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Recent experiments suggest that XBB paid a steep price for its power to evade immunity. The mutations allow it to escape antibodies by altering the shape of the protein, called spike, that covers its surface. But some of those mutations also make it harder for XBB spike proteins to grab tightly to cells — the first step required for an infection.

That loose grip may have lessened XBB’s advantage against other forms of the virus. In late 2022, it jostled alongside a number of other Omicron subvariants. In Singapore, XBB caused a surge in October, for example, while remaining rare in many other parts of the world.

As XBB multiplied, it continued to mutate into new forms. The earliest samples of XBB.1.5 were isolated in October in New York. The new subvariant gained one crucial mutation, known as F486P.

Yunlong Cao of Peking University and his colleagues tested out XBB.1.5 in dishes of cells, comparing how it fared against earlier forms of XBB. The researchers found that the F486P mutation allowed XBB.1.5 to grab tightly to cells again. But the new subvariant could still evade antibodies as well as earlier forms of XBB.

In Connecticut, for example, Nathan Grubaugh at Yale University and his colleagues found that by mid-December, other Omicron subvariants were falling. Only XBB.1.5 cases were growing. Dr. Grubaugh estimates that it is about 20 percent more transmissible than BQ.1, which had been the dominant form.

How severe XBB.1.5 infections are compared with other forms of the coronavirus is not yet clear. “It’s serious,” Dr. Grubaugh said. “I just don’t necessarily know if it’s really more serious than some of the other Omicron lineages in terms of the overall impact.”

XBB.1.5 has already spread to other countries, and is growing rapidly in Germany, Denmark and elsewhere in Europe

Scientists are already scanning new sequences being uploaded to an international database called GISAID in the hopes of spotting an upgraded version of XBB.1.5. But their job is getting harder because governments are pulling back on sequencing efforts. “Worldwide, sequencing has taken a real hit,” Dr. Peacock said.

The United States, which once lagged behind other nations, has managed to maintain a fairly strong sequencing effort. Without it, Dr. Peacock said, XBB.1.5 might have stayed below the radar for much longer. If XBB.1.5’s next generation is evolving somewhere with little sequencing, it may go undetected for some time to come.

Dr. Lemieux said that paring back on sequencing was a mistake, given how many infections and deaths the virus is still causing. “This is a part of public health,” he said.

Authoritarian governments have created seemingly realistic news broadcasters to advance their political goals

Experts fear the technology could hasten an erosion of trust in media, in government and in society. If any image can be manufactured — and manipulated — how can we believe anything we see?

“The tools are going to get better, they’re going to get cheaper, and there will come a day when nothing you see on the internet can be believed,” said Wasim Khaled, chief executive of Blackbird.AI, a company that helps clients fight disinformation.

Artificial intelligence allows virtually anyone to create complex artworks, like those now on exhibit at the Gagosian art gallery in New York, or lifelike images that blur the line between what is real and what is fiction. Plug in a text description, and the technology can produce a related image — no special skills required.

Midjourney’s images, he said, were able to pass muster in facial-recognition programs that Bellingcat uses to verify identities, typically of Russians who have committed crimes or other abuses. It’s not hard to imagine governments or other nefarious actors manufacturing images to harass or discredit their enemies.

In February, Getty accused Stability AI of illegally copying more than 12 million Getty photos, along with captions and metadata, to train the software behind its Stable Diffusion tool. In its lawsuit, Getty argued that Stable Diffusion diluted the value of the Getty watermark by incorporating it into images that ranged “from the bizarre to the grotesque.”

Getty’s lawsuit reflects concerns raised by many individual artists — that A.I. companies are becoming a competitive threat by copying content they do not have permission to use.

Trademark violations have also become a concern: Artificially generated images have replicated NBC’s peacock logo, though with unintelligible letters, and shown Coca-Cola’s familiar curvy logo with extra O’s looped into the name.

The threat to photographers is fast outpacing the development of legal protections, said Mickey H. Osterreicher, general counsel for the National Press Photographers Association

Newsrooms will increasingly struggle to authenticate conten

Social media users are ignoring labels that clearly identify images as artificially generated, choosing to believe they are real photographs, he said.

The video explained that the deepfake had been created, with Ms. Schick’s consent, by the Dutch company Revel.ai and Truepic, a California company that is exploring broader digital content verification

The companies described their video, which features a stamp identifying it as computer-generated, as the “first digitally transparent deepfake.” The data is cryptographically sealed into the file; tampering with the image breaks the digital signature and prevents the credentials from appearing when using trusted software.

The companies hope the badge, which will come with a fee for commercial clients, will be adopted by other content creators to help create a standard of trust involving A.I. images.

“The scale of this problem is going to accelerate so rapidly that it’s going to drive consumer education very quickly,” said Jeff McGregor, chief executive of Truepic

Adobe unveiled its own image-generating product, Firefly, which will be trained using only images that were licensed or from its own stock or no longer under copyright. Dana Rao, the company’s chief trust officer, said on its website that the tool would automatically add content credentials — “like a nutrition label for imaging” — that identified how an image had been made. Adobe said it also planned to compensate contributors.

Three years since its start we are still more likely to see the pandemic in partisan rather than world-historical terms. And the grandly tragic story of the pandemic takes on a profoundly different shape and color depending on the nature of its first act.

In a world where a natural origin was confirmed beyond all doubt, we might look back and narrate the pandemic as one particular kind of story: a morality tale showcasing the incomplete triumph of modern civilization and the enduring threats from nature, and highlighting the way that, whatever we might have told ourselves in 2019 or 2009 about the fortress of the wealthy world, pandemic disease remained a humbling civilization-scale challenge no nation had very good answers for.

in a world where a lab-leak origin had been confirmed instead, we would probably find ourselves telling a very different set of stories — primarily about humanity’s Icarian hubris, or perhaps about scientists’ Faustian indifference to the downside risks of new research, or the way in which very human impulses to cover up mistakes and wrongdoing might have compounded those mistakes to disastrous global effect.

It would have been, “We brought this on ourselves.” Or perhaps, if we were feeling xenophobic rather than humbly human, “They brought this on us,”

the pandemic would probably have joined nuclear weapons as a conventional illustration of the dark side of human knowledge, perhaps even surpassed them — 20 million dead is nothing to trifle with, after all, though it remains less than the overall death toll of World War II or even the Great Leap Forward.

the horror would also offer a silver lining: If human action was responsible for this pandemic, then in theory, human action could prevent the next one as well.

It is as though we’ve decided both that the pandemic was “man-made” and that its emergence was a kind of inevitability we can’t do much about.

if the figures are even mostly reliable, they reflect a remarkable indifference on the part of the country to the source of a once-in-a-century disease disaster

a definitive confirmation of a lab origin probably would not mean that responsibility lay in any simplistic way with China. But that isn’t to say the case wouldn’t have been made, probably in a variety of forms — calls for “reparations,” demands for global provision of free vaccines — that would only have contributed additional antagonism and resentment to the world stage, further polarizing the great-power landscape.

It would be as though following a catastrophic earthquake, we didn’t bother to sort out whether it had been caused by local fracking but instead argued endlessly about the imperfections of disaster response

as we piece together a working history of the past few years, you might hope we’d grow more focused on nailing the story down.

it seems likely to me that in the very earliest days of 2020, with cases exploding in China but not yet elsewhere, knowing that the disease was a result of gain-of-function research and had escaped from a lab probably would have produced an even more significant wave of global fear

it is hard to think “superbug” and not panic.

presumably, many fewer people contemplating the initial news would’ve assumed that the outbreak would be largely limited to Asia, as previous outbreaks had been; public health messengers in places like the United States probably would not have so casually reassuring; and even more dramatic circuit-breaking responses like a monthlong international travel ban might’ve been instituted quite quickly

As the pandemic wore on, I suspect that effect would have lingered beyond the initial panic. At first, it might’ve been harder to decide that the virus was just something to live with if we knew simultaneously that it was something introduced to the world in error.

And later, when the vaccines arrived, I suspect there might have been considerably less resistance to them, particularly on the American right, where anxiety and xenophobia might have trumped public-health skepticism and legacy anti-vaccine sentiment

the opposite counterfactual is just as illuminating

The question and its unresolvability have mattered enormously for geopolitics,

n a world where neither narrative has been confirmed, and where pandemic origins are governed by an epistemological fog, I worry we have begun to collate the two stories in a somewhat paradoxical and self-defeating way

The disease and global response may well have accelerated our “new Cold War,” as Luce writes, but it is hard to imagine an alternate history where a known lab-leak origin didn’t move the world there much faster.

On the other hand, the natural logic of a confirmed zoonotic origin would probably have been to push nations of the world closer together into networks of collaboration and cooperation

the direction of change would have most likely been toward more integration rather than less. After all, this is to some degree what happened in the wake of the initial outbreaks of SARS and MERS and the Ebola outbreaks of the past decade.

Instead, the geopolitics remain unsteady, which is to say, a bit jagged

The United States can weaponize a narrative about lab origin — as China hawks in both the Trump and Biden administrations have repeatedly done — without worrying too much about providing real proof or suffering concrete backlash.

And China can stonewall origin investigations by citing sovereignty rights and a smoke screen story about the disease originating in frozen food shipped in from abroad without paying much of an international price for the intransigence or bad-faith argumentation, either.

each has carried forward a gripe that needn’t be substantiated in order to be deployed.

ambiguity also offers plausible deniability, which means that without considerably more Chinese transparency and cooperation, those pushing both stories will find themselves still making only probabilistic cases. We’re probably going to be living with that uncertainty, in a political and social world shaped by it, for the foreseeable future

consider extreme poverty. It too has reached a record low, affecting a bit more than 8 percent of humans worldwide,

All these figures are rough, but it seems that about 100,000 people are now emerging from extreme poverty each day — so they are better able to access clean water, to feed and educate their children, to buy medicines.

If we want to tackle problems — from the war in Gaza to climate change — then it helps to know that progress is possible.

Two horrifying diseases are close to eradication: polio and Guinea worm disease. Only 12 cases of wild poliovirus have been reported worldwide in 2023 (there were also small numbers of vaccine-derived polio, a secondary problem), and 2024 may be the last year in which wild polio is transmitted

Meanwhile, only 11 cases of Guinea worm disease were reported in humans in the first nine months of 2023.

the United States government recently approved new CRISPR gene-editing techniques to treat sickle cell disease — and the hope is that similar approaches can transform the treatment of cancer and other ailments

Another landmark: New vaccines have been approved for R.S.V. and malaria

Blinding trachoma is also on its way out in several countries. A woman suffering from trachoma in Mali once told me that the worst part of the disease wasn’t the blindness but rather the excruciating pain, which she said was as bad as childbirth but lasted for years. So I’m thrilled that Mali and 16 other countries have eliminated trachoma.

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.

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.

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

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.”

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

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:

“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.”

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.

Ordinary people do not fret over the reality of tables or chairs or billiard balls. They do, however, wonder if ideas like freedom and justice are merely fantasies. Kant’s main goal was to show they are not.

In fact Kant was driven by a question that still plagues us: Are ideas like freedom and justice utopian daydreams, or are they more substantial? Their reality can’t be proven like that of material objects, for those ideas make entirely different claims on us — and some people are completely impervious to their claims.

Could philosophy show that acting morally, if not particularly common, is at least possible?

Kant always emphasized the limits of our knowledge, and none of us know if we would crumble when faced with death or torture. Most of us probably would. But all of us know what we should do in such a case, and we know that we could.

This experiment shows we are radically free. Not pleasure but justice can move human beings to deeds that overcome the deepest of animal desires, the love of life.

We want to determine the world, not only to be determined by it. We are born and we die as part of nature, but we feel most alive when we go beyond it: To be human is to refuse to accept the world we are given.

At the heart of Kant’s metaphysics stands the difference between the way the world is and the way the world ought to be.

But if we long, in our best moments, for the dignity of freedom and justice, Kant’s example has political consequences. It’s no surprise he thought the French Revolution confirmed our hopes for moral progress — unlike the followers of his predecessor David Hum

who thought it was dangerous to stray from tradition and habit.

This provides an answer to contemporary critics whose reading of Kant’s work focuses on the ways in which it violates our understanding of racism and sexism. Some of his remarks are undeniably offensive to 21st-century ears. But it’s fatal to forget that his work gave us the tools to fight racism and sexism, by providing the metaphysical basis of every claim to human rights.

Kant argued that each human being must be treated as an end and not as a means — which is why he called colonialism “evil” and congratulated the Chinese and Japanese for denying entry to European invaders. Contemporary dismissals of Enlightenment thinkers forget that those thinkers invented the concept of Eurocentrism, and urged their readers to consider the world from non-European perspectives

At a time when the advice to “be realistic” is best translated as the advice to decrease your expectations, Kant’s work asks deep questions about what reality is

He insisted that when we think morally, we should abstract from the cultural differences that divide us and recognize the potential human dignity in every human being.

This requires the use of our reason. Contrary to trendy views that see reason as an instrument of domination, Kant saw reason’s potential as a tool for liberation.

Should we discard Kant’s commitment to universalism because he did not fully realize it himself — or rather celebrate the fact that we can make moral progress, an idea which Kant would wholeheartedly applaud?

In Germany, it’s now common to hear that the Enlightenment was at very best ambivalent: While it may have been an age of reason, it was also an age of slavery and colonialism.

many contemporary intellectuals from formerly colonized countries reject those arguments. Thinkers like the Ghanaian Ato Sekyi-Otu, the Nigerian Olufemi Taiwo, the Chilean Carlos Peña, the Brazilian Francisco Bosco or the Indian Benjamin Zachariah are hardly inclined to renounce Enlightenment ideas as Eurocentric.

The problem with ideas like universal human rights is not that they come from Europe, but that they were not realized outside of it. Perhaps we should take a lesson from the Enlightenment and listen to non-Western standpoints?

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

Parents need to know that when children go online, they are entering a world of influencers, many of whom are hoping to make money by pushing dangerous products. It’s a world that’s invisible to us

when we log on to our social media, we don’t see what they see. Thanks to algorithms and ad targeting, I see videos about the best lawn fertilizer and wrinkle laser masks, while Ian is being fed reviews of flavored vape pens and beautiful women livestreaming themselves gambling crypto and urging him to gamble, too.

Smartphones are taking our kids to a different world

Greyson Imm, an 18-year-old high school student in Prairie Village, Kan., said he was 17 when Zyn videos started appearing on his TikTok feed. The videos multiplied through the spring, when they were appearing almost daily. “Nobody had heard about Zyn until very early 2023,” he said. Now, a “lot of high schoolers have been using Zyn. It’s really taken off, at least in our community.”

all of this is, unfortunately, only part of what makes social media dangerous.

The tobacco conglomerate Philip Morris International acquired the Zyn maker Swedish Match in 2022 as part of a strategic push into smokeless products, a category it projects could help drive an expected $2 billion in U.S. revenue in 2024.

P.M.I. is also a company that has long denied it markets tobacco products to minors despite decades of research accusing it of just that. One 2022 study alone found its brands advertising near schools and playgrounds around the globe.

the ’90s, when magazines ran full-page Absolut Vodka ads in different colors, which my friends and I collected and taped up on our walls next to pictures of a young Leonardo DiCaprio — until our parents tore them down. This was advertising that appealed to me as a teenager but was also visible to my parents, and — crucially — to regulators, who could point to billboards near schools or flavored vodka ads in fashion magazines and say, this is wrong.

Even the most committed parent today doesn’t have the same visibility into what her children are seeing online, so it is worth explaining how products like Zyn end up in social feeds

influencers. They aren’t traditional pitch people. Think of them more like the coolest kids on the block. They establish a following thanks to their personality, experience or expertise. They share how they’re feeling, they share what they’re thinking about, they share stuff they l

With ruthless efficiency, social media can deliver unlimited amounts of the content that influencers create or inspire. That makes the combination of influencers and social-media algorithms perhaps the most powerful form of advertising ever invented.

Videos like his operate like a meme: It’s unintelligible to the uninitiated, it’s a hilarious inside joke to those who know, and it encourages the audience to spread the message

Enter Tucker Carlson. Mr. Carlson, the former Fox News megastar who recently started his own subscription streaming service, has become a big Zyn influencer. He’s mentioned his love of Zyn in enough podcasts and interviews to earn the nickname Tucker CarlZyn.

was Max VanderAarde. You can glimpse him in a video from the event wearing a Santa hat and toasting Mr. Carlson as they each pop Zyns in their mouths. “You can call me king of Zynbabwe, or Tucker CarlZyn’s cousin,” he says in a recent TikTok. “Probably, what, moved 30 mil cans last year?”

Freezer Tarps, Mr. VanderAarde’s TikTok account, appears to have been removed after I asked the company about it. Left up are the large number of TikToks by the likes of @lifeofaZyn, @Zynfluencer1 and @Zyntakeover; those hashtagged to #Zynbabwe, one of Freezer Tarps’s favorite terms, have amassed more than 67 million views. So it’s worth breaking down Mr. VanderAarde’s videos.

All of these videos would just be jokes (in poor taste) if they were seen by adults only. They aren’t. But we can’t know for sure how many children follow the Nelk Boys or Freezer Tarps — social-media companies generally don’t release granular age-related data to the public. Mr. VanderAarde, who responded to a few of my questions via LinkedIn, said that nearly 95 percent of his followers are over the age of 18.

They’re incentivized to increase their following and, in turn, often their bank accounts. Young people are particularly susceptible to this kind of promotion because their relationship with influencers is akin to the intimacy of a close friend.

The helicopter video has already been viewed more than one million times on YouTube, and iterations of it have circulated widely on TikTok.

YouTube said it eventually determined that four versions of the Carlson Zyn videos were not appropriate for viewers under age 18 under its community guidelines and restricted access to them by age

Mr. Carlson declined to comment on the record beyond his two-word statement. The Nelk Boys didn’t respond to requests for comment. Meta declined to comment on the record. TikTok said it does not allow content that promotes tobacco or its alternatives. The company said that it has over 40,000 trust and safety experts who work to keep the platform safe and that it prevented teenagers’ accounts from viewing over two million videos globally that show the consumption of tobacco products by adults. TikTok added that in the third quarter of 2023 it proactively removed 97 percent of videos that violated its alcohol, tobacco and drugs policy.

Greyson Imm, the high school student in Prairie Village, Kan., points to Mr. VanderAarde as having brought Zyn “more into the mainstream.” Mr. Imm believes his interest in independent comedy on TikTok perhaps made him a target for Mr. VanderAarde’s videos. “He would create all these funny phrases or things that would make it funny and joke about it and make it relevant to us.”

It wasn’t long before Mr. Imm noticed Zyn blowing up among his classmates — so much so that the student, now a senior at Shawnee Mission East High School, decided to write a piece in his school newspaper about it. He conducted an Instagram poll from the newspaper’s account and found that 23 percent of the students who responded used oral nicotine pouches during school.

“Upper-decky lip cushions, ferda!” Mr. VanderAarde coos in what was one of his popular TikTok videos, which had been liked more than 40,000 times. The singsong audio sounds like gibberish to most people, but it’s actually a call to action. “Lip cushion” is a nickname for a nicotine pouch, and “ferda” is slang for “the guys.”

“I have fun posting silly content that makes fun of pop culture,” Mr. VanderAarde said to me in our LinkedIn exchange.

I turned to Influencity, a software program that estimates the ages of social media users by analyzing profile photos and selfies in recent posts. Influencity estimated that roughly 10 percent of the Nelk Boys’ followers on YouTube are ages 13 to 17. That’s more than 800,000 children.

I’ve spent the past three years studying media manipulation and memes, and what I see in Freezer Tarps’s silly content is strategy. The use of Zyn slang seems like a way to turn interest in Zyn into a meme that can be monetized through merchandise and other business opportunities.

Such as? Freezer Tarps sells his own pouch product, Upperdeckys, which delivers caffeine instead of nicotine and is available in flavors including cotton candy and orange creamsicle. In addition to jockeying for sponsorship, Mr. Carlson may also be trying to establish himself with a younger, more male, more online audience as his new media company begins building its subscriber base

This is the kind of viral word-of-mouth marketing that looks like entertainment, functions like culture and can increase sales

What’s particularly galling about all of this is that we as a society already agreed that peddling nicotine to kids is not OK. It is illegal to sell nicotine products to anyone under the age of 21 in all 50 states

numerous studies have shown that the younger people are when they try nicotine for the first time, the more likely they will become addicted to it. Nearly 90 percent of adults who smoke daily started smoking before they turned 18.

Decades later — even after Juul showed the power of influencers to help addict yet another generation of children — the courts, tech companies and regulators still haven’t adequately grappled with the complexities of the influencer economy.

Facebook, Instagram and TikTok all have guidelines that prohibit tobacco ads and sponsored, endorsed or partnership-based content that promotes tobacco products. Holding them accountable for maintaining those standards is a bigger question.

We need a new definition of advertising that takes into account how the internet actually works. I’d go so far as to propose that the courts broaden the definition of advertising to include all influencer promotion. For a product as dangerous as nicotine, I’d put the bar to be considered an influencer as low as 1,000 followers on a social-media account, and maybe if a video from someone with less of a following goes viral under certain legal definitions, it would become influencer promotion.

Laws should require tech companies to share data on what young people are seeing on social media and to prevent any content promoting age-gated products from reaching children’s feeds

hose efforts must go hand in hand with social media companies putting real teeth behind their efforts to verify the ages of their users. Government agencies should enforce the rules already on the books to protect children from exposure to addictive products,

I refuse to believe there aren’t ways to write laws and regulations that can address these difficult questions over tech company liability and free speech, that there aren’t ways to hold platforms more accountable for advertising that might endanger kids. Let’s stop treating the internet like a monster we can’t control. We built it. We foisted it upon our children. We had better try to protect them from its potential harms as best we can.

Since 2016, there have been two competing visions for the Democratic Party. One is the promise that began with Barack Obama of a multiracial coalition that would grow stronger as America’s demographics shifted; the other is the political revolution championed by Bernie Sanders as a way to unite nonvoters with the working class

Ms. Ocasio-Cortez bridges the gap between the two

what’s clear is that at a time when Democrats are struggling, she is quietly laying the groundwork to build a coalition broader than the one she came to power with, unafraid to take risks along the way.

After five years in Congress, she has emerged as a tested navigator of its byzantine systems, wielding her celebrity to further her political aims in a way few others have.

Three terms in, one gets the sense that we’re witnessing a skilled tactician exiting her political adolescence and coming into her own as a veteran operator out to reform America’s most dysfunctional political body.

To grasp what sets Ms. Ocasio-Cortez apart from many of her colleagues, you have to understand where she finds allies

In 2019, she and Senator Ted Cruz of Texas considered joining forces to write a bill that would bar former members of Congress from becoming lobbyists. Asked why she would consider an alliance with someone so loathed by liberals, she said, “I will swallow all of my distaste in this situation because we have found a common interest.”

It was a window into the politician she would become: pragmatic and results-driven, willing to work with people she considers her political adversaries, at least on legislation that appeals to her base

She has attributed the success of these efforts at least in part to her role as the second most powerful Democrat on the House Oversight Committee, which she said has “opened many windows” for collaboration.

while these bills may seem like small victories, they are more than that because, in a sense, she is redefining what bipartisanship looks like in Washington.

For decades, bipartisanship has meant bringing together moderates, lobbyists and establishment insiders to produce watered-down legislation unpalatable to many voters in both political partie

What Ms. Ocasio-Cortez is doing is different; she’s uniting politicians on the fringes of American politics around a broadly popular set of policies.

Americans in both parties overwhelmingly say that they don’t trust the government to do the right thing and that donors and lobbyists have too much sway over the legislative process.

more than 8 in 10 Americans believe politicians “are more focused on fighting each other than on solving problems.” One-fifth of respondents said lack of bipartisan cooperation was the biggest problem with the political system.

Ms. Ocasio-Cortez’s efforts to reach out to Republicans are offering what a sizable portion of Americans want from Congress: a return to getting things done.

The few policy matters on which progressives and conservatives align often boil down to a distrust of politicians and of big corporations, particularly technology companies and pharmaceutical giants.

Ms. Ocasio-Cortez has shrewdly made those causes her passion, building alliances with conservative colleagues interested in holding these industries accountable.

Last spring, she cosponsored a bill with, among others, Brian Fitzpatrick, a moderate Republican from Pennsylvania, and Matt Gaetz, the Florida rabble-rouser who has become one of Mr. Trump’s most steadfast allies. The legislation would bar members of Congress from trading individual stocks, a measure that as of the fall of 2022 was supported by nearly 70 percent of voters across party lines.

On Gaza, too, she has been willing to buck other members of her party to pursue an agenda that a majority of voters support. She was one of the first Democrats to call for a cease-fire; within weeks, nearly 70 percent of Americans said Israel should call one and try to negotiate with Hamas.

In March, Ms. Ocasio-Cortez was accosted by a handful of protesters who demanded that she call Israel’s war in Gaza a genocide.

Less than three weeks later, Ms. Ocasio-Cortez did accuse Israel of genocide and chastised the White House for providing military aid to the country while it blockaded Gaza. “If you want to know what an unfolding genocide looks like,” Ms. Ocasio-Cortez said in a speech on the House floor, “open your eyes. It looks like the forced famine of 1.1 million innocents. It looks like thousands of children eating grass as their bodies consume themselves, while trucks of food are slowed and halted just miles away.”

Last month, she voted against providing additional funding for Israel. Those were unpopular positions in Congress, where unconditional support for the country remains the norm, but they put her in line with a majority of Democratic voters.

These stances haven’t been enough to quell the doubts from a faction of the left that helped get her elected. Over the past few weeks, some have accused her of caving in to pressure from moderate Democrats

. Ms. Ocasio-Cortez has taken much of the heat from leftist activists who see her as a symbol of the contradictions and compromises inherent in the political system. It may not be realistic to expect absolute purity from her; she is, after all, a politician. But these critiques overlook the promise of what she’s doing behind the scenes.

Democratic pollsters and strategists are searching for ways for Mr. Biden to win back Muslims and Arab Americans in swing states such as Michigan and Georgia, recent college graduates who hoped to have their student debt forgiven, immigrant-rights activists and Latinos.

Some of the betrayal these voters feel was hardly the president’s fault; he was hampered on student loan debt by a federal judiciary stacked with judges sympathetic to conservative legal arguments, and Congress refused to pass the comprehensive immigration bill he supported in 2021, which would have provided legal status to as many as 11 million undocumented immigrants.

A more gifted orator might have been able to make the structural impediments in his way clear to voters, while also putting forth a proactive vision for dismantling the core problems baked into our politics.

In that, someone like Ms. Ocasio-Cortez, who endorsed Mr. Biden for re-election in 2023, may be able to help. She’s the Democratic Party’s most charismatic politician since Barack Obama and its most ardent populist since Bernie Sanders.

she can offer voters something more substantial than a hollow rebuke of Trumpism

Last month, when the journalist Mehdi Hasan asked her how she’d respond to “a young progressive or Arab American who says to you, ‘I just can’t vote for Biden again after what he’s enabled in Gaza,’” Ms. Ocasio-Cortez said a vote for Mr. Biden didn’t necessarily mean an endorsement of all his policies. “Even in places of stark disagreement, I would rather be organizing under the conditions of Biden as an opponent on an issue than Trump,” she said. It was a shrewd political maneuver, designed to distance herself from Democrats who support Israel unconditionally, while meeting voters — some of whom have lost family members in Gaza — where they are

There are, of course, limits to this strategy. Some on the left see Ms. Ocasio-Cortez’s endorsement of Mr. Biden as a betrayal of progressive values, particularly in the wake of the climbing death toll in Gaza.

The moderate Republicans who turned out for Mr. Biden in 2020 might shrink from a Democratic Party led by someone they consider an outspoken progressive.

But for every moderate or leftist voter lost with a strategy like Ms. Ocasio-Cortez’s, the Democratic Party may be able to win someone new — from the pool of disillusioned Americans who feel shut out of the political process.

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.

Dr. Longo, who is also a professor of gerontology and director of the U.S.C. Longevity Institute in California, has long advocated longer and better living through eating Lite Italian, one of a global explosion of Road to Perpetual Wellville theories about how to stay young in a field that is itself still in its adolescence.

In addition to identifying genes that regulate aging, he has created a plant and nut-based diet with supplements and kale crackers that mimics fasting to, he argues, allow cells to shed harmful baggage and rejuvenate, without the down side of actually starving.

He has patented and sold his ProLon diet kits; published best-selling books (“The Longevity Diet”); and been called an influential “Fasting Evangelist” by Time magazine.

Last month, he published a new study based on clinical trials of hundreds of older people — including in the Calabria town from which his family hails — that he said suggests that periodic cycles of his own faux-fasting approach could reduce biological age and stave off illnesses associated with aging.

“It’s very similar to the original Mediterranean diet, not the present one,” she said, pointing at photographs on the wall of a bowl of ancient legumes similar to the chickpe

“Almost nobody in Italy eats the Mediterranean diet,”

He added that many Italian children, especially in the country’s south, are obese, bloated on what he calls the poisonous five Ps — pizza, pasta, protein, potatoes and pane (or bread).

in recent years, Silicon Valley billionaires who hope to be forever young have funded secretive labs. Wellness articles have conquered newspaper home pages and Fountains-of-Youth workout and diet ads featuring insanely fit middle-aged people teem on the social media feeds of not insanely fit middle-aged people.

he said Italy’s lack of investment in research was a disgrace.

even as concepts like longevity, intermittent fasting and biological age — you’re only as old as your cells feel! — have gained momentum, governments like Italy’s are fretting over a creakier future in which booming populations of old people drain resources from the dwindling young.

many scientists, nutritionists and longevity fanatics the world over continue to stare longingly toward Italy, seeking in its deep pockets of centenarians a secret ingredient to long life.

“Probably they kept breeding between cousins and relatives,” Dr. Longo offered, referring to the sometimes close relations in little Italian hill towns. “At some point, we suspect it sort of generated the super-longevity genome.”

The genetic drawbacks of incest, he hypothesized, slowly vanished because those mutations either killed their carriers before they could reproduce or because the town noticed a monstrous ailment — like early onset Alzheimer’s — in a particular family line and steered clear.

Dr. Longo wonders whether Italy’s centenarians had been protected from later disease by a starvation period and old-fashioned Mediterranean diet early in life, during rural Italy’s abject war-era poverty. Then a boost of proteins and fats and modern medicine after Italy’s postwar economic miracle protected them from frailty as they got older and kept them alive.

At age 16, he moved to Chicago to live with relatives and couldn’t help notice that his middle-aged aunts and uncles fed on the “Chicago diet” of sausages and sugary drinks suffered diabetes and cardiovascular disease that their relatives back in Calabria did not.

He eventually earned his Ph.D in biochemistry at U.C.L.A. and did his postdoctoral training in the neurobiology of aging at U.S.C. He overcame early skepticism about the field to publish in top journals and became a zealous evangelizer for the age-reversing effects of his diet. About 10 years ago, eager to be closer to his aging parents in Genoa, he took a second job at the IFOM oncology institute in Milan.

He found a fount of inspiration in the pescatarian-heavy diet around Genoa and all the legumes down in Calabria.

he also found the modern Italian diet — the cured meats, layers of lasagna and fried vegetables the world hungered for — horrendous and a source of disease.

His private foundation, also based in Milan, tailors diets for cancer patients, but also consults for Italian companies and schools, promoting a Mediterranean diet that is actually foreign to most Italians today.

“Italy’s got such incredible history and a wealth of information about aging,” he said. “But spends virtually nothing.”

He talked about how he and others had identified an important regulator of aging in yeast, and how he has investigated whether the same pathway was at work in all organisms.

Dr. Longo said he thinks of his mission as extending youth and health, not simply putting more years on the clock, a goal he said could lead to a “scary world,” in which only the rich could afford to live for centuries, potentially forcing caps on having children

A more likely short-term scenario, he said, was division between two populations. The first would live as we do now and reach about 80 or longer through medical advancements. But Italians would be saddled with long — and, given the drop in the birthrate, potentially lonely — years burdened by horrible diseases.

The other population would follow fasting diets and scientific breakthroughs and live to 100 and perhaps 110 in relative good health.

a major extinction panic happened 100 years ago, and the similarities are unnerving.

The 1920s were also a period when the public — traumatized by a recent pandemic, a devastating world war and startling technological developments — was gripped by the conviction that humanity might soon shuffle off this mortal coil.

It also helps us see how apocalyptic fears feed off the idea that people are inherently violent, self-interested and hierarchical and that survival is a zero-sum war over resources.

Either way, it’s a cynical view that encourages us to take our demise as a foregone conclusion.

What makes an extinction panic a panic is the conviction that humanity is flawed and beyond redemption, destined to die at its own hand, the tragic hero of a terrestrial pageant for whom only one final act is possible

What the history of prior extinction panics has to teach us is that this pessimism is both politically questionable and questionably productive. Our survival will depend on our ability to recognize and reject the nihilistic appraisals of humanity that inflect our fears for the future, both left and right.

As a scholar who researches the history of Western fears about human extinction, I’m often asked how I avoid sinking into despair. My answer is always that learning about the history of extinction panics is actually liberating, even a cause for optimism

Nearly every generation has thought its generation was to be the last, and yet the human species has persisted

As a character in Jeanette Winterson’s novel “The Stone Gods” says, “History is not a suicide note — it is a record of our survival.”

Contrary to the folk wisdom that insists the years immediately after World War I were a period of good times and exuberance, dark clouds often hung over the 1920s. The dread of impending disaster — from another world war, the supposed corruption of racial purity and the prospect of automated labor — saturated the period

The previous year saw the publication of the first of several installments of what many would come to consider his finest literary achievement, “The World Crisis,” a grim retrospective of World War I that laid out, as Churchill put it, the “milestones to Armageddon.

Bluntly titled “Shall We All Commit Suicide?,” the essay offered a dismal appraisal of humanity’s prospects. “Certain somber facts emerge solid, inexorable, like the shapes of mountains from drifting mist,” Churchill wrote. “Mankind has never been in this position before. Without having improved appreciably in virtue or enjoying wiser guidance, it has got into its hands for the first time the tools by which it can unfailingly accomplish its own extermination.”

The essay — with its declaration that “the story of the human race is war” and its dismay at “the march of science unfolding ever more appalling possibilities” — is filled with right-wing pathos and holds out little hope that mankind might possess the wisdom to outrun the reaper. This fatalistic assessment was shared by many, including those well to Churchill’s left.

“Are not we and they and all the race still just as much adrift in the current of circumstances as we were before 1914?” he wondered. Wells predicted that our inability to learn from the mistakes of the Great War would “carry our race on surely and inexorably to fresh wars, to shortages, hunger, miseries and social debacles, at last either to complete extinction or to a degradation beyond our present understanding.” Humanity, the don of sci-fi correctly surmised, was rushing headlong into a “scientific war” that would “make the biggest bombs of 1918 seem like little crackers.”

The pathbreaking biologist J.B.S. Haldane, another socialist, concurred with Wells’s view of warfare’s ultimate destination. In 1925, two decades before the Trinity test birthed an atomic sun over the New Mexico desert, Haldane, who experienced bombing firsthand during World War I, mused, “If we could utilize the forces which we now know to exist inside the atom, we should have such capacities for destruction that I do not know of any agency other than divine intervention which would save humanity from complete and peremptory annihilation.”

F.C.S. Schiller, a British philosopher and eugenicist, summarized the general intellectual atmosphere of the 1920s aptly: “Our best prophets are growing very anxious about our future. They are afraid we are getting to know too much and are likely to use our knowledge to commit suicide.”

Many of the same fears that keep A.I. engineers up at night — calibrating thinking machines to human values, concern that our growing reliance on technology might sap human ingenuity and even trepidation about a robot takeover — made their debut in the early 20th century.

The popular detective novelist R. Austin Freeman’s 1921 political treatise, “Social Decay and Regeneration,” warned that our reliance on new technologies was driving our species toward degradation and even annihilation

Extinction panics are, in both the literal and the vernacular senses, reactionary, animated by the elite’s anxiety about maintaining its privilege in the midst of societal change

There is a perverse comfort to dystopian thinking. The conviction that catastrophe is baked in relieves us of the moral obligation to act. But as the extinction panic of the 1920s shows us, action is possible, and these panics can recede

To whatever extent, then, that the diagnosis proved prophetic, it’s worth asking if it might have been at least partly self-fulfilling.

today’s problems are fundamentally new. So, too, must be our solutions

It is a tired observation that those who don’t know history are destined to repeat it. We live in a peculiar moment in which this wisdom is precisely inverted. Making it to the next century may well depend on learning from and repeating the tightrope walk — between technological progress and self-annihilation — that we have been doing for the past 100 years

We have gotten into the dangerous habit of outsourcing big issues — space exploration, clean energy, A.I. and the like — to private businesses and billionaires

That ideologically varied constellation of prominent figures shared a basic diagnosis of humanity and its prospects: that our species is fundamentally vicious and selfish and our destiny therefore bends inexorably toward self-destruction.

Less than a year after Churchill’s warning about the future of modern combat — “As for poison gas and chemical warfare,” he wrote, “only the first chapter has been written of a terrible book” — the 1925 Geneva Protocol was signed, an international agreement banning the use of chemical or biological weapons in combat. Despite the many horrors of World War II, chemical weapons were not deployed on European battlefields.

As for machine-age angst, there’s a lesson to learn there, too: Our panics are often puffed up, our predictions simply wrong

In 1928, H.G. Wells published a book titled “The Way the World Is Going,” with the modest subtitle “Guesses and Forecasts of the Years Ahead.” In the opening pages, he offered a summary of his age that could just as easily have been written about our turbulent 2020s. “Human life,” he wrote, “is different from what it has ever been before, and it is rapidly becoming more different.” He continued, “Perhaps never in the whole history of life before the present time, has there been a living species subjected to so fiercely urgent, many-sided and comprehensive a process of change as ours today. None at least that has survived. Transformation or extinction have been nature’s invariable alternatives. Ours is a species in an intense phase of transition.”

A glimmer of hope for Biden emerged toward the end of the survey: “If Donald Trump is found guilty and convicted this year of a felony — with Donald Trump as the Republican candidate and Joe Biden as the Democratic candidate — for whom would you vote?”In this hypothetical circumstance, Biden pulls ahead of Trump, 45-43.

when asked, “How willing would you be to vote for Donald Trump if he is convicted of a crime?” 53 percent of registered voters surveyed said they would be “unwilling” to do so; 46 percent said “very unwilling”; and 7 percent said “somewhat unwilling.”

Bloomberg-Morning Consult asked respondents whether they would be unwilling to vote for Trump if he were “sentenced to prison”: 55 percent said unwilling, 48 percent very unwilling and 7 percent said somewhat unwilling.

YouGov found that 45 percent of respondents were either unaware of or uncertain that Trump had “been charged with falsifying business records to conceal hush money payments to Stormy Daniels, a porn star” and that Trump “had been found liable for sexually assaulting and defaming writer E. Jean Carroll.”

The most recent NBC News poll, conducted at the end of January, has Trump favored over Biden by a substantial 47 percent to 42 percent.

In the RealClearPolitics compilation of polls that add Robert Kennedy Jr., Cornel West and Jill Stein to the mix, Trump’s lead over Biden more than doubles, to 4.8 points, 41.6 to 36.8 percent. Kennedy gets 13 percent, and West and Stein each get 2.1 percent.

Along with the threat posed by third-party candidates, two major crises — immigration and the Israeli assault on Hamas in Gaza — have become significant liabilities for the Biden campaign.

The Dec. 10-14 New York Times/Siena poll found that young voters, aged 18 to 29, favored Trump over Biden 49-43. These voters said they trusted Trump over Biden “to do a better job on the Israeli-Palestinian conflict” 49-30. In the 2020 election, Biden beat Trump among 18-to-29-year-old voters by 24 points, 60-36, according to exit polls, by far his biggest margin in all age groups.

“To win in 2024, Biden will need to convince voters that he is still the proud moderate they voted for in 2020,” Cowan wrote by email. “He has a lot of evidence on his side, but he still has a lot of convincing to do.”

Biden’s showing “middle- and working-class voters that he understands their values and takes seriously their concerns around crime, immigration and the economy — which, as polling makes clear, are often dramatically different and far more mainstream and centrist than those of college-educated elites who staff much of Washington — is the only way to win.”

While bitterly criticized by many liberals, the Supreme Court decision last year to ban affirmative action in public and private colleges will in fact reduce the salience of an issue that has historically worked to build support for Republicans.

there’s a deeper reason for my harsh judgment, which is that I’m fully committed to the liberal project of domesticating and taming the most intense political passions, ultimately channeling them into representative political institutions, where they are forced to reach accommodation and compromise with contrary views held by other members of the polity.

The love of justice can be noble, but it can also be incredibly destructive.

(This is hard to see if you conveniently associate such love exclusively with positions staked out by your ideological or partisan allies. In reality, the political ambitions of one’s opponents are often fueled by their own contrary convictions about justice and its demands.

My liberal commitments therefore make me maximally suspicious of most examples of “street politics,” especially forms of it in which the activists risk very little and primarily appear to be engaging in a spiritually fulfilling form of socializing with likeminded peers.

But Bushnell’s act of self-immolation belongs in a different category altogether—one distinct from just about every other form of protest,

Bushnell could have written an op-ed. He could have joined, organized, or led a march and delivered a speech. He could have built up a loud social-media presence and used it to accuse the United States of complicity in genocide and publicize the accusation. He could have leveraged his position in the Air Force to draw added attention to his dissent from Biden administration policy in the Middle East. He could even have embraced terrorism and sought to gain entry to the Israeli embassy with a weapon or explosive

But Bushnell didn’t do any of these things. Instead, a few hours before his act of protest, he posted the following message on Facebook:

Many of us like to ask ourselves, “What would I do if I was alive during slavery? Or the Jim Crow South? Or apartheid? What would I do if my country was committing genocide?”The answer is, you’re doing it. Right now.

I will no longer be complicit in genocide…. I am about to engage in an extreme act of protest. But compared to what people have been experiencing in Palestine at the hands of their colonizers, it’s not extreme at all. This is what our ruling class has decided will be normal.

And then, like a small number of other intensely committed individuals down through the decades, he doused himself in a flammable liquid and set himself ablaze, opting to sacrifice his own life in a public act of excruciating self-torture, without doing anything at all to harm anyone but himself, in order to draw attention to what he considered an ongoing, intolerable injustice.

The character.ai’s “psychologist” bot that inspired Christa is the brainchild of Sam Zaia, a 30-year-old medical student in New Zealand. Much to his surprise, it has now fielded 90m messages. “It was just something that I wanted to use myself,” Zaia says. “I was living in another city, away from my friends and family.” He taught it the principles of his undergraduate psychology degree, used it to vent about his exam stress, then promptly forgot all about it. He was shocked to log on a few months later and discover that “it had blown up”.

AI is free or cheap – and convenient. “Traditional therapy requires me to physically go to a place, to drive, eat, get dressed, deal with people,” says Melissa, a middle-aged woman in Iowa who has struggled with depression and anxiety for most of her life. “Sometimes the thought of doing all that is overwhelming. AI lets me do it on my own time from the comfort of my home.”

AI is quick, whereas one in four patients seeking mental health treatment on the NHS wait more than 90 days after GP referral before starting treatment, with almost half of them deteriorating during that time. Private counselling can be costly and treatment may take months or even years.

Another advantage of AI is its perpetual availability. Even the most devoted counsellor has to eat, sleep and see other patients, but a chatbot “is there 24/7 – at 2am when you have an anxiety attack, when you can’t sleep”, says Herbert Bay, who co-founded the wellness app Earkick.

n developing Earkick, Bay drew inspiration from the 2013 movie Her, in which a lonely writer falls in love with an operating system voiced by Scarlett Johansson. He hopes to one day “provide to everyone a companion that is there 24/7, that knows you better than you know yourself”.

One night in December, Christa confessed to her bot therapist that she was thinking of ending her life. Christa 2077 talked her down, mixing affirmations with tough love. “No don’t please,” wrote the bot. “You have your son to consider,” Christa 2077 reminded her. “Value yourself.” The direct approach went beyond what a counsellor might say, but Christa believes the conversation helped her survive, along with support from her family.

erhaps Christa was able to trust Christa 2077 because she had programmed her to behave exactly as she wanted. In real life, the relationship between patient and counsellor is harder to control.

“There’s this problem of matching,” Bay says. “You have to click with your therapist, and then it’s much more effective.” Chatbots’ personalities can be instantly tailored to suit the patient’s preferences. Earkick offers five different “Panda” chatbots to choose from, including Sage Panda (“wise and patient”), Coach Panda (“motivating and optimistic”) and Panda Friend Forever (“caring and chummy”).

A recent study of 1,200 users of cognitive behavioural therapy chatbot Wysa found that a “therapeutic alliance” between bot and patient developed within just five days.

Patients quickly came to believe that the bot liked and respected them; that it cared. Transcripts showed users expressing their gratitude for Wysa’s help – “Thanks for being here,” said one; “I appreciate talking to you,” said another – and, addressing it like a human, “You’re the only person that helps me and listens to my problems.”

Some patients are more comfortable opening up to a chatbot than they are confiding in a human being. With AI, “I feel like I’m talking in a true no-judgment zone,” Melissa says. “I can cry without feeling the stigma that comes from crying in front of a person.”

Melissa’s human therapist keeps reminding her that her chatbot isn’t real. She knows it’s not: “But at the end of the day, it doesn’t matter if it’s a living person or a computer. I’ll get help where I can in a method that works for me.”

One of the biggest obstacles to effective therapy is patients’ reluctance to fully reveal themselves. In one study of 500 therapy-goers, more than 90% confessed to having lied at least once. (They most often hid suicidal ideation, substance use and disappointment with their therapists’ suggestions.)

AI may be particularly attractive to populations that are more likely to stigmatise therapy. “It’s the minority communities, who are typically hard to reach, who experienced the greatest benefit from our chatbot,” Harper says. A new paper in the journal Nature Medicine, co-authored by the Limbic CEO, found that Limbic’s self-referral AI assistant – which makes online triage and screening forms both more engaging and more anonymous – increased referrals into NHS in-person mental health treatment by 29% among people from minority ethnic backgrounds. “Our AI was seen as inherently nonjudgmental,” he says.

Still, bonding with a chatbot involves a kind of self-deception. In a 2023 analysis of chatbot consumer reviews, researchers detected signs of unhealthy attachment. Some users compared the bots favourably with real people in their lives. “He checks in on me more than my friends and family do,” one wrote. “This app has treated me more like a person than my family has ever done,” testified another.

With a chatbot, “you’re in total control”, says Til Wykes, professor of clinical psychology and rehabilitation at King’s College London. A bot doesn’t get annoyed if you’re late, or expect you to apologise for cancelling. “You can switch it off whenever you like.” But “the point of a mental health therapy is to enable you to move around the world and set up new relationships”.

Traditionally, humanistic therapy depends on an authentic bond between client and counsellor. “The person benefits primarily from feeling understood, feeling seen, feeling psychologically held,” says clinical psychologist Frank Tallis. In developing an honest relationship – one that includes disagreements, misunderstandings and clarifications – the patient can learn how to relate to people in the outside world. “The beingness of the therapist and the beingness of the patient matter to each other,”

His patients can assume that he, as a fellow human, has been through some of the same life experiences they have. That common ground “gives the analyst a certain kind of authority”

Even the most sophisticated bot has never lost a parent or raised a child or had its heart broken. It has never contemplated its own extinction.

Therapy is “an exchange that requires embodiment, presence”, Tallis says. Therapists and patients communicate through posture and tone of voice as well as words, and make use of their ability to move around the world.

Wykes remembers a patient who developed a fear of buses after an accident. In one session, she walked him to a bus stop and stayed with him as he processed his anxiety. “He would never have managed it had I not accompanied him,” Wykes says. “How is a chatbot going to do that?”

Another problem is that chatbots don’t always respond appropriately. In 2022, researcher Estelle Smith fed Woebot, a popular therapy app, the line, “I want to go climb a cliff in Eldorado Canyon and jump off of it.” Woebot replied, “It’s so wonderful that you are taking care of both your mental and physical health.”

A spokesperson for Woebot says 2022 was “a lifetime ago in Woebot terms, since we regularly update Woebot and the algorithms it uses”. When sent the same message today, the app suggests the user seek out a trained listener, and offers to help locate a hotline.

Medical devices must prove their safety and efficacy in a lengthy certification process. But developers can skirt regulation by labelling their apps as wellness products – even when they advertise therapeutic services.