the American Medical Association declared obesity a disease in 2013, Rebecca Puhl told me, some thought “it might reduce stigma, because it was putting more emphasis on the uncontrollable factors that contribute to obesity.” Others guessed that it would do the opposite, because no one likes to be “diseased.”

why wasn’t there another kind of nagging voice that wouldn’t stop—a sense of worry over what the future holds? And if she wasn’t worried for herself, then what about for Meghann or for Tristan, who are barely in their 40s? Wouldn’t they be on these drugs for another 40 years, or even longer? But Barb said she wasn’t worried—not at all. “The technology is so much better now.” If any problems come up, the scientists will find solutions.

This is May 2024: Humanity is in the early stages of a standoff with generative AI, which offers methods through which visual art, writing, music, and computer code can be created by a machine in seconds with the simplest of prompts

Most of us are still in the sizing-up phase for generative AI, staring warily at a technology that’s been hyped as world-changing and job-disrupting (even, some proponents argue, potentially civilization-ending), and been foisted on the public in a very short period of time. It’s a weird, exhausting, exciting, even tense moment. Enter: THE CRUSHER.

There is about a zero percent chance that the company did not understand the optics of releasing this ad at this moment. Apple is among the most sophisticated and moneyed corporations in all the world.

this time, it’s hard to like what the company is showing us. People are angry. One commenter on X called the ad “heartbreaking.

Although watching things explode might be fun, it’s less fun when a multitrillion-dollar tech corporation is the one destroying tools, instruments, and other objects of human expression and creativity.

Apple is a great technology company, but it is a legendary marketer. Its ads, its slickly produced keynotes, and even its retail stores succeed because they offer a vision of the company’s products as tools that give us, the consumers, power.

The third-order annoyance is in the genre. Apple has essentially aped a popular format of “crushing” videos on TikTok, wherein hydraulic presses are employed to obliterate everyday objects for the pleasure of idle scrollers.

It’s unclear whether some of the ad might have been created with CGI, but Apple could easily round up tens of thousands of dollars of expensive equipment and destroy it all on a whim. However small, the ad is a symbol of the company’s dominance.

The iPad was one of Steve Jobs’s final products, one he believed could become as popular and perhaps as transformative as cars. That vision hasn’t panned out. The iPad hasn’t killed books, televisions, or even the iPhone

The iPad is, potentially, a creative tool. It’s also an expensive luxury device whose cheaper iterations, at least, are vessels for letting your kid watch Cocomelon so they don’t melt down in public, reading self-help books on a plane, or opting for more pixels and better resolution whilst consuming content on the toilet.

Odds are, people aren’t really furious at Apple on behalf of the trumpeters—they’re mad because the ad says something about the balance of power

it is easy to be aghast at the idea that AI will wipe out human creativity with cheap synthetic waste.

The fundamental flaw of Apple’s commercial is that it is a display of force that reminds us about this sleight of hand. We are not the powerful entity in this relationship. The creative potential we feel when we pick up one of their shiny devices is actually on loan. At the end of the day, it belongs to Apple, the destroyer.

how many are aware that President Biden is among the more popular — well, less unpopular — leaders in the Western world?

First, let’s talk about some other international comparisons that seem relevant to the current situation.

But public perception of our economic performance is strongly colored by rising prices. Inflation — the rate at which prices are rising — has subsided a lot, but prices haven’t and won’t come down

No matter what we did, many people were going to die — but the death toll was affected by politics, perhaps especially by the way vaccines became a front in the culture war. And America had a really bad pandemic, even compared with its peers. U.S. life expectancy was already lagging behind comparable countries’ by 2019, but the gap widened after Covid-19 struck.

On the other hand, the U.S. economy experienced an exceptionally strong bounce back from the pandemic recession. Even after adjusting for inflation, U.S. gross domestic product per capita is up 7 percent since the eve of the pandemic, greatly exceeding growth in other major wealthy economies

This would seem on the face of it to say something good about Biden’s economic policies.

Although we hear politicians on the campaign trail trying to make hay with the old Reagan-era question — Are you better off than you were four years ago? — there’s a lot of amnesia about what was actually happening in 2020, namely a deadly, terrifying pandemic

there have been huge recriminations against policymakers, both the Biden administration and the Federal Reserve, either for supposedly causing the bout of inflation or at any rate failing to prevent it.

the similarities between the wealthiest nations are more revealing than their differences.

Inflation surged almost everywhere after the pandemic. And if you take care to compare “apples to Äpfel” — to use the same consumer price measures — inflation has been remarkably similar in different countries.

Since the eve of the pandemic, the Harmonized Index of Consumer Prices has risen 19.6 percent in the United States and 19.8 percent in the euro area.

This strongly suggests that pandemic-related disruptions, rather than national policies, were inflation’s main driver.

Still, inflation rankles voters. Even when income growth exceeds inflation, as it has in the United States, people tend to feel that they earned their higher wages only to have them snatched away by higher prices

this is probably the most important reason that, according to tracking polls conducted by Morning Consult, every single leader of a Group of 7 nation is underwater, with more voters disapproving than approving of their leadership.

So who’s the winner of this unpopularity contest? Who has the least bad net approval? The answer is Joe Biden, with Giorgia Meloni of Italy a close second. The other Group of 7 leaders are even more unpopular

this has political consequences

every political analysis that says the fault for Biden’s low approval lies with the president and his campaign — that he’s too old (although that narrative, after suddenly peaking, mostly faded away after his State of the Union address) or is out of touch with the concerns of “real” Americans — needs to explain why he’s doing less badly than his foreign peers.

17 percent of G.D.P.

there is now one administrator or manager for every 4.7 employees, doing things like designing anti-harassment trainings, writing corporate mission statements, collecting data and managing “systems.”

This situation is especially grave in higher education. The Massachusetts Institute of Technology now has almost eight times as many nonfaculty employees as faculty employees

The general job of administrators, who are invariably good and well-meaning people, is to supervise and control, and they gain power and job security by hiring more people to work for them to create more supervision and control

As Philip K. Howard has been arguing for years, good organizations give people discretion to do what is right. But the trend in public and private sector organizations has been to write rules that rob people of the power of discretion

Their power is similar to what Annie Lowrey of The Atlantic has called the “time tax.” If you’ve ever fought a health care, corporate or university bureaucracy, you quickly realize you don’t have the time for it, so you give up

kids’ activities, from travel sports to recess, are supervised, and rules dominate. Parents are afraid their kids might be harmed, but as Jonathan Haidt and Greg Lukianoff have argued, by being overprotective, parents make their kids more fragile and more vulnerable to harm.

High school students design their lives to fit the metrics that college admissions officers require. And what traits are selective schools looking for? They’re looking for students who are willing to conform to the formulas the gatekeepers devise.

t Stanford is apparently now tamed. I invite you to read Ginevra Davis’s essay “Stanford’s War on Social Life” in Palladium, which won a vaunted Sidney Award in 2022 and details how university administrators cracked down on student initiatives to make everything boring, supervised and safe.

Mark Edmundson teaches literature at the University of Virginia. The annual self-evaluations he had to submit used to be one page. Now he has to fill out about 15 electronic pages of bureaucratese that include demonstrating how his work advances D.E.I., to make sure his every waking moment conforms to the reigning ideology.

the whole administrative apparatus comes with an implied view of human nature. People are weak, fragile, vulnerable and kind of stupid. They need administrators to run their lives

The result is the soft despotism that Tocqueville warned us about centuries ago, a power that “is absolute, minute, regular, provident and mild.”

this kind of power is now centerless. Presidents and executives don’t run companies, universities or nations. Power is now held by everyone who issues work surveys and annual reports, the people who create H.R. trainings and collect data

Trumpian populism is about many things, but one of them is this: working-class people rebelling against administrators. It is about people who want to lead lives of freedom, creativity and vitality, who find themselves working at jobs, sending their kids to schools and visiting hospitals, where they confront “an immense and tutelary power” (Tocqueville’s words) that is out to diminish them.

Opening the marriage wasn’t just about doing whatever — and whoever — she wanted, she said. She had to cast off internalized sexism and her tendency to put others’ needs before her own, issues she worked through in therapy. What began as sexual thrill-seeking led unexpectedly to self-discovery.

“I thought non-monogamy was going to be all about the sex,” she said. “I thought I was going on a big sexual adventure, and it was going to be super exciting. And it was, until it wasn’t.”

Eventually, Winter swore off men who were cheating and began seeing people who were also in open relationships, a demographic that became easier to find when online dating services added non-monogamous to their menus. Even then, options were limited.

Winter and her husband struggled with when and how to tell their sons about their arrangement, and wanted to wait until their children were mature enough to handle it. That plan failed when their oldest son, then 13, saw his dad’s online dating profile on his laptop, and texted his mother in a panic, asking if they were in an open marriage. Her youngest son found out in a similar way a few years ago, when he was 14, she said.

Food prices have risen by another 6.1 per cent from already high levels in 2022

Soaring energy prices mean that 5.5 million Germans say they weren’t able to heat their house properly over the past year

there have been further investigations into his alleged connections to a tax fraud scheme that happened when he was mayor of Hamburg (Scholz denies any wrongdoing).

‘Food…petrol and energy: everything has become so expensive that I have nothing left at the end of the month. There was a time when I could go out sometimes, or go to the cinema. Such extras are no longer possible.’

three quarters said they had to make cuts in their spending on consumer items and leisure time activities.

Recent scandals and spectacular failings of his government have cemented the public’s impression of incompetence.

Only around a quarter think he is fit to be chancellor, down from over 60 per cent when he took office in December 2021.

Last month, a bombshell ruling by the constitutional court declared the creative accounting of his administration illegal, blowing a €60 billion (£52 billion) hole in public finances and an even bigger one in what remained of Scholz’s reputation as a crisis chancellor.

What’s worse is that he doesn’t appear to care about the increasing despair in his country. Naturally aloof, his mannerisms and rhetoric sometimes drift into outright dismissiveness

Currently only 15 per cent would vote for his centre-left Social Democrats (SPD). That marks a 10 point-drop in support from the last election and the lowest result in the SPD’s post-war history by some margin.

One would think that such catastrophic loss of confidence would lead to serious soul-searching by Scholz or, failing that, within the SPD, which still thinks of itself as one of Germany’s main political parties. But there is no sign of any such critical reflection.

Understanding how empathy can immobilize us like that is a critical step for helping others — and ourselves.

Empathic distress explains why many people have checked out in the wake of these tragedies

Having concluded that nothing they do will make a difference, they start to become indifferent.

The symptoms of empathic distress were originally diagnosed in health care, with nurses and doctors who appeared to become insensitive to the pain of their patients.

Early researchers labeled it compassion fatigue and described it as the cost of caring.

when two neuroscientists, Olga Klimecki and Tania Singer, reviewed the evidence, they discovered that “compassion fatigue” is a misnomer. Caring itself is not costly. What drains people is not merely witnessing others’ pain but feeling incapable of alleviating it.

In times of sustained anguish, empathy is a recipe for more distress, and in some cases even depression. What we need instead is compassion.

empathy and compassion aren’t the same. Empathy absorbs others’ emotions as your own: “I’m hurting for you.”

Compassion focuses your action on their emotions: “I see that you’re hurting, and I’m here for you.”

“Empathy is biased,” the psychologist Paul Bloom writes. It’s something we usually reserve for our own group, and in that sense, it can even be “a powerful force for war and atrocity.”

Dr. Singer and their colleagues trained people to empathize by trying to feel other people’s pain. When the participants saw someone suffering, it activated a neural network that would light up if they themselves were in pain. It hurt. And when people can’t help, they escape the pain by withdrawing.

To combat this, the Klimecki and Singer team taught their participants to respond with compassion rather than empathy — focusing not on sharing others’ pain but on noticing their feelings and offering comfort.

A different neural network lit up, one associated with affiliation and social connection. This is why a growing body of evidence suggests that compassion is healthier for you and kinder to others than empathy:

When you see others in pain, instead of causing you to get overloaded and retreat, compassion motivates you to reach out and help

The most basic form of compassion is not assuaging distress but acknowledging it.

in my research, I’ve found that being helpful has a secondary benefit: It’s an antidote to feeling helpless.

To figure out who needs your support after something terrible happens, the psychologist Susan Silk suggests picturing a dart board, with the people closest to the trauma in the bull’s-eye and those more peripherally affected in the outer rings.

Once you’ve figured out where you belong on the dart board, look for support from people outside your ring, and offer it to people closer to the center.

Even if people aren’t personally in the line of fire, attacks targeting members of a specific group can shatter a whole population’s sense of security.

If you notice that people in your life seem disengaged around an issue that matters to you, it’s worth considering whose pain they might be carrying.

Instead of demanding that they do more, it may be time to show them compassion — and help them find compassion for themselves, too.

Your small gesture of kindness won’t end the crisis in the Middle East, but it can help someone else. And that can give you the strength to help more.

Anecdotally, it seems like everybody knows someone who has dropped out of the mainstream, vowing to vote for the AfD or talking about emigrating

What has started to dawn on us in recent months, and what the meeting in Potsdam laid bare, is that the far right is not about having horrific ideas — it is about enacting horrific ideas.

Germany’s far-right adherents really mean it. With funding, support and a very real chance of winning federal states this year, they are closer to power than they have ever been in the nearly 75-year history of post-Nazi Germany.

In his recent book “Triggerpunkte,” or “Trigger Points,” Steffen Mau, a sociologist at Humboldt University in Berlin, rejects the notion that German society is polarized neatly in two. In Germany, he argues, divisions instead run through several areas such as climate, migration and social justice. You can be moved by some issues, indifferent to others

In recent months, those motivated by their opposition to migration or climate policies were the most vocal and visible. Now those who care about democracy, minority rights and the rule of law have reached their trigger point, too.

But only a handful of cancers—of the breast, lung, colon and cervix—have screening tests recommended by the U.S. Preventive Services Task Force

Many companies are developing blood tests that can detect cancer signals before symptoms occur, and Grail’s is the most advanced. A study found it can identify more than 50 types of cancer 52% of the time and the 12 deadliest cancers in Stages I through III 68% of the time.

There’s a hitch. The test costs $949 and isn’t covered by Medicare or most private insurance.

The trouble is that this cancer is almost never caught early. There’s no routine screening for it, and symptoms don’t develop until it is advanced. Mr. Royse, 64, had no idea he was sick until he took a blood test called Galleri, produced by the Menlo Park, Calif., startup Grail. He had surgery and chemotherapy and is now cancer-free.

Mr. Royse visited Grail’s website, which referred him to a telemedicine provider who ordered a test. Another telemedicine doctor walked him through his results, which showed a cancer signal likely emanating from the pancreas, gallbladder, stomach or esophagus.

An MRI revealed a suspicious mass on his pancreas, which a biopsy confirmed was cancerous. Mr. Royse had three months of chemotherapy, surgery and another three months of chemotherapy, which ended last February. Because pancreatic cancer often recurs, he gets CT and MRI scans every three months. In addition, he has signed up for startup Natera’s Signatera customized blood test, which checks DNA specific to the patient’s cancer and can signal its return before signs are visible on the scans

Grail’s test likewise looks for DNA shed by cancer cells, which is tagged by molecules called methyl groups that are specific to a cancer’s origin. Grail uses genetic sequencing and machine learning to recognize links between DNA methyl groups and particular cancers

The test “is based on how much DNA is being shed by tumor,” Grail’s president, Josh Ofman, says. “Some tumors shed a lot of DNA. Some shed almost none.

ut slow-growing tumors typically aren’t shedding a lot of DNA.” That reduces the probability that Grail’s test will identify indolent cancers that pose no immediate danger.

Grail’s test has a roughly 0.5% false-positive rate, meaning 1 in 200 patients who don’t have cancer will get a positive signal

Its positive predictive value is 43%, so that of every 100 patients with a positive signal, 43 actually have cancer

the legislation’s price tag could reduce political support. According to one private company’s estimate, the test could cost the government $39 billion to $145 billion over a decade. Mr. Goldman counters that analysts usually overestimate the costs and underestimate the benefits of medical interventions.

Because Grail uses machine learning to detect DNA-methylation cancer linkages, the Grail test’s accuracy should improve as more tests and patient data are collected

regulators may balk at approving the test, and insurers at covering it, until it becomes cheaper and more reliable.

How would the FDA weigh the risk that a false positive on a test like Grail’s could require invasive follow-up testing against the dire but hard-to-quantify risk that a deadly cancer wouldn’t be caught until it’s much harder to treat? It’s unclear.

some experts urge the FDA to require large randomized controlled trials before approving blood cancer tests. “Multicancer screening would entail tremendous costs and potentially substantial harms,” H. Gilbert Welch and Tanujit Dey of Brigham and Women’s Hospital wrote

Dr. Welch and Mr. Dey also suggested that companies should be required to prove their tests reduce overall mortality, even though the FDA doesn’t require drugmakers to prove their products reduce deaths or extend life. Clinical trials for the mRNA Covid vaccines didn’t show they reduced deaths.

One alternative is to rely on real-world studies, which Grail is already doing. One study of patients 50 and older without signs of cancer showed that the test doubled the number of cancers detected.

One recurring problem he has seen: “Epidemiologists are always getting cancer wrong,” he says. “Epidemiologists a decade ago said U.S. overtreats cancers. Well, no, the EU undertreats cancer.”

A 2012 study that he co-authored found that the higher U.S. spending on cancer care relative to Europe between 1983 and 1999 resulted in significantly higher survival rates for American patients than for those in Europe

By his study’s calculation, U.S. spending on cancer treatments during that period resulted in $556 billion in net benefits owing to reduced mortality.

He expects Galleri and other multicancer early-detection tests to reduce deaths and produce public-health and economic benefits that exceed their monetary costs

Expanding access to multicancer early-detection tests could also help solve the chicken-and-egg problem of drug development. Because few patients are diagnosed at early stages of some cancers, it’s hard to develop treatments for them

the positive predictive value for some recommended cancer screenings is far lower. Fewer than 1 in 10 women with an abnormal finding on a mammogram are diagnosed with breast cancer.

Mr. Royse makes the same point with personal force. “I would be dead right now if not for multicancer early-detection testing,” Mr. Royse told an FDA advisory committee last fall. “The longer the FDA waits, the more people are going to die. It’s that simple.”

Researchers call this effect “the liar’s dividend,” and politicians have already tried to cast off unfavorable clips as AI-generated: Last month, Donald Trump falsely claimed that an attack ad had used AI to make him look bad.

“Deepfake” could become the “fake news” of 2024, an infrequent but genuine phenomenon that gets co-opted as a means of discrediting the truth

Steve Bannon’s infamous assertion that the way to discredit the media is to “flood the zone with shit.”

AI is less likely to create new dynamics than to amplify existing ones. Presidential campaigns, with their bottomless coffers and sprawling staff, have long had the ability to target specific groups of voters with tailored messaging

They might have thousands of data points about who you are, obtained by gathering information from public records, social-media profiles, and commercial brokers

“It is now so cheap to engage in this mass personalization,” Laura Edelson, a computer-science professor at Northeastern University who studies misinformation and disinformation, told me. “It’s going to make this content easier to create, cheaper to create, and put more communities within the reach of it.”

That sheer ease could overwhelm democracies’ already-vulnerable election infrastructure. Local- and state-election workers have been under attack since 2020, and AI could make things worse.

Those officials have also expressed the worry, he said, that generative AI will turbocharge the harassment they face, by making the act of writing and sending hate mail virtually effortless. (The consequences may be particularly severe for women.)

past attacks—most notably the Russian hack of John Podesta’s email, in 2016—have wrought utter havoc. But now pretty much anyone—whatever language they speak and whatever their writing ability—can send out hundreds of phishing emails in fluent English prose. “The cybersecurity implications of AI for elections and electoral integrity probably aren’t getting nearly the focus that they should,”

Just last week, AI-generated audio surfaced of one Harlem politician criticizing another. New York City has perhaps the most robust local-news ecosystem of any city in America, but elsewhere, in communities without the media scrutiny and fact-checking apparatuses that exist at the national level, audio like this could cause greater chaos.

In countries that speak languages with less online text for LLMs to gobble up, AI tools may be less sophisticated. But those same countries are likely the ones where tech platforms will pay the least attention to the spread of deepfakes and other disinformation, Edelson told me. India, Russia, the U.S., the EU—this is where platforms will focus. “Everything else”—Namibia, Uzbekistan, Uruguay—“is going to be an afterthought,”

Most of us tend to fret about the potential fake video that deceives half of the nation, not about the flood of FOIA requests already burying election officials. If there is a cost to that way of thinking, the world may pay it this year at the polls.

The alarm is growing louder, but the German public remains unconvinced that the security of Germany and Europe has been fundamentally threatened by a newly aggressive Russia.

Mr. Pistorius’s status as one of the country’s most popular politicians has given him a freedom to speak that others — including his boss, Chancellor Olaf Scholz — do not enjoy.

The prospect of a re-elected Mr. Trump has German officials and many of their fellow NATO counterparts informally discussing whether the nearly 75-year-old alliance structure they are planning to celebrate in Washington this year can survive without the United States at its center. Many German officials say that Mr. Putin’s best strategic hope is NATO’s fracture.

Only a year ago NATO was celebrating a new sense of purpose and a new unity, and many were confidently predicting Mr. Putin was on the run.

now, with an undependable America, an aggressive Russia and a striving China, as well as a seemingly stalemated war in Ukraine and a deeply unpopular conflict in Gaza, German officials are beginning to talk about the emergence of a new, complicated and troubling world, with severe consequences for European and trans-Atlantic security.

“Nobody knows how or whether this will last,” Mr. Pistorius said of the current war, arguing for a rapid buildup in the size of the German military and a restocking of its arsenal.

“If Ukraine were forced to surrender, that would not satisfy Russia’s hunger for power,” the chief of Germany’s intelligence service, Bruno Kahl, said last week. “If the West does not demonstrate a clear readiness to defend, Putin will have no reason not to attack NATO anymore.”

In the decades since the Soviet Union collapsed, most Germans have grown accustomed to the notions that the country’s security would be assured if it worked with Russia, not against it, and that China is a necessary partner with a critical market for German automobiles and equipment.

Mr. Scholz, a Social Democrat whose party traditionally sought decent ties with Moscow, seems reluctant to discuss the far more confrontational future with Russia or China that German defense and intelligence chiefs describe so vividly.

few politicians will take on the subject in public. Mr. Scholz is especially careful, tending to Germany’s relationship with the United States and wary of pushing Russia and its unpredictable president too hard.

Polls show that Germans want to see a more capable German military. But only 38 percent of those surveyed said they wanted their country to be more involved in international crises, the lowest figure since that question began to be asked in 2017, according to the Körber Foundation, which conducted the survey. Of that group, 76 percent said the engagement should be primarily diplomatic, and 71 percent were against a military leadership role for Germany in Europe.

The most vivid example of his caution is his continued refusal to provide Ukraine a long-range, air-launched cruise missile called the Taurus.

The Taurus has a range of more than 300 miles, meaning Ukraine could use it to strike deep into Russia. And Mr. Scholz is not willing to take that chance — nor is the country’s Bundestag, which voted against a resolution calling for the transfer. While the decision seems to fit German opinion, Mr. Scholz wants to avoid the subject.

Mr. Scholz has moved with great caution. He has opposed — along with Mr. Biden — setting a timetable for Ukraine’s eventual entry into the alliance

German military officials recently set off a small outcry when they suggested that the country must be “kriegstüchtig,” which roughly translates to the ability to fight and win a war.

Norbert Röttgen, an opposition legislator and a foreign policy expert with the Christian Democrats, said the term was regarded as “rhetorical overreach” and quickly dropped.

“Scholz has always said that ‘Ukraine must not lose but Russia must not win,’ which indicated that he’s always thought of an impasse that would lead to a diplomatic process,” Mr. Röttgen said. “He thinks of Russia as more important than all the countries between us and them, and he lacks a European sense and of his possible role as a European leader.”

Mr. Scholz clearly feels most comfortable relying heavily on Washington, and senior German officials say he especially mistrusts Emmanuel Macron, the president of France, who has argued for European “strategic autonomy.” Mr. Macron has found few followers on the continent.

Even Mr. Scholz’s main European defense initiative, a coordinated ground-based air defense against ballistic missiles known as Sky Shield, depends on a mix of American, American-Israeli and German missile systems.

Mr. Scholz’s ambitions are also hamstrung by his increasingly weak economy. It shrank 0.3 percent last year, and roughly the same is expected in 2024. The cost of the Ukraine war and China’s economic problems — which have hit the auto and manufacturing sectors hardest — have exacerbated the problem.

While Mr. Scholz acknowledges that the world has changed, “he is not saying that we must change with it,” said Ulrich Speck, a German analyst.

“He is saying that the world has changed and that we will protect you,”

Germans, and even the Social Democrats, “have come to the realization that Germany lives in the real world and that hard power matters,”

“At the same time,” he said, “there’s still this hope that this is all just a bad dream, and Germans will wake up and be back in the old world.”

Two sources said that during the early weeks of the war they were permitted to kill 15 or 20 civilians during airstrikes on low-ranking militants. Attacks on such targets were typically carried out using unguided munitions known as “dumb bombs”, the sources said, destroying entire homes and killing all their occupants.

“You don’t want to waste expensive bombs on unimportant people – it’s very expensive for the country and there’s a shortage [of those bombs],” one intelligence officer said. Another said the principal question they were faced with was whether the “collateral damage” to civilians allowed for an attack.

“Because we usually carried out the attacks with dumb bombs, and that meant literally dropping the whole house on its occupants. But even if an attack is averted, you don’t care – you immediately move on to the next target. Because of the system, the targets never end. You have another 36,000 waiting.”

ccording to conflict experts, if Israel has been using dumb bombs to flatten the homes of thousands of Palestinians who were linked, with the assistance of AI, to militant groups in Gaza, that could help explain the shockingly high death toll in the war.

Details about the specific kinds of data used to train Lavender’s algorithm, or how the programme reached its conclusions, are not included in the accounts published by +972 or Local Call. However, the sources said that during the first few weeks of the war, Unit 8200 refined Lavender’s algorithm and tweaked its search parameters.

Responding to the publication of the testimonies in +972 and Local Call, the IDF said in a statement that its operations were carried out in accordance with the rules of proportionality under international law. It said dumb bombs are “standard weaponry” that are used by IDF pilots in a manner that ensures “a high level of precision”.

“The IDF does not use an artificial intelligence system that identifies terrorist operatives or tries to predict whether a person is a terrorist,” it added. “Information systems are merely tools for analysts in the target identification process.”

In earlier military operations conducted by the IDF, producing human targets was often a more labour-intensive process. Multiple sources who described target development in previous wars to the Guardian, said the decision to “incriminate” an individual, or identify them as a legitimate target, would be discussed and then signed off by a legal adviser.

n the weeks and months after 7 October, this model for approving strikes on human targets was dramatically accelerated, according to the sources. As the IDF’s bombardment of Gaza intensified, they said, commanders demanded a continuous pipeline of targets.

“We were constantly being pressured: ‘Bring us more targets.’ They really shouted at us,” said one intelligence officer. “We were told: now we have to fuck up Hamas, no matter what the cost. Whatever you can, you bomb.”

Lavender was developed by the Israel Defense Forces’ elite intelligence division, Unit 8200, which is comparable to the US’s National Security Agency or GCHQ in the UK.

After randomly sampling and cross-checking its predictions, the unit concluded Lavender had achieved a 90% accuracy rate, the sources said, leading the IDF to approve its sweeping use as a target recommendation tool.

Lavender created a database of tens of thousands of individuals who were marked as predominantly low-ranking members of Hamas’s military wing, they added. This was used alongside another AI-based decision support system, called the Gospel, which recommended buildings and structures as targets rather than individuals.

The accounts include first-hand testimony of how intelligence officers worked with Lavender and how the reach of its dragnet could be adjusted. “At its peak, the system managed to generate 37,000 people as potential human targets,” one of the sources said. “But the numbers changed all the time, because it depends on where you set the bar of what a Hamas operative is.”

broadly, and then the machine started bringing us all kinds of civil defence personnel, police officers, on whom it would be a shame to waste bombs. They help the Hamas government, but they don’t really endanger soldiers.”

Before the war, US and Israeli estimated membership of Hamas’s military wing at approximately 25-30,000 people.

there was a decision to treat Palestinian men linked to Hamas’s military wing as potential targets, regardless of their rank or importance.

According to +972 and Local Call, the IDF judged it permissible to kill more than 100 civilians in attacks on a top-ranking Hamas officials. “We had a calculation for how many [civilians could be killed] for the brigade commander, how many [civilians] for a battalion commander, and so on,” one source said.

Another source, who justified the use of Lavender to help identify low-ranking targets, said that “when it comes to a junior militant, you don’t want to invest manpower and time in it”. They said that in wartime there was insufficient time to carefully “incriminate every target”

So you’re willing to take the margin of error of using artificial intelligence, risking collateral damage and civilians dying, and risking attacking by mistake, and to live with it,” they added.

When it came to targeting low-ranking Hamas and PIJ suspects, they said, the preference was to attack when they were believed to be at home. “We were not interested in killing [Hamas] operatives only when they were in a military building or engaged in a military activity,” one said. “It’s much easier to bomb a family’s home. The system is built to look for them in these situations.”

Such a strategy risked higher numbers of civilian casualties, and the sources said the IDF imposed pre-authorised limits on the number of civilians it deemed acceptable to kill in a strike aimed at a single Hamas militant. The ratio was said to have changed over time, and varied according to the seniority of the target.

The IDF’s targeting processes in the most intensive phase of the bombardment were also relaxed, they said. “There was a completely permissive policy regarding the casualties of [bombing] operations,” one source said. “A policy so permissive that in my opinion it had an element of revenge.”

“There were regulations, but they were just very lenient,” another added. “We’ve killed people with collateral damage in the high double digits, if not low triple digits. These are things that haven’t happened before.” There appears to have been significant fluctuations in the figure that military commanders would tolerate at different stages of the war

One source said that the limit on permitted civilian casualties “went up and down” over time, and at one point was as low as five. During the first week of the conflict, the source said, permission was given to kill 15 non-combatants to take out junior militants in Gaza

at one stage earlier in the war they were authorised to kill up to “20 uninvolved civilians” for a single operative, regardless of their rank, military importance, or age.

“It’s not just that you can kill any person who is a Hamas soldier, which is clearly permitted and legitimate in terms of international law,” they said. “But they directly tell you: ‘You are allowed to kill them along with many civilians.’ … In practice, the proportionality criterion did not exist.”

Experts in international humanitarian law who spoke to the Guardian expressed alarm at accounts of the IDF accepting and pre-authorising collateral damage ratios as high as 20 civilians, particularly for lower-ranking militants. They said militaries must assess proportionality for each individual strike.

An international law expert at the US state department said they had “never remotely heard of a one to 15 ratio being deemed acceptable, especially for lower-level combatants. There’s a lot of leeway, but that strikes me as extreme”.

Sarah Harrison, a former lawyer at the US Department of Defense, now an analyst at Crisis Group, said: “While there may be certain occasions where 15 collateral civilian deaths could be proportionate, there are other times where it definitely wouldn’t be. You can’t just set a tolerable number for a category of targets and say that it’ll be lawfully proportionate in each case.”

Whatever the legal or moral justification for Israel’s bombing strategy, some of its intelligence officers appear now to be questioning the approach set by their commanders. “No one thought about what to do afterward, when the war is over, or how it will be possible to live in Gaza,” one said.

Another said that after the 7 October attacks by Hamas, the atmosphere in the IDF was “painful and vindictive”. “There was a dissonance: on the one hand, people here were frustrated that we were not attacking enough. On the other hand, you see at the end of the day that another thousand Gazans have died, most of them civilians.”