Medical News

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[Read: Christian parents have a blueprint for IVF]

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

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

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

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

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

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

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

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

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

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

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

Recently, in a few cities across the country, Starbucks quietly unveiled a pair of drinks, one resembling a pistachio milkshake, the other a mossy sludge. Unlike with green beverages already on the Starbucks menu, their hue does not come from matcha, mint, or grapes. They are green because they contain actual greens—or, at least, a dried and powdered form of them sold by the supplement company AG1. Now getting a hefty dose of vegetables—including, but not limited to, broccoli, spinach, and, uh, “grasses”—is as easy as ordering an iced AG1 Coconutmilk Blend or its sibling, the Watermelon Blend.

Powdered greens are hardly a new concept: Dehydrated, pulverized vegetables, sweetened with natural sugars, have been stirred into shakes and smoothies for decades. But AG1, formerly known as Athletic Greens, is one of many powdered-greens brands that are having a moment. Inescapable on the social-media feeds of wellness influencers, powdered greens are riding the same wave as green juices and Erewhon smoothies. These health-coded, aesthetically pleasing, status-symbol products are cool, pleasant-tasting vectors for plain old vegetables.

Powdered greens claim all sorts of benefits, such as more energy, stronger immunity, and a happier gut. But above all, they promise convenience—a “hack” for eating vegetables, as Suja, another powdered-greens company, frames it. The basic premise is that eating vegetables is a slog, but a necessary one. Buying and consuming fresh vegetables—cleaning, chopping, cooking, and chewing them—is apparently so energetically taxing, so time-consuming, so horrible that it’s better to sneak them into tasty drinks, some of which are flavored like candy.

Yes, swirling powder into liquid is less strenuous than massaging kale. And drinking food is a faster way to choke down something foul-tasting. There was a time when eating vegetables was challenging and disgusting, but not now. Greens have never been so cheap, tasty, or accessible. There are so many better ways to eat veggies than slurping them down like baby food.

The wellness industry is full of products marketed as shortcuts to better health, some more dubious than others. At the very least, powdered greens can be a genuinely useful way to get a solid amount of vegetables. Americans “really under-consume leafy greens,” Anna Rosales, a dietician and senior director at the Institute for Food Technologists, told me. According to the USDA, only 10 percent of people eat the recommended amount of vegetables, which is roughly 2.5 cups a day. That’s a problem because greens reduce the risk of chronic ailments such as diabetes, obesity, and heart disease.

Greens that are dried through freezing instead of heat retain more nutrients and fiber, Rosales said. But green powders should be viewed as a “safety net”—they’re meant to “help us get to a place where we’re closer to the dietary recommendations.” They’re not a replacement for greens, or an excuse to eat less of them. In pretty much every way, normal greens are better than the powdered kind. The classic complaint about vegetables is that people don’t have time to buy and prepare fresh produce. As a working parent, I can relate. Often, grocery shopping and cooking are simply out of the question. How about just grabbing a salad to go?

Earlier this year, I wrote about the fast-casual salad chains expanding out of coastal cities and into Middle America. They aren’t all $18-a-bowl places such as Sweetgreen; an exclusively drive-through chain called Salad and Go, based in the Southwest, offers options for less than $7—about the same price as a Big Mac.

Standard fast-food chains, some of which waffled on salad in previous decades, now regularly sell it: Wendy’s and Chick-fil-A’s offerings have even been praised for being quite tasty. Growing interest in salad is pressuring restaurants to make them better, or at least more interesting: Caesar salads are mutating to include all sorts of weird ingredients such as tequila and fava beans, as my colleague Ellen Cushing wrote, but “even bastardized ones rock, and people want to buy them.”

Even if salad isn’t your thing, ready-made vegetable dishes are easier than ever to get a hold of. Gone are the days when the only options available at fast-casual restaurants were the celery sticks that came with chicken wings. Crispy brussels sprouts, spinach-artichoke dip, and sweet-potato fries (along with salad) are now standard fare at national chains such as Applebee’s, Olive Garden, and Cheesecake Factory. (While not particularly healthy in these forms, they count toward your vegetable intake: Just eight brussels sprouts comprise a single serving.)

Even at-home options are better now. It takes about the same time to shake up a cup of greens as it does to heat up a frozen dish of, say, roasted-squash-and-tomato pasta or spinach saag paneer. Many meal-subscription services will ship such dishes directly to your home. Most grocery stores offer precut vegetables to save on cooking prep time (or to eat directly out of the tray). And discount stores such as Dollar General have even begun to sell fresh produce. There are simply more ways than ever to get your greens.

Of course, eating at restaurants and subscribing to meal plans are out of budget for a lot of people. Many Americans struggle to meet the fruit-and-vegetable dietary guidelines because of cost, which has only increased with inflation. Regular vegetables aren’t cheap, but neither is the powdered stuff. Powdered greens range from $1 to $3.30 per drink, according to a recent roundup by Fortune; a month’s supply of AG1 would set you back $99. The number of vegetable servings in each unit of green powder depends on the brand, yet even those that offer three or four servings of vegetables per scoop aren’t exactly cost-effective. A 12-ounce bag of frozen broccoli at Walmart, which would supply you with four servings of vegetables, costs a little more than $1.

The real allure of powdered greens may not be time or cost, but rather that they feel like a cheat code for health. A company called Kroma Wellness markets its Supergreens Elixir Jar as the “easiest way to nourish your body”; another, Bloom, claims that “you don’t have to make any revolutionary changes to feel your best this year—all it takes is one daily scoop!” Andrew Huberman, a neuroscientist who hosts a popular health podcast, is also the science adviser for AG1, and has called it the “simplest, most straightforward way” to get his daily dose of nutrients. The hard way, in contrast, would be to overhaul your diet and lifestyle so that you consistently eat enough greens—and learn to like them. Doing so is guaranteed to improve your health, but not overnight, and not without significant effort. You certainly won’t experience the immediate sense of accomplishment you get after downing a glass of greens.

Even so, as it has become easier than ever to eat vegetables, habits can be hard to break. Children holding their nose while they choke down lima beans is not so different from adults guzzling sweetened greens through a straw. Sometimes, parents add pureed beets to brownies, mash squash into macaroni and cheese, and fold black beans into burgers because children won’t eat them otherwise. Yet this practice is contested: Some argue that kids should just learn to enjoy their vegetables. Adults should do the same.

Powdered greens are the latest complication in America’s long, messy relationship with vegetables. At best, vegetables are thought of as side dishes; at worst, they’re the thing you spit into a napkin when no one’s looking. Vegetarians have been mocked for more than a century. That all children hate greens is baked into pop culture. The notion that vegetables are a second-tier food is so pervasive that it’s easy to overlook the fact that vegetables are actually really good now—so good that you don’t need to chug them down in sugary drinks. Powdered greens may be helping some adults get more vegetables, but they perpetuate the underlying problem: They still treat greens as something you have to, rather than want to, eat.

The first person who taught me something about death and defiance was the mother of a family friend, an older woman who had moved from Punjab to the United States to be closer to her son. I remember her as delicate and draped always in pastel salwar kameezes. After she was diagnosed with breast cancer, which moved quickly to claim her bones and her brain, her desire to return to Punjab intensified. When my parents told me about the end of her life, it was with a mixture of disbelief and conviction: She survived the days-long journey to the village where she’d been born—laboring to breathe for nearly the entire flight, grimacing through prayers when she ran out of pain medication—and died two days after she arrived.

I thought of her story this week as I read about former President Jimmy Carter’s intention to live long enough to vote for Kamala Harris. Carter, who has been on hospice for well over a year, turned 100 on Tuesday and has survived far longer than many expected he would. The notion that he has rallied in order to contribute in one final way to American democracy raises a familiar question that arises in my own work with patients and families: Do we have some control, conscious or not, over when we die? Can a person stretch the days of their life to include a last meaningful act or moment?

As a palliative-care physician, I have encountered the phenomenon of people dying only after specific circumstances materialize. There was the gentleman whose family held vigil in the intensive-care unit while he continued on, improbably, even without the support of the ventilator, dying only after his estranged son had arrived. There was the woman whose fragility precluded any further chemotherapy, but who survived long enough without it to witness the birth of her first grandchild. There was the woman who was deeply protective of her daughter, and died from cirrhosis only after she’d left for the night, possibly to spare her the agony of witnessing her death. The unexpected happens frequently enough that I tell patients and families that two timelines shape the moment of death: the timeline of the body, governed by the more predictable laws of physiology, and that of the soul, which may determine the moment of death in a way that defies medical understanding and human expectations. When people wonder about the circumstance of the last heartbeat, of the final breath, I can see how they never stop searching for their loved ones’ personhood or intention, a last gesture that reveals or solidifies who that person is.

Despite the prevalence of stories suggesting that people may have the ability to time their death, no scientific evidence supports this observation. Decades ago, several studies documented a dip in deaths just before Jewish holidays, with a corresponding rise immediately afterward, suggesting that perhaps people could choose to die after one final holiday celebration. A larger study later found that certain holidays (Christmas and Thanksgiving, in this case) and personally meaningful days (birthdays) had no significant effect on patterns of dying. But this phenomenon doesn’t lend itself easily to statistical analysis, either: The importance of holidays, for instance, can’t quite stand in for the very individual motivations that define the anecdotes shared in hospital break rooms or around a dinner table. And the human truth that many recognize in these stories raises the question of whether we believe them any less fully in the absence of proof.

Palliative care often involves helping people confront and develop a relationship to uncertainty, which governs so much of the experience of illness. And when my patients tell me about themselves and about who they are now that they are sick, willpower often makes an appearance. Many say that if they focus on the positive, or visualize the disappearance of their cancer, or fight hard enough, they will win the battle for more time. I hear in their words echoes of what Nietzsche wrote, what the psychiatrist Viktor Frankl used to make sense of his years in German concentration camps: “He who has a why to live for can bear almost any how.”

And we want to believe that love or desire or commitment or heroism is still possible right up until the very end. As my patients grow sicker, and as death approaches, I talk with them and their families about what they can hope for even if a cure isn’t possible. That, in fact, death can still contain something generative. A time that may have seemed beyond further meaning becomes instead an opportunity, or an extension of the dying person’s commitments to their country, their family, their dreams. Soon, President Carter will be able to cast that vote: Next week, Georgia registrars will start mailing out absentee ballots; early voting begins the week after that. His promise to himself is a reminder that dying cannot fully dampen purpose, even as a person’s life narrows.

The idea that willpower can be an ally against death is appealing too, because it offers the possibility of transcendence, of defying the limits that the body, or illness, may impose. But, having also seen the many ways that the body does not bend to the mind, I do find myself regarding willpower with caution: What if you as a person are a fighter, but your body simply cannot fight the cancer any longer? I wonder, with my patients, if they can strive for more time without shouldering personal responsibility for the limits of biology. Similarly, two people on ventilators may love their families equally. One may die only after the final beloved family member arrives, whereas the other may die before the person rushing across the ocean makes it home. We don’t always know why. If Carter casts his vote and dies shortly thereafter, that might affirm the notion that others, too, can write the final sentence in their story. But what would it mean if Carter died before casting his vote? If he lived another year, or if he lived to see Donald Trump take office again, or watch the election be violently contested? Living with loss requires remembering that we can locate the person we have loved or admired in any given set of events that comprised their life, not just the last one.

I try to imagine my family friend’s long flight from Los Angeles to Delhi, and her ride in the taxi back to Punjab. I think about how she found a way to endure what she was told she couldn’t, all to feel beneath her feet the soil she knew best, to die in the one place that she felt belonged to her. What if her doctors had been right and she had died on the plane? My family might have mourned her single-mindedness, or we might have admired her defiance nonetheless. What makes these stories so compelling is that they remind us that death, however ravenous, cannot devour hope or possibility, even if what transpires is not the ending we imagined.

Of the first three elements to appear after the Big Bang, only one is available to buy as a bath soak. The Sads Smashing Anti-Stress Bath Treatment, which comes in shiny silver packaging, lists lithium as an ingredient and promises to take users “from weighed down to mellowed out.” It’s one of dozens of over-the-counter lithium supplements that claim to support a healthy mood. The metal is also an ingredient in Novos Core, a supplement marketed to “target the 12 root causes of aging,” plus in Life Extension, XtendLife, LifeLink, Youngevity, and AgeImmune. The anti-aging entrepreneur Bryan Johnson’s “Essential” multivitamin includes lithium too. “I am on a 1mg daily dose,” Johnson told me in an email.

Lithium, in other words, has become firmly entrenched in the wellness industry’s extensive library of supplements. But in crucial ways, it is unlike the other trendy products that dance across your Instagram stories. At higher doses, lithium is a powerful treatment for severe mood disorders—and preliminary evidence suggests that lower doses might improve well-being for people without mood disorders too. The problem is, American companies have little business interest in finding out how effective it really is.

If you put pure lithium into water, it will explode into crimson flames, but mixed with acids, lithium forms stable salts. Lithium compounds also dissolve uric acid, which doctors in the mid-1800s believed to be the cause of many illnesses. Physicians began using lithium to treat “a wide range of ailments, including headaches, diabetes, asthma, indigestion, obesity, skin disorders, rheumatism,” Walter Brown wrote in his book Lithium: A Doctor, a Drug, and a Breakthrough. By the end of the century, lithia water (water with a trace amount of lithium) was marketed as a patent medicine. (In that era, patent medicines—trademarked, proprietary cure-alls, many of which contained alcohol or opium—were a popular alternative to going to the doctor.) 7 Up was originally named Bib-Label Lithiated Lemon-Lime Soda, contained lithium citrate, and was marketed as a health tonic and hangover cure. Sears sold Schieffelin’s Effervescent Lithia Tablets, which were marketed for a variety of health concerns, including gout.

In 1949, lithium chloride, a table-salt alternative marketed to people with heart conditions, caused an outbreak of lithium poisoning in which at least two people died. The FDA, which had already started cracking down on patent medicines, quickly banned lithium in food products; later, researchers found that high doses of lithium can cause kidney failure, thyroid damage, tremors, and nausea. In 1970, the agency approved lithium carbonate for bipolar disorder; today, it’s also used off-label mostly for major depressive disorder. Then, in 1994, the FDA created the category of “dietary supplements,” which it does not evaluate, ushering lithium—mostly in the form of lithium orotate—back into a patent-medicine-like gray zone.

For decades, scientists have debated whether the lithia-water craze had any truth to it—if low doses of lithium might benefit a larger population than people with mental-health conditions, maybe even everyone. Some researchers think it’s worth investigating whether lithium is an essential micronutrient, like calcium or magnesium, with a recommended daily minimum of some yet-to-be-determined amount. Lithium carbonate is typically given at 600 to 900 milligrams a day for mood disorders. We get minuscule amounts of lithium from foods such as grains, potatoes, tomatoes, and cabbage. Depending on where you live and what mineral deposits are nearby, your tap water may also contain lithium. A 2024 review paper led by Allan Young, a psychiatrist at King’s College London, determined that most lithium orotate supplements on the market today contain a “micro” dose of 5 to 20 milligrams, and many have a “trace” dose of just 1 milligram. (The Sads Smashing Anti-Stress Bath Treatment contains 127 milligrams of lithium orotate, but it’s meant to be absorbed through the skin, not ingested.)

[From the May 1928 issue: The secret of longevity]

The effects of such low doses remain a mystery. Although a 2020 meta-analysis of studies from nine countries (including the United States) found that higher amounts of naturally occurring lithium in tap water are indeed associated with lower suicide rates, studies from places such as Switzerland and the East of England have found no association. In a 2021 study of rural Argentina, places with more lithium in their tap water had more suicides. Martin Plöderl, a co-author of the recent Switzerland study, told me that his team has found a publication bias in studies of lithium in tap water: Those with positive findings are more likely to end up in journals. Research into lithium’s effects on dementia, Alzheimer’s, and longevity has also been promising but inconclusive. A 2011 study of tap-water data from Japan found that the more lithium in the water, the longer people lived. Lithium consumption has been linked to longer life spans in flies, roundworms, and yeast, perhaps because it regulates molecules involved in metabolism and resistance to stress, Michael Ristow, a medical researcher at Charité University Medicine Berlin and co-author of the Japan study, said. A 2019 study found that bipolar-disorder patients who take lithium have longer telomeres—a proxy for lower biological age—than patients with other psychiatric disorders. And a more recent study from Japan found that people who took lithium for mood disorders had lower rates of dementia than similar patients who did not take lithium.

These data are compelling enough for Ristow, who told me he takes a low dose of lithium every day. Nassir Ghaemi, a psychiatrist at Tufts University School of Medicine, did not comment on his personal use, but told me, “I think it’s beneficial in people who are middle-aged and older, who have any risk factors for dementia.” To really be sure, randomized trials in humans are needed. Because lithium is an ancient element, however, it can’t be patented—only novel inventions are available for intellectual-property protection. In order to obtain a patent, a company would have to come up with some different delivery method or other improvement. Pharmaceutical companies, which are regulated by the FDA, therefore have little reason to fund an expensive clinical trial, especially when cheap versions are already sold over the counter. But supplement companies have incentive to sell lithium OTC without conducting rigorous research on its effects. Zero clinical trials for lithium orotate are currently registered in the U.S., despite its widening market availability.

Scientists don’t yet know whether lithium-orotate supplementation would yield different results than lithium in tap water. Only two studies on such supplementation have ever been conducted in humans—one from 1973 and one from 1986—and they have small sample sizes and no placebo groups. “Given lithium does work at least for preventing bipolar disorder, it’s a scandal that we don’t know how it works,” Young told me. If low-dose lithium remains akin to a patent medicine, Americans could miss out on understanding how and how well it works, and if taking it comes with any risks. In at least one case report from 2007, a woman took 18 tablets of a lithium supplement called Find Serenity Now at once and went to the hospital after vomiting. She was discharged with no other serious issues, but the risks of long-term use simply haven’t been assessed.

[Read: I went to a rave with the 46-year-old millionaire who claims to have the body of a teenager]

In the late 19th century, people such as Mark Twain and President Theodore Roosevelt traveled to Lithia Springs, Georgia, to drink lithium-rich water. The springs’ appeal endures: You can order water from its website, which states, “Locals have always believed Lithia Spring Water flows from the fountain of youth.” Lithium predates human life, is extracted from stone, and can have a profound impact on a person’s emotional life. No wonder it tempts our never-ending desire for some primordial cure-all, whether it be found in a groundwater spring or in our very own bathtubs.

Presidents always seem to have a crisis to deal with. George W. Bush had 9/11. Barack Obama had the Great Recession. Donald Trump had the coronavirus pandemic. Joe Biden had the war in the Middle East. For America’s next president, the crisis might be bird flu.

The United States is in the middle of an unprecedented bout of bird flu, also known as H5N1. Since 2022, the virus has killed millions of birds and spread to mammals, including cows. Dairy farms are struggling to contain outbreaks. A few humans have fallen sick, too—mostly farmworkers who spend a lot of time near chickens or cows—but Americans have largely remained nonplussed by bird flu. No one in the U.S. has died or gotten seriously sick, and the risk to us is considered low, because humans rarely spread the virus to others.

On Friday, the fear of human-to-human spread grew ever so slightly: The CDC confirmed that four health-care workers in Missouri had fallen sick after caring for a patient who was infected with bird flu. A few weeks earlier, three other Missourians showed symptoms of bird flu after coming in contact with the same person. It’s still unclear if the workers were infected with H5N1 or some other respiratory bug; only one has been given an H5N1 test, which came back negative.

The CDC says the risk to humans has not changed, but the incident in Missouri underscores that the virus is only likely to generate more scares about human-to-human transmission. The virus is showing no signs of slowing down. In the absolute worst-case scenario—where Friday’s news is the first sign of the virus freely spreading from person to person—we are hurtling toward another pandemic. But the outbreak doesn’t have to get that dire to create headaches for the American public, and liabilities for the next president.

Either Trump or Kamala Harris will inherit an H5N1 response that has been nightmarishly complex, controversial, and at times slow. Three government agencies—the FDA, the CDC, and the U.S. Department of Agriculture—share responsibility for the bird-flu response, and it’s unclear which agency is truly in charge. The USDA, for example, primarily protects farmers, while the CDC is focused on public health, and the FDA monitors the safety of milk.

Adding to the complexity is that a lot of power also rests with the states, many of which have been loath to involve the feds in their response. States must typically invite federal investigators to assess potential bird-flu cases in person, and some have bristled at the prospect of letting federal officials onto farms. The agriculture commissioner for Texas, which has emerged as one of the bird-flu hot spots, recently said the federal government needs to “back off.” Meanwhile, wastewater samples—a common way to track the spread of a virus—indicate that bird flu is circulating through 10 of the state’s cities.

Government alone can only do so much. Though only 14 Americans have knowingly come down with bird flu, we have a woefully incomplete picture of how widely it is spreading in humans. Since March, about 230 people nationwide have been tested for the virus. Although the federal government has attempted to compel farmworkers to get tested—even offering them $75 to give blood and nasal swabs—it has struggled to make inroads. That could be because of a range of factors, such as distrust of the federal government because of farmworkers’ immigration status, and lack of awareness about the growing threat of bird flu. A USDA spokesperson told me the agency expects testing to increase as it “continues outreach to farmers.”

You should be experiencing some serious déjà vu by now. In 2020, the U.S. was operating in the dark regarding COVID because tests were scarce, many states were not publicly reporting their COVID numbers, and the federal government and states were fighting over lockdowns. The systematic problems that dogged the pandemic response are still impediments today, and it’s unclear whether either candidate has a plan to fix them. Trump and Harris both seem more intent on pretending that the worrying signs of bird flu simply don’t exist. Neither has outlined a plan for containing the virus, or said much of anything publicly about it. (The Trump and Harris campaigns did not respond to requests for comment.) If America is going to avoid repeating our COVID mistakes, things need to change fast. Angela Rasmussen, a virologist at the University of Saskatchewan, highlighted the need for more widespread testing, and vaccinations for those at high risk of catching the virus. (The federal government has a stockpile of bird-flu vaccines, but has not deployed them.)

H5N1 is already showing its potential to spoil both candidates’ promises to lower grocery prices. Poultry flocks have been hit hard by bird flu, and the price of eggs has spiked by 28 percent compared with a year ago. (Inflation also played a role in increased prices, but bird flu is mostly to blame.) The next president will have to spar with America’s dairy industry if they want to get useful data on how widely the virus is spreading. Dairy farmers have been reluctant to test workers or animals for fear of financial losses. But none of this will compare with the disruption that a new president will have to deal with should this virus spread more freely to humans. For Americans, that will likely mean a return to masks, another vaccine to get, and isolation. Some experts are warning that schools could be affected if the virus begins spreading to humans more readily.

Bird flu doesn’t seem like a winning message for either candidate. Talk of preparing for any type of infectious disease triggers the fears of uncertainty, isolation, and inconvenience that Americans are still trying to shake after the pandemic. It’s hard to imagine either Trump or Harris starting their presidency by instituting the prevention measures that so many people have grown to hate. Unfortunately, the next commander in chief may not have a choice.

On a recent Sunday morning, I sat on a cushioned mat across from Sister True Vow, a Buddhist nun at Blue Cliff Monastery. I had traveled two hours north from Brooklyn to Pine Bush, New York, to seek her perspective on the human tendency to want. “Desire and craving mean forever running and grasping after something we don’t yet have,” Sister True Vow told me, making gentle but unwavering eye contact. There was something else I wanted to know about desire, though. So I asked what she thought of Ozempic.

Before my visit to Blue Cliff, I had been thinking about how so many people taking GLP-1 medications find that, without even trying, they’ve suddenly released their desires for food, alcohol, tobacco, shopping, and more—and how Buddhists have been contemplating this exact transition for centuries. In his first sermon after reaching enlightenment, the Buddha taught that humans suffer because of our desires, and we must unshackle ourselves from them in order to become enlightened. And to some people who take Ozempic or other GLP-1 medications, the lack of cravings feels like freedom. For others, life becomes a little empty. If renunciation of desire is the key to enlightenment, why does the medication version of Nirvana seem relatively lackluster?

Roughly one in eight Americans has tried a GLP-1 drug, a number that could increase as pressure is put on companies to lower prices and generics enter the market. This means that millions of Americans could soon confront a changed relationship with their general sense of desire. It’s a rare chance to peer inside a mindset that’s usually reserved for the spiritually awakened, and discover what it’s like to stop wanting, and what achieving that state in a matter of weeks reveals about the nature of human desire.

GLP-1 drugs such as Ozempic, Wegovy, and Mounjaro mimic a hormone that not only stimulates insulin production but also interacts with the brain’s reward circuitry. Scientists are still working out exactly how people respond psychologically. Despite some anecdotal reports of depression and anxiety, a recent study didn’t find an uptick in neuropsychiatric issues with semaglutide, the active ingredient in Ozempic and Wegovy, compared with three other antidiabetic medications; another found that the drugs are not significantly associated with increased suicidal thoughts. The question of desire is more subtle. Davide Arillotta, a psychiatrist at the University of Florence, recently led a study that analyzed tens of thousands of English-language posts about GLP-1 drugs on YouTube, Reddit, and TikTok and found that, unsurprisingly, many express enthusiasm about weight loss. But other people “reported a lack of interest in activities they once enjoyed, as well as feelings of emotional dullness,” he told me.

[Read: Did scientists accidentally invent an anti-addiction drug?]

Anna, a 51-year-old in California who works in marketing—and who requested to withhold her last name to discuss details of her medical history—told me that several months after she started taking Mounjaro, she began to feel listless. Anna was diagnosed with depression 20 years ago, and treated her symptoms successfully. This was different. She still enjoyed aspects of her life: playing with her dog, spending time with her kids. “I still get joy out of them, but I have to force myself to do them,” she told me. In subreddits about GLP-1 drugs, others express similar concerns. “Does anyone feel depressed or feel lack of enjoyment of life while on ozempic ?” one person asked. From another: “Does the apathy fade?” “I just haven’t been finding much interest, joy, or motivation to do things. I haven’t been able to pinpoint why, exactly,” someone else wrote.

Desire, or wanting, is a discrete mental phenomenon that is driven by the neurotransmitter dopamine. In the 1980s, Kent Berridge, a neuroscientist at the University of Michigan, led a study demonstrating that the neurobiology of wanting was separate from liking. Wanting is the motivation to pursue a reward, whereas liking is the enjoyment we get from that reward. This wanting is different from a cognitive plan, like wanting to stop by the library later; it’s an urge to act. Berridge and others have shown that wanting involves different chemicals and areas of the brain than liking does. This means we can want what we don’t like, and enjoy what we don’t crave; for example, Berridge has argued that addiction stems from the triumph of desire over enjoyment. Anhedonia, the loss of pleasure in activities that used to be meaningful, is commonly understood to be a symptom of psychological conditions such as depression. A better term for what’s happening to some GLP-1 users, Berridge said, would be avolition—a loss of motivation and wanting.

The circuitry of desire can be surprisingly easy to manipulate. Berridge has shown that increasing dopamine can make rats seek out painful electric shocks. Some people who take dopamine-increasing Parkinson’s drugs develop compulsive gambling or shopping habits—an issue of too much wanting. Certain Tourette’s drugs, such as Haldol, lower dopamine levels, and can make life feel dull to some people. In his 1985 book, The Man Who Mistook His Wife for a Hat and Other Clinical Tales, the neurologist Oliver Sacks wrote about a man with Tourette’s named Ray, who said that when he took Haldol, he was “average, competent, but lacking energy, enthusiasm, extravagance and joy.” Ray’s solution was to take the drug during the week, then get his fix of exuberance on the weekends.

GLP-1 drugs affect dopamine pathways in the brain in ways that scientists are still working to understand. Kyle Simmons, who’s leading a clinical trial of GLP-1 drugs for alcohol-use disorder, told me that his team plans to pay special attention to participants’ potential loss in pleasure and their loss in wanting—and the difference between the two. Researchers still don’t know whether taking a GLP-1 drug reduces all cravings or just the strongest ones, Berridge said. But the evidence from other desire-disrupting drugs and experiments can help illuminate why certain people on GLP-1 drugs end up feeling a bit blah. Some might have previously relied on food to regulate their emotions, and can’t eat at the same volume anymore. Others may feel lethargic simply because they’re eating less. And for a person who is used to strong feelings of wanting, “all of a sudden, that goes away, and you have to reestablish what your behavioral drivers should be,” Karolina Skibicka, a neuroscientist at Penn State who did some of the first studies on GLP-1 and dopamine in rats, told me.

[Read: The science behind Ozempic was wrong]

This explanation mirrored what Sister True Vow said as she reflected on my questions about anecdotal reports of apathy and GLP-1 drugs. Buddhism recommends contemplating your cravings over a period of years in order to gradually loosen your grip on them in a deliberate way. Ozempic and its peers, by contrast, “do it in a chemical way, without the psychology of us coming along with it,” Sister True Vow said. When people strongly identify with their cravings, feeling them disappear over a matter of weeks can be jarring. But it can also be an opportunity to uncover the roots of our desire in order to eventually let them go in a more deliberate way, Sister True Vow said. This doesn’t mean people have to forgo enjoyment of the present moment—in fact, Buddhism encourages such pleasures.

The Buddha’s first sermon also described the Middle Way: a balance between the extremes of asceticism and indulgence. Enlightenment is approached not by breaking completely free from desire, but by gaining awareness of how and why you want things. After many months on the drugs, some GLP-1 users appear to be finding their own Middle Way. “I have had to learn more about what desire is, how it works,” Anna told me. When she meditated on what exactly she liked about her favorite hobby—collecting perfume—she realized that she is drawn to the infinite variety of scents, how they produce memories and smell different depending on where on the body they’re applied. I told her she sounded a bit like a Buddhist.

Modern American life is often accused of overloading our dopamine system with TikTok swipes and Amazon Prime deliveries, to the point that influencers and psychologists alike have endorsed “dopamine fasting” to help people break their instant-gratification habits. Desire, in other words, is a monster to be tamed if happiness is to be achieved. Yet people’s emotional responses to GLP-1 drugs reveal that our relationship with wanting is more complex. If an overattachment to every craving can bring suffering, a total renunciation of them can be unsatisfying too.