The Sucker

On a Thursday evening in September, I excused myself from the family dinner table and slipped into my bedroom. I didn’t want my kids to see what I was about to do.

With the door locked behind me, I pulled out my phone and downloaded the DraftKings betting app. I felt a certain thrill as I typed in my debit-card information and deposited $500. The first game of the NFL season was a few minutes away. Anything seemed possible.

I am not, by temperament, a gambling man. As a suburban dad with four kids, a mortgage, and a minivan, I’m more likely to be found wrestling a toddler into a car seat than scouring moneylines or consulting betting touts. And as a practicing Mormon, I am prohibited from indulging in games of chance. Besides, I had always thought of gambling as a waste of time. This makes me an outlier among my generational peers: Since 2018, Americans have wagered more than half a trillion dollars on sports, and roughly half of men ages 18 to 49 have an active account with an online sportsbook.

When I set out to report on the sports-betting industry—its explosive growth, its sudden cultural ubiquity, and what it’s doing to America—my editors thought I should experience the phenomenon firsthand. Mindful of my religious constraints, they proposed a work-around: The Atlantic would stake me $10,000 to gamble with over the course of the upcoming NFL season. The magazine would cover any losses, and—to ensure my ongoing emotional investment—split any winnings with me, 50–50. Surely God would approve of such an arrangement, my editors reasoned, because I wouldn’t be risking my own hard-earned money.

This spiritual loophole intrigued me. But for the sake of my soul, I decided I’d better consult a higher ecclesiastical authority than The Atlantic’s masthead.

A few days later, I sat across from my bishop, explaining the experiment and watching a look of pastoral concern come over his face. After some consideration, he said (a bit tentatively, if I’m being honest), “I don’t think you’re doing anything wrong.” He grasped the difference between gambling with my own money and using my employer’s for research purposes. But he had also seen too many lives wrecked by vice to let me leave without a warning. He told me stories he’d heard about upstanding family men who had let an initially modest gambling habit ruin them, and a cautionary tale about a churchgoing lawyer who developed an unhealthy curiosity about sex work after handling a prostitution case and wound up devastating his family.

I promised the bishop that I would steer clear of slippery slopes. “This will really just be a journalistic exercise,” I assured him.

Fifteen minutes before kickoff, I scrolled through the available wagers on DraftKings in wide-eyed bewilderment. Struggling to make sense of the terminology—Profit boosts? Alternative spreads?—I punched in bets almost at random. I bet that the Eagles would beat the Cowboys by at least nine points, based on the sophisticated premise that the Eagles had won the previous Super Bowl and the Cowboys had not. I placed a bet that Eagles quarterback Jalen Hurts would throw for more than 200 yards, and wagered on something called a “same-game parlay” that would pay out if both Hurts and running back Saquon Barkley scored touchdowns.

Then, after tucking in my kids for the night, I turned on the TV in our bedroom and settled in next to my wife, Annie.

Watching the game was unexpectedly stressful. Toggling among my five different bets—monitoring their progress, weighing live “cash out” options—left me feeling harried and sweaty. Four seconds into the game, I got a taste of the capriciousness of the enterprise when the Eagles’ best defender inexplicably spit on the Cowboys’ quarterback and got himself ejected. Had the Eagles’ chances of beating the spread, and my chances at winning $75, just been expectorated away?

Ever since the advent of sports, humans have found ways to lose money gambling on them.

But the experience was also strangely mesmerizing. For 200 bucks, I had purchased an artificial rooting interest in a game I had no reason to care about. I kept watching even after a weather delay pushed it late into the night, scrolling frenetically next to my sleeping wife in search of angles to exploit with late-game bets. Most of my bets ended up losing, but the long-shot Hurts-Barkley parlay hit, and when the game ended, I calculated that I was up $20.

The next morning, I proudly shared the news with Annie, who high-fived me and immediately began to fantasize about how we would spend my winnings for the season. Could we replace our dying KitchenAid mixer? Remodel the kitchen pantry? Like so many wives before her, she had looked upon my foray into sports gambling with a bemused air of exasperation; now she was seeing a potential upside.

I laughed at her sudden enthusiasm—but I was starting to get ideas myself. I had made $20 on my very first night of gambling. Scale up the wager sizes, multiply across all 272 games in the NFL season, throw in some NBA and college football, and I stood to make—what, $10,000? $20,000? More?

I knew, of course, that I wouldn’t win every bet. But I didn’t see the harm in dreaming. As Annie and I traded home-improvement fantasies, I tried my best not to dwell on the last thing the bishop had said to me: “Be careful.” 

Practically overnight, we took an ancient vice—long regarded as soul-rotting and civilizationally ruinous—put it on everyone’s phone, and made it as normal and frictionless as checking the weather. What could possibly go wrong? [...]

Week Two

Total gambled: $376.00
Down $58.15

If I was going to do this, I decided, I would need a gambling guru—someone to talk me through the basics of sound sports betting (if such a thing existed) and teach me best practices.

The obvious choice was Nate Silver, America’s most famous statistics nerd. Silver first made a name for himself as the founder of 538, an election-forecasting website that accurately predicted the winner of all 50 states in the 2012 presidential campaign. A few years ago, Silver, citing a midlife crisis and political fatigue, discarded the pundit suits, threw on a baseball cap, and started writing more about gambling. He launched a newsletter full of sophisticated sports-betting models and wrote a book about the psychology of successful gamblers. He estimates that he has netted in the “mid–six figures” over the course of his gambling life. If anyone could turn me into a respectable bettor, I figured, it was him.

Before our first call, I sheepishly sent Silver my week-one bet slips. After that first triumphant game, things had gone downhill. Scrolling through DraftKings’ offerings, I had turned into a little kid at a carnival, emptying my parents’ wallet into any ring toss or high striker that caught my eye. I’d taken fliers on games without doing any research, and placed live bets on whatever ESPN happened to be showing when I turned on the TV. On Saturday afternoon, while casually watching a random college-football game with my brother, I bet $10 that the point total wouldn’t go over 52.5, lost, tried to make my money back with a new bet that it wouldn’t go over 61.5, and lost that one too. Of the 14 wagers I’d placed in my first week, I’d won three.

Silver pulled up my slips when we got on the phone, and began to audibly react as he scrolled:

“Okay …”

“Oh.”

“Oh no.” He started laughing.

Is it possible to be emasculated by Nate Silver? Apparently, yes.

Perhaps sensing my humiliation, he tried to soften his assessment. “Look, the nice way to put it is that you’re betting like a recreational bettor.” I took this as a withering insult.

Silver laid out some basic realities of the sports-betting economy. The books effectively charge you about 4.5 percent for every bet you place, he explained, which means it isn’t enough to win 50.1 percent of the time; you have to win 52.5 percent of your bets just to break even, and that’s before taxes. My most obvious mistake, he said, was that I was using only DraftKings. To find edges, I would need to shop for lines across at least three or four books every week.

He gave me other tips, too: Avoid “prop bets” on individual players (Josh Allen to rush for more than 50 yards) and multi-leg parlays, which pay out only if every outcome hits (the Chiefs cover the spread, the Ravens win, and the Chargers score more than 24 points). Props and parlays are how sportsbooks generate most of their profits. “They’re suckers’ bets,” Silver said, which made sense, given that I had already placed several of them.

Live betting—placing wagers in the middle of games—was also a bad idea, he told me, because it leads to gambling based on emotion more than logic. Also, televised games are broadcast on a delay, which means the sportsbooks can adjust lines before you even see what has happened on the field. You are, in effect, betting against people who live 20 seconds in the future.

To guard against emotional betting, Silver suggested a Tuesday-morning ritual: I should sit in a quiet place, study the lines for that week’s games, gather information on injury reports and weather forecasts, and then place $100 bets on the six or seven games I liked best.

Before we hung up, I asked Silver what kind of profit would make it a successful season for me.

He seemed confused by the question. “If you make one penny, that would be better than 98 percent of people over an entire season,” Silver answered, as if this were obvious.

I was taken aback. Hadn’t Silver himself made hundreds of thousands of dollars gambling? Yes, he said, but that was mostly from poker tournaments. Sports betting was a game of razor-thin margins and microscopic edges. NFL football was among the hardest sports to win money on—the lines were too sharp, the teams too evenly matched. Silver told me that, even with his quantish models and prognosticatory brilliance, he would consider it cause to celebrate if he broke even on the season.

by McKay Coppins, The Atlantic |  Read more:
Image: Tyler Comrie/Getty

[ed. See also: The Online Sports Gambling Experiment Has Failed (DS).]

America and Public Disorder, and "The Kill Line"

Two weeks ago, on the blue line to O’Hare, my car had two men smoking joints, a broken woman, her eyes dilated and blank, sitting in a nest of filthy bags smelling of sewage, and a man barking into the void, shirtless, who was washing himself with flour tortillas, which would disintegrate, littering the subway floor, before he took out another and began the same process. This didn't shock me, or anyone else around me, since I'd seen some variation of this dystopian scene on every Chicago metro line I'd ridden, every pedestrian walkway I'd passed through, and on most street corners.

Three weeks ago, in Duluth, half the riders on every bus I took were mentally tortured and/or intoxicated. The downtown Starbucks, pedestrian malls, and shuttered doorways of vacated buildings all housed broken people. Same in Indianapolis, El Paso, New York City, Jacksonville, LA, Phoenix, and almost every community I’ve been to in the U.S., save for those gated by wealth.

An epidemic of mental illness and/or addiction plays out in the U.S. in public, with our streets, buses, parking lots, McDonald’s, parks, and Starbucks as ad hoc institutions for the broken, addicted, and tortured.That is not the case for the rest of the world, including where I am now, Seoul. My train from the airport was spotless, and so is the ten-mile river park I walk each day here, which given that large parts of it are beneath roadways is especially impressive. In the U.S. it would have impromptu homes of tents, cardboard, and tarps, smell of urine, and the exercise spots that dot its length probably couldn’t exist because of a fear of being vandalized.

You can learn more about the U.S. by traveling overseas and comparing, and five years of that has taught me we accept far too much public disorder.

We are the world’s richest country, and yet our buses, parking lots, and city streets are filthy, chaotic, and threatening. Antisocial and abnormal behavior, open addiction, and mentally tortured people are common in almost every community regardless of size.

I’ve written about this many times before, because it is so striking, and it has widespread consequences, beyond the obvious moral judgement that a society should simply not be this way.

It’s a primary reason why we shy away from dense walkable spaces and instead move towards suburban sprawl. People in the U.S. don’t respect, trust, or want to be around other random citizens, out of fear and disgust. Japanese/European style urbanism—density, fantastic public transport, mixed-use zoning, that so many American tourists admire—can't happen here because there is a fine line between vibrant streets and squalid ones, and that line is public trust. The U.S. is on the wrong side of it. Simply put, nobody wants to be accosted by a stranger, no matter how infrequent, and until that risk is close to nil, people will continue edging towards isolated living.

It is why we “can’t have nice things” because we have to construct our infrastructure to be asshole-proof, and so we don’t build anything or build with a fortress mentality, stripping our public spaces down to the austere and utilitarian, emptying them of anything that can be vandalized.

The canonical example of this is La Sombrita, the laughably expensive Los Angeles “bus stop” that was a single pole to provide shade and security lighting, but did neither. La Sombrita exists precisely because it doesn’t do anything, which is the end result of a decades-long process of defensive construction. If you build a nice bus stop it is either immediately broken or turned into shelters for the destitute, and so you stop building those.

Another nice thing we don’t have in the U.S. is public restrooms. We don’t have them out of a justified fear of abuse, which is the same reason many Starbucks lock their restrooms. McDonald’s does this as well, depending on the location, and also even strips them of mirrors in the especially bad communities, to discourage people from using them for an hour-long morning toilet, as well as breaking the mirrors just for the hell of it.

This lack of public restrooms became an issue on Twitter when the latest round of debate about disorder in the U.S. was kicked off when a tweeter noted how offensive it was to have seen someone urinating in a crowded New York subway car.

This debate brought out a lot of absurd arguments, mostly from those trying to shrug it off or suggest it was simply the price of living in a big city.

No, the rest of the world doesn’t tolerate the amount of antisocial behavior we in the U.S. do. If someone were to piss on a subway anywhere else in the world, and very very few ever would want to (more on why below), they are removed from society for a period of time.

We however let people who aren’t mentally competent continue to engage in self-destructive and aberrant behavior without removing them, which consequently ruins it for everyone else, except those wealthy enough to build their own private islands of comfort.

Someone peeing on the subway is not of sound mind, and it isn’t normal behavior by any measure. It’s a sign of distress that should cause an intervention—by police, social workers, whoever—that mandates them into an institution for a period of time, until they regain sanity and stability. For someone actively psychotic —civil commitment to psychiatric hospital. For violent individuals refusing treatment—secure prison facilities with mandatory programs. For severe addiction—medical detox and residential treatment without the ability to walk away.

They should not be allowed to do whatever they want because they cannot control themselves enough to have that freedom. Someone shouting at strangers, someone washing themselves with flour tortillas, someone punching at the air voicing threats shouldn’t, for their own safety and others, be out roaming the streets. [...]

I’ve been very careful up to now not to use the word homeless, because it’s become an overly broad category that covers families in motels with Section 8 vouchers, people sleeping on friends’ couches until they can get back on their feet, mothers with children in long-term shelters, and then those who live in tents under bridges or sleep in a soiled sleeping bag.

Eighty-five percent (or so) of those in this broad category are not causing problems. They are, like most everyone else, doing their best to get by and better themselves. Sure, they have more complicated and chaotic lives than most, but they try to play by the rules as best they can.

Our problems in public spaces come from the fifteen percent or so who fall into the last group—the stubbornly intransigent—which are people who have options for housing but turn them down for a variety of reasons, some driven by mental demons, some by an overwhelming desire to always be on drugs, some simply out of preference to be alone. Others in this category have been ejected from housing because of continual violent and threatening behavior.

They are not, by almost any metric, of sound mind, and shouldn’t be granted the full privileges other citizens have.

The cover photo is John, and he is in this category. He had set himself on fire the day before I met him, freebasing a perc 30, and refused to go to the hospital because he didn’t want to lose his favorite spot behind the garbage bin, since it was only a block away from dealers and perfect to piss in. He had a government room he didn’t use because catching on fire (something he did every now and then) set off smoke alarms. He also thought it was cursed and monitored by the same people who had held him captive on an island in the middle of the Pacific—an island he escaped from three months before by swimming the four hundred miles. He showed me an arm, covered with burns, that he claimed was where a shark had bit him.

John should be mandated into a prison, a mental institution, or a rehab clinic, until he is competent enough to be on his own, not out on the streets in mental and physical pain, setting himself on fire. It is as simple as that, although I understand a change like this comes with additional nuanced policy debate. As for costs, it is more a question of redirecting what we spend rather than finding additional money, because we already spend an immense amount on this problem—the New York City budget for homeless services is four billion—without 'solving' it.

Even if you put aside the destruction this type of behavior has done to broader society, and your concerns are only focused on the health and welfare of the stubbornly intransigent, then our current system is still deeply wrong. We are not providing them justice by allowing them to choose a public display of mental misery, where the self harm they can do is far greater than when being monitored.

Beneath all this discussion is the additional question of why we in the U.S. have so many mentally unstable people, why so many are addicted to drugs, why so many people are OK with doing shocking things.

by Chris Arnade, Walks the World | Read more:
Images: X/uncredited

[ed. We've lost the plot. Or not. Maybe this is just an accurate reflection of this country's priorities over the last 50 years or so. Even worse, with AI just around the corner, it's going to get a lot worse unless our government starts working for its people again (and our people start working for our country again, beginning with acknowledging their own civic duties and responsibilities that go beyond simply paying taxes, gaming the system, and trying to make as much money as possible). From the comments:]

***

One of the things travel does best is remove the normalization filter we build at home. When you move between countries long enough, patterns that once felt “just how things are” start to look like choices societies have made - or failed to make.

What strikes me in pieces like this is not the comparison itself, but the discomfort it creates. Clean transit systems, safe public spaces, and functioning streets aren’t cultural miracles; they’re outcomes of priorities, incentives, and sustained public decisions. When those systems break down, the result isn’t abstract policy failure - it’s visible human suffering playing out in the most ordinary places.

Travel doesn’t just show us new landscapes. It quietly exposes which problems we’ve decided to tolerate.

***

[ed. See also: The Kill Line: Why China Is Suddenly Obsessed With American Poverty (NYT).]

Chinese commentators are talking a lot these days about poverty in the United States, claiming China’s superiority by appropriating an evocative phrase from video game culture.

The phrase, “kill line,” is used in gaming to mark the point where the condition of opposing players has so deteriorated that they can be killed by one shot. Now, it has become a persistent metaphor in Communist Party propaganda.

“Kill line” has been used repeatedly on social media and commentary sites, as well as news outlets linked to the state. It has gained traction in China to depict the horror of American poverty — a fatal threshold beyond which recovery to a better life becomes impossible. The phrase is used as a metaphor to encompass homelessness, debt, addiction and economic insecurity. In its official use, the “kill line” hovers over the heads of Americans but is something Chinese people don’t have to fear. [...]

The power is in the simplicity of what it describes: an abrupt threshold where misery begins and a happy life is irreversibly lost. The narrative is meant to offer China’s people emotional relief while attempting to deflect criticism of its leaders.

The worse things look across the Pacific, the logic of the propaganda goes, the more tolerable present struggles become. [...]

The fact is that societal inequality is a problem in both China and the United States. And the American economy no doubt leaves many people in fragile positions. The causes are complex.

Yet in China, poverty is experienced and perceived differently. In most Chinese cities, street begging and visible homelessness are tightly managed, making them far less prominent in daily life. Many urban residents encounter such scenes only through foreign reporting, rebroadcast by Chinese state media, about the United States and other places. [...]

When I was growing up in China in the early 1980s, my family subscribed to China Children’s News, which ran a weekly column with a simple slogan: “Socialism is good; capitalism is bad.” It described seniors in American cities scavenging for food, and homeless people freezing to death. Those stories were not invented, but they lacked context and were presented as the dominant experiences in American society. Much of Chinese society was still closed off from the world, and reliable information was scarce.

That many people accepted such narratives was hardly surprising. What’s striking is that similar portrayals continue to resonate today, when access to information is relatively much greater despite state control.

The formula is simple: magnify foreign suffering to deflect from domestic problems. That approach is taking shape today around the “kill line” metaphor.

The phrase is believed to have been first popularized in this new context on the Bilibili video platform in early November by a user known as Squid King. In a five-hour video, he stitched together what he claimed were firsthand encounters of poverty from time he spent in the United States. His video used scenes of children knocking on doors on a cold Halloween night asking for food, delivery workers suffering from hunger because of their meager wages and injured laborers discharged from hospitals because they could not pay.

The scenes were presented not as isolated cases but as evidence of a system: Above the “kill line,” life continues; below it, society stops treating people as human.

The narrative spread beyond the Squid King video, and many people online repeated his anecdotes. Essays on the nationalist news site Guancha and China’s biggest social media platform, WeChat, described the “kill line” as the “real operating logic” of American capitalism. [...]

In many of the commentaries, anecdotes about Americans experiencing abrupt financial crises are followed by comparisons with China. Universal basic health care, minimum subsistence guarantees and poverty alleviation campaigns are cited as evidence that China does not permit anyone to fall into sudden distress.

“China’s system will not allow a person to be ‘killed’ by a single misfortune,” one commentary from a provincial propaganda department states.

Many readers expressed shock at American poverty and gratitude for China’s system. “At least we have a safety net,” said one commenter...

“A topic does not gain traction simply because people are foolish,” one person wrote on WeChat. “Often, it spreads because confronting reality is harder.”

by Li Yuan, NY Times |  Read more:

Image: Doris Liou

Tomorrow’s Smart Pills Will Deliver Drugs and Take Biopsies

One day soon, a doctor might prescribe a pill that doesn’t just deliver medicine but also reports back on what it finds inside you—and then takes actions based on its findings.

Instead of scheduling an endoscopy or CT scan, you’d swallow an electronic capsule smaller than a multivitamin. As it travels through your digestive system, it could check tissue health, look for cancerous changes, and send data to your doctor. It could even release drugs exactly where they’re needed or snip a tiny biopsy sample before passing harmlessly out of your body.

This dream of a do-it-all pill is driving a surge of research into ingestible electronics: smart capsules designed to monitor and even treat disease from inside the gastrointestinal (GI) tract. The stakes are high. GI diseases affect tens of millions of people worldwide, including such ailments as inflammatory bowel disease, celiac disease, and small intestinal bacterial overgrowth. Diagnosis often involves a frustrating maze of blood tests, imaging, and invasive endoscopy. Treatments, meanwhile, can bring serious side effects because drugs affect the whole body, not just the troubled gut.

If capsules could handle much of that work—streamlining diagnosis, delivering targeted therapies, and sparing patients repeated invasive procedures—they could transform care. Over the past 20 years, researchers have built a growing tool kit of ingestible devices, some already in clinical use. These capsule-shaped devices typically contain sensors, circuitry, a power source, and sometimes a communication module, all enclosed in a biocompatible shell. But the next leap forward is still in development: autonomous capsules that can both sense and act, releasing a drug or taking a tissue sample.

That’s the challenge that our lab—the MEMS Sensors and Actuators Laboratory (MSAL) at the University of Maryland, College Park—is tackling. Drawing on decades of advances in microelectromechanical systems (MEMS), we’re building swallowable devices that integrate sensors, actuators, and wireless links in packages that are small and safe enough for patients. The hurdles are considerable: power, miniaturization, biocompatibility, and reliability, to name a few. But the potential payoff will be a new era of personalized and minimally invasive medicine, delivered by something as simple as a pill you can swallow at home. [...]

Targeted drug delivery is one of the most compelling applications for ingestible capsules. Many drugs for GI conditions—such as biologics for inflammatory bowel disease—can cause serious side effects that limit both dosage and duration of treatment. A promising alternative is delivering a drug directly to the diseased tissue. This localized approach boosts the drug’s concentration at the target site while reducing its spread throughout the body, which improves effectiveness and minimizes side effects. The challenge is engineering a device that can both recognize diseased tissue and deliver medication quickly and precisely.

With other labs making great progress on the sensing side, we’ve devoted our energy to designing devices that can deliver the medicine. We’ve developed miniature actuators—tiny moving parts—that meet strict criteria for use inside the body: low power, small size, biocompatibility, and long shelf life.

Some of our designs use soft and flexible polymer “cantilevers” with attached microneedle systems that pop out from the capsule with enough force to release a drug, but without harming the intestinal tissue. While hollow microneedles can directly inject drugs into the intestinal lining, we’ve also demonstrated prototypes that use the microneedles for anchoring drug payloads, allowing the capsule to release a larger dose of medication that dissolves at an exact location over time.

In other experimental designs, we had the microneedles themselves dissolve after injecting a drug. In still others, we used microscale 3D printing to tailor the structure of the microneedles and control how quickly a drug is released—providing either a slow and sustained dose or a fast delivery. With this 3D printing, we created rigid microneedles that penetrate the mucosal lining and gradually diffuse the drug into the tissue, and soft microneedles that compress when the cantilever pushes them against the tissue, forcing the drug out all at once.

by Reza Ghodssi, Justin Stine, Luke Beardslee, IEEE Spectrum |  Read more:

Image: Maximilian Franz/Engineering at Maryland Magazine

Alcohol Death Rates in Europe

Source: Institute for Health Metrics and Evaluation (OWID)
via:
[ed. A few surprises.]

"Alcohol death rates in Europe. Apparently very low in cultures where drunkenness is frowned upon and where alcohol is only consumed in company of others and served alongside meals. Spain and Italy for example." via:

I Regret to Inform You that the FDA is FDAing Again

I had high hopes and low expectations that the FDA under the new administration would be less paternalistic and more open to medical freedom. Instead, what we are getting is paternalism with different preferences. In particular, the FDA now appears to have a bizarre anti-vaccine fixation, particularly of the mRNA variety (disappointing but not surprising given the leadership of RFK Jr.).

The latest is that the FDA has issued a Refusal-to-File (RTF) letter to Moderna for their mRNA influenza vaccine, mRNA-1010. An RTF means the FDA has determined that the application is so deficient it doesn’t even warrant a review. RTF letters are not unheard of, but they’re rare—especially given that Moderna spent hundreds of millions of dollars running Phase 3 trials enrolling over 43,000 participants based on FDA guidance, and is now being told the (apparently) agreed-upon design was inadequate. [...]

In context, this looks like the regulatory rules of the game are being changed retroactively—a textbook example of regulatory uncertainty destroying option value. STAT News reports that Vinay Prasad personally handled the letter and overrode staff who were prepared to proceed with review. Moderna took the unusual step of publicly releasing Prasad’s letter—companies almost never do this, suggesting they’ve calculated the reputational risk of publicly fighting the FDA is lower than the cost of acquiescing.

Moreover, the comparator issue was discussed—and seemingly settled—beforehand. Moderna says the FDA agreed with the trial design in April 2024, and as recently as August 2025 suggested it would file the application and address comparator issues during the review process.

Finally, Moderna also provided immunogenicity and safety data from a separate Phase 3 study in adults 65+ comparing mRNA-1010 against a licensed high-dose flu vaccine, just as FDA had requested—yet the application was still refused.

What is most disturbing is not the specifics of this case but the arbitrariness and capriciousness of the process. The EU, Canada, and Australia have all accepted Moderna’s application for review. We may soon see an mRNA flu vaccine available across the developed world but not in the United States—not because it failed on safety or efficacy, but because FDA political leadership decided, after the fact, that the comparator choice they inherited was now unacceptable.

The irony is staggering. Moderna is an American company. Its mRNA platform was developed at record speed with billions in U.S. taxpayer support through Operation Warp Speed — the signature public health achievement of the first Trump administration. The same government that funded the creation of this technology is now dismantling it. In August, HHS canceled $500 million in BARDA contracts for mRNA vaccine development and terminated a separate $590 million contract with Moderna for an avian flu vaccine. Several states have introduced legislation to ban mRNA vaccines. Insanity.

The consequences are already visible. In January, Moderna’s CEO announced the company will no longer invest in new Phase 3 vaccine trials for infectious diseases: “You cannot make a return on investment if you don’t have access to the U.S. market.” Vaccines for Epstein-Barr virus, herpes, and shingles have been shelved. That’s what regulatory roulette buys you: a shrinking pipeline of medical innovation.

An administration that promised medical freedom is delivering medical nationalism: fewer options, less innovation, and a clear signal to every company considering pharmaceutical investment that the rules can change after the game is played. And this isn’t a one-product story. mRNA is a general-purpose platform with spillovers across infectious disease and vaccines for cancer; if the U.S. turns mRNA into a political third rail, the investment, talent, and manufacturing will migrate elsewhere. America built this capability, and we’re now choosing to export it—along with the health benefits.

by Alex Tabarrok, Marginal Revolution |  Read more:

Image: Brian Snyder/Reuters

[ed. See also: F.D.A. Refuses to Review Moderna Flu Vaccine (NYT); and, Trump official overruled FDA scientists to reject Moderna’s flu shot (Ars Technica).]

Why Even the Healthiest People Hit a Wall at Age 70

Are we currently determining how much of aging is lifestyle changes and interventions and how much of it is basically your genetic destiny?

 

[Transcript:] We are constantly being bombarded with health and lifestyle advice at the moment. I feel like I cannot open my social media feeds without seeing adverts for supplements or diet plans or exercise regimes. And I think that this really is a distraction from the big goals of longevity science. This is a really difficult needle to thread when it comes to talking about this stuff because I'm a huge advocate for public health. I think if we could help people eat better, if we could help 'em do more exercise, if we could help 'em quit smoking, this would have enormous effects on our health, on our economies all around the world. But this sort of micro-optimization, these three-hour long health podcasts that people are digesting on a daily basis these days, I think we're really majoring in the minors. We're trying to absolutely eke out every last single thing when it comes to living healthily. And I think the problem is that there are real limits to what we can do with health advice. 

So for example, there was a study that came out recently that was all over my social media feeds. And the headline was that by eating the best possible diet, you can double your chance of aging healthily. But I decided to dig into the results table. The healthiest diet was something called the Alternative Healthy Eating Index or AHEI. And even the people who are sticking most closely to this best diet, according to this study, the top 20% of adherence to the AHEI, only 13.6% of them made it to 70 years old without any chronic diseases. That means that over 85% of the people sticking to the best diet, according to this study, got to the age of 70 with at least something wrong with them. And that shows us that optimizing diet only has so far it can go. 

We're not talking about immortality or living to 120 here. If you wanna be 70 years old and in good enough health to play with your grandkids, I cannot guarantee that you can do that no matter how good your diet is. And that's why we need longevity medicine to help keep people healthier for longer. And actually, I think even this idea of 120, 150-year-old lifespans, you know, immortality even as a word that's often thrown around, I think the main thing we're trying to do is get people to 80, 90 years old in good health. 'cause we already know that most people alive today, when they reach that age, are unfortunately gonna be frail. They're probably gonna be suffering from two or three or four different diseases simultaneously. And what we wanna do is try and keep people healthier for longer. And by doing that, they probably will live longer but kind of as a side effect. 

If you look at photographs of people from the past, they often look older than people in the present day who are the same age. And part of these are these terrible fashion choices that people made in the past. And we can look back and, you know, understand the mistakes they've made with hindsight. But part of that actually is aging biology. I think the fact that people can be different biological ages at the same chronological ages, something that's really quite intuitive. All of us know people who've waltzed into their 60s looking great and, you know, basically as fit as someone in their 40s or 50s. And we know similar people who have also gone into their 60s, but they're looking haggard, they've got multiple different diseases, they're already struggling through life. 

In the last decade, scientists have come up with various measures of what's called biological age as distinct from chronological age. So your chronological age is just how many candles there are on your birthday cake. And obviously, you know, most of us are familiar with that. But the idea of biological age is to look inside your cells, look inside your body, and work out how old you are on a biological level. Now we aren't perfect at doing this yet, but we do have a variety of different measures. We can use blood tests, we can use what are called epigenetic tests, or we can do things that are far more sort of basic and functional, how strong your grip is declines with age. And by comparing the value of something like your grip strength to an average person of a given age, we can assign you a biological age value. And I think the ones that are getting the most buzz at the moment within the scientific community, but also all around the internet, are these epigenetic age tests. 

So the way that this works is that you'll take a blood test or a saliva sample and scientists will measure something about your epigenome. So the genome is your DNA, it's the instruction manual of life. And the epigenome is a layer of chemistry that sits on top of your genome. If you think of your DNA is that instruction manual, then the epigenome is the notes in the margin. It's the little sticky notes that have been stuck on the side and they tell the cell which DNA to use at which particular time. And we know that there are changes to this epigenome as you get older. And so by measuring the changes in the epigenome, you can assign someone a biological age. 

At the moment, these epigene clocks are a really great research tool. They're really deepening our understanding of biological aging in the lab. I think the problem with these tests as applied to individuals is we don't know enough about exactly what they're telling us. We don't know what these individual changes in epigenetic marks mean. We know they're correlated with age, but what we don't know is if they're causally related. And in particular, we don't know if you intervene, if you make a change in your lifestyle, if you start taking a certain supplement and that reduces your biological age. We don't know whether that actually means you're gonna dilate or whether it means you're gonna stay healthier for longer or whether you've done something that's kind of adjacent to that. And so we need to do more research to understand if we can causally impact these epigenetic measures. (...)

Machine learning and artificial intelligence are gonna be hugely, hugely important in understanding the biology of aging. Because the body is such a complicated system that in order to really understand it, we're gonna need these vast computer models to try and decode the data for us. The challenge is that what machine learning can do at the moment is it can identify correlations. So it can identify things that are associated with aging, but it can't necessarily tell us what's causing something else. So for example, in the case of these epigenetic clocks, the parts of the epigenome that change with age have been identified because they correlate. But what we don't know is if you intervene in any one of these individual epigenetic marks, if you move it in the direction of something younger, does that actually make people healthier? And so what we need to do is more experiments where we try and work out if we can intervene in these epigenetic, in these biological clocks, can we make people live healthier for longer? 

Over the last 10 or 15 years, scientists have really started to understand the fundamental underlying biology of the aging process. And they broke this down into 12 what are called hallmarks of aging. One of those hallmarks is the accumulation of senescent cells. Now senescent is just a biological technical term for old. These are cells that accumulate in all of our bodies as the years go by. And scientists have noticed that these cells seem to drive a range of different diseases as we get older. And so the idea was what if we could remove these cells and leave the rest of the cells of the body intact? Could that slow down or even partially reverse the aging process? And scientists identified drugs called it senolytic drugs. 

These are drugs that kill those senescent cells and they tried them out in mice and they do indeed effectively make the mice biologically younger. So if you give mice a course of senolytic drugs, it removes those senescent cells from their body. And firstly, it makes them live a bit longer. That's a good thing if you're slowing down the aging process, the basic thing you want to see. But it's not dragging out that period of frailty at the end of life. It's keeping the mice healthier for longer so they get less cancer, they get less heart disease, they get fewer cataracts. The mice are also less frail. They basically send the mice to a tiny mouse-scale gym in these experiments. And the mice that have been given the drugs, they can run further and faster on the mousey treadmills that they try them out on. 

It also seems to reverse some of the cognitive effects that come along with aging. So if you put an older mouse in a maze, it's often a bit anxious, doesn't really want to explore. Whereas a younger mouse is desperate to, you know, run around and find the cheese or whatever it is mice doing in mazes. And by giving them these senolytic drugs, you can unlock some of that youthful curiosity. And finally, these mice just look great. You do not need to be an expert mouse biologist to see which one has had the pills and which one hasn't. They've got thicker fur. They've got plumper skin. They've got brighter eyes. They've got less fat on their bodies. And what this shows us is that by targeting the fundamental processes of aging, by identifying something like senescent cells that drives a whole range of age-related problems, we can hit much perhaps even all of the aging process with a single treatment. 

Senescent cells are, of course, only one of these 12 hallmarks of aging. And I think in order to both understand and treat the aging process, we're potentially gonna only treatments for many, perhaps even all of those hallmarks. There's never gonna be a single magic pill that can just make you live forever. Aging is much, much more complicated than that. But by understanding this relatively short list of underlying processes, maybe we can come up with 12, 20 different treatments that can have a really big effect on how long we live. 

One of the most exciting ideas in longevity science at the moment is what's called cellular reprogramming. I sometimes describe this as a treatment that has fallen through a wormhole from the future. This is the idea that we can reset the biological clock inside of our cells. And the idea first came about in the mid 2000s because there was a scientist called Shinya Yamanaka who was trying to find out how to turn regular adult body cells all the way back to the very beginning of their biological existence. And Yamanaka and his team were able to identify four genes that you could insert into a cell and turn back that biological clock. 

Now, he was interested in this from the point of view of creating stem cells, a cell that can create any other kind of cell in the body, which we might be able to use for tissue repair in future. But scientists also noticed, as well as turning back the developmental clock on these cells, it also turns back the aging clock, cells that are given these four Yamanaka factors actually are biologically younger than cells that haven't had the treatment. And so what scientists decided to do was insert these Yamanaka factor genes into mice. 

Now if you do this in a naive way, so there's genes active all the time, it's actually very bad news for the mice, unfortunately. because these stem cells, although they're very powerful in terms of what kind of cell they can become, they are useless at being a liver cell or being a heart cell. And so the mice very quickly died of organ failure. But if you activate these genes only transiently, and the way that scientists did it the first time successfully was essentially to activate them at weekends. So they produced these genes in such a way that they could be activated with the drug and they gave the mice the drug for two days of the week, and then gave them five days off so the Yamanaka factors were then suppressed. They found that this was enough to turn back the biological clock in those cells, but without turning back the developmental clock and turn them into these stem cells. And that meant the mice stayed a little bit healthier. We now know that they can live a little bit longer with this treatment too.

Now the real challenge is that this is a gene therapy treatment. It involves delivering four different genes to every single cell in your body. The question is can we, with our puny 2020s biotechnology, make this into a viable treatment, a pill even, that we can actually use in human beings? I really think this idea of cellular reprogramming appeals to a particular tech billionaire sort of mentality. The idea that we can go in and edit the code of life and reprogram our biological age, it's a hugely powerful concept. And if this works, the fact that you can turn back the biological clock all the way to zero, this really is a very, very cool idea. And that's what's led various different billionaires from the Bay Area to invest huge, huge amounts of money in this. 

Altos Labs is the biggest so-called startup in this space. And I wouldn't really call it a startup 'cause it's got funding of $3 billion from amongst other people, Jeff Bezos, the founder of Amazon. Now I'm very excited about this because I think $3 billion is enough to have a good go and see if we can turn this into a viable human treatment. My only concern is that epigenetics is only one of those hallmarks of aging. And so it might be the case that we solve aging inside our individual cells, but we leave other parts of the aging process intact. (...)

Probably the quickest short-term wins in longevity science are going to be repurposed existing drugs. And the reason for this is because we spent many, many years developing these drugs. We understand how they work in humans. We understand a bit about their safety profile. And because these molecules already exist, we've just tried them out in mice, in, you know, various organisms in the lab and found that a subset of them do indeed slow down the aging process. The first trial of a longevity drug that was proposed in humans was for a drug called metformin, which is a pre-existing drug that we prescribe actually for diabetes in this case, and has some indications that it might slow down the aging process in people. (...)

I think one of the ones that's got the most buzz around it at the moment is a drug called rapamycin. This is a drug that's been given for organ transplants. It's sometimes used to coat stents, which these little things that you stick in the arteries around your heart to expand them if you've got a contraction of those arteries that's restricting the blood supply. But we also know from experiments in the lab that can make all kinds of different organisms live longer, everything from single-cell yeast, to worms, to flies, to mice, to marmoset, which are primates. They're very, very evolutionarily close to us as one of the latest results. 

Rapamycin has this really incredible story. It was first isolated in bacteria from a soil sample from Easter Island, which is known as Rapa Nui in the local Polynesians. That's where the drug gets its name. And when it was first isolated, it was discovered to be antifungal. It could stop fungal cells from growing. So that was what we thought we'd use it for initially. But when the scientists started playing around with in the lab, they realized it didn't just stop fungal cells from growing. It also stopped many other kinds of cells as well, things like up to and including human cells. And so the slight disadvantage was that if you used it as an antifungal agent, it would also stop your immune cells from being able to divide, which is obviously be a bit of a sort of counterintuitive way to try and treat a fungal disease. So scientists decided to use it as an immune suppressant. It can stop your immune system from going haywire when you get an organ transplant, for example, and rejecting that new organ. 

It is also developed as an anti-cancer drug. So if it can stop cells dividing or cancer as cells dividing out of control. But the way that rapamycin works is it targets a fundamental central component of cellular metabolism. And we noticed that that seemed to be very, very important in the aging process. And so by tamping it down by less than you would do in a patient where you're trying to suppress their immune system, you can actually rather than stopping the cell dividing entirely, you can make it enter a state where it's much more efficient in its use of resources. It starts this process called autophagy, which is Greek for self-eating, autophagy. And that means it consumes old damaged proteins, and then recycles them into fresh new ones. And that actually is a critical process in slowing down aging, biologically speaking. And in 2009, we found out for the first time that by giving it to mice late in life, you could actually extend their remaining lifespan. They live by 10 or 15% longer. And this was a really incredible result. 

This was the first time a drug had been shown to slow down aging in mammals. And accordingly, scientists have become very, very excited about it. And we've now tried it in loads of different contexts and loads of different animals and loads of different organisms at loads of different times in life. You can even wait until very late in a mouse lifespan to give it rapamycin and you still see most of that same lifespan extension effect. And that's fantastic news potentially for us humans because not all of us, unfortunately, can start taking a drug from birth 'cause most of us were born quite a long time ago. But rapamycin still works even if you give it to mice who are the equivalent of 60 or 70 years old in human terms. And that means that for those of us who are already aged a little bit, Rapamycin could still help us potentially. And there are already biohackers out there trying this out for themselves, hopefully with the help of a doctor to make sure that they're doing everything as safely as possible to try and extend their healthy life. And so the question is: should we do a human trial of rapamycin to find out if it can slow down the aging process in people as well? (...)

We've already got dozens of ideas in the lab for ways to slow down, maybe even reverse the age of things like mice and cells in a dish. And that means we've got a lot of shots on goal. I think it'll be wildly unlucky if none of the things that slow down aging in the lab actually translate to human beings. That doesn't mean that most of them will work, probably most of them won't, but we only need one or two of them to succeed and really make a big difference. And I think a great example of this is GLP-1 drugs, the ozempics, the things that are allowing people to suddenly lose a huge amount of weight. We've been looking for decades for these weight loss drugs, and now we finally found them. It's shown that these breakthroughs are possible, they can come out of left field. And all we need to do in some cases is a human trial to find out if these drugs actually work in people. 

And what that means is that, you know, the average person on planet earth is under the age of 40. They've probably got 40 or 50 years of life expectancy left depending on the country that they live in. And that's an awful lot of time for science to happen. And if then in the next 5 or 10 years, we do put funding toward these human trials, we might have those first longevity drugs that might make you live one or two or five years longer. And that gives scientists even more time to develop the next treatment. And if we think about some more advanced treatments, not just drugs, things like stem cell therapy or gene therapy, those things can sound pretty sci-fi. But actually, we know that these things are already being deployed in hospitals and clinics around the world. They're being deployed for specific serious diseases, for example, where we know that a single gene can be a problem and we can go in and fix that gene and give a child a much better chance at a long, healthy life. 

But as we learn how these technologies work in the context of these serious diseases, we're gonna learn how to make them effective. And most importantly, we're gonna learn how to make them safe. And so we could imagine doing longevity gene edits in human beings, perhaps not in the next five years, but I think it'll be foolish to bet against it happening in the next 20 years, for example. 

by Andrew Steele, The Big Think |  Read more:

Image: Yamanka factors via:

[ed. See also: Researchers Are Using A.I. to Decode the Human Genome (NYT).]

Growing Pains: Taking the Magic Out of Mushrooms

‘The attrition is setting in’: how Oregon’s magic mushroom experiment lost its way.

Jenna Kluwe remembers all the beautiful moments she saw in a converted dental clinic in east Portland.

For six months, she managed the Journey Service Center, a “psilocybin service center” where adults 21 and older take supervised mushroom trips. She watched elderly clients with terminal illnesses able to enjoy life again. She saw one individual with obsessive compulsive disorder so severe they spent hours washing their hands who could casually eat food that fell on the floor.

“It’s like five years of therapy in five hours,” Kluwe, a former therapist from Michigan, said.

In 2020, Oregon made history by becoming the first US state to legalize the use of psilocybin in a supervised setting, paving the way for magic mushrooms to treat depression, PTSD and other mental health challenges. A flurry of facilities like the Journey Service Center, as well as training centers for facilitators to guide the sessions, sprung up across the state.

But five years later, the pioneering industry is grappling with growing pains. Kluwe recalled how early last year, her business partner abruptly told her the center was out of money and would close in March – the first in a wave of closures that set off alarms about the viability of Oregon’s program.

The Journey Service Center isn’t alone. The state’s total number of licensed service centers has dropped by nearly a third, to 24, since Oregon’s psilocybin program launched in 2023. The state’s 374 licensed facilitators, people who support clients during sessions, similarly fell. And just this week, Portland’s largest “shroom room” – an 11,000 sq ft venue with views of Mt Hood offering guided trips in addition to corporate retreats – reportedly closed down.

“The attrition is setting in, and a lot of people are not renewing their license because it is hard to make money,” said Gary Bracelin, the owner of Drop Thesis Psilocybin Service Center.

Many worry about how the program’s rules and fees have pushed the cost of a psilocybin session as high as $3,000, putting it out of reach for many just as psychedelics are gaining mainstream acceptance as a mental health treatment. Insurance typically doesn’t cover sessions, meaning people have to pay out of pocket.

Furthermore, the industry is struggling to reach a diverse group of clients: state data show that most people who’ve taken legal psilocybin in Oregon are white, over 44 and earn more than roughly $95,000 or more a year.

Depending on who you ask, these are either signs of an experiment buckling under hefty rules and fees – or a landmark program finding its footing.

“It’s not totally shocking for a brand new program to have a higher price tag,” said Heidi Pendergast, Oregon director of advocacy group Healing Advocacy Fund. She added: “I think that any new industry would see this sort of opening and closing.”

Pendergast pointed to data showing the program is safe with severe reactions vanishingly rare among the estimated 14,000 people who have taken legal psilocybin in the state since mid-2023.

Some practitioners, however, say the state has a long way to go to realize the program’s promises, while other centers are experimenting with new ways to keep costs down, broaden their clientele, and integrate with the mainstream medical system.

‘Some of them are total overkill’

Legal psilocybin seemed like a natural fit for Bracelin. The self-described serial entrepreneur previously founded a cannabis dispensary chain and did sales and marketing for outdoor products during snowboarding’s early days. When the program launched, he started jumping through the many hoops for Drop Thesis to start taking clients in January 2024.

The first obstacle, he said, was finding a property that met the state’s requirements to be more than 1,000 feet from a school and not located in a residential area – with a landlord willing to rent for the center. Bracelin said more than a dozen landlords turned him down before he found a spot. Then there was the challenge of getting insurance for a business centered on a federally illegal drug. The center used private funders instead of banks, he said.

Drop Thesis charges $2,900 for a session, which can last up to six hours as well as before and after meetings with a facilitator, while offering discounts to veterans and during Pride Month as well as one monthly scholarship that covers the full price, Bracelin said.

Factored into the price of a session is the cost of a facilitator and a “licensee representative” who walks clients through paperwork and other requirements. State rules require centers to pay a $10,000 annual licensing fees, install surveillance cameras, alarm systems and securely store mushrooms in safes.

“Some [rules] are definitely justified,” Bracelin said. “And some of them are total overkill, out of fear from people who don’t understand the product.”...

Adding to regulatory hurdles is the fact that Oregon’s local governments can ask voters to ban psilocybin businesses, creating a patchwork of bans in 25 of Oregon’s 36 counties and in dozens of cities.

Angela Allbee, the manager of Oregon’s psilocybin program, said in an emailed statement that the state became the first to enact regulations for a drug that’s federally illegal, and those regulations were written with broad input that have proven safe. As more data and feedback come in, the state will consider adjusting the rules, she said...

Although psilocybin is associated with mental health concerns, the 2020 ballot initiative that created Oregon’s program was designed to keep it outside of the medical system. Now, many supporters say it needs an outside source of cash, which could come from integration with the medical system.

Oregon lawmakers earlier this year took a first step toward making that a reality.

by Jake Thomas, The Guardian |  Read more:

Images: uncredited/Jake Thomas 

K-Beauty Boom Explodes

On a recent Saturday at an Ulta Beauty store in midtown Manhattan, Denise McCarthy, a mother in her 40s, stood in front of a wall of tiny pastel bottles, tubes and compacts. Her phone buzzed — another TikTok from her 15-year-old daughter.

“My kids text me the TikToks,” she told CNBC, scooping Korean lip tints and sunscreens into her basket, destined for Christmas stockings. “I don’t even know what half of this does. I just buy the ones they send me.”

Two aisles over, a group of college students compared swatches of Korean cushion foundations. A dad asked a store associate whether a viral Korean sunscreen was the one “from the girl who does the ‘get ready with me’ videos.” Near the checkout, a display of Korean sheet mask mini-packs was nearly empty.

Scenes like this are playing out across the country.

Once a niche reserved for beauty obsessives, Korean cosmetics — known as K-beauty — are breaking fully into the American mainstream, fueled by TikTok virality, younger and more diverse shoppers, and aggressive expansion from retailers such as Ulta, Sephora, Walmart and Costco.

K-beauty sales in the United States are expected to top $2 billion in 2025, up more than 37% from last year, according to market research firm NielsenIQ, far outpacing the broader beauty market’s single-digit growth.

And even as trade tensions complicate supply chains, brands and retailers told CNBC the momentum is strong.

“We have no plans of slowing down and see more opportunities to penetrate the market,” said Janet Kim, vice president at K-beauty brand Neogen.

In the first half of 2025, South Korea shipped a record $5.5 billion worth of cosmetics, up nearly 15% year over year, and has become the leading exporter of cosmetics to the U.S., surpassing France, according to data from the South Korean government.

“The growth has been remarkable,” said Therese-Ann D’Ambrosia, vice president of beauty and personal care at NielsenIQ. “When you compare that to the broader beauty market, which is growing at single digits, K-beauty is clearly operating in a different gear right now.” (...)

The ‘second wave’

Over the past decade, there’s also been a rise in Korean entertainment in the U.S. — from pop groups such as BTS and Blackpink to this year’s Netflix hit “KPop Demon Hunters” —which has helped push South Korea’s cultural exports to unprecedented popularity.

“Korean culture has exploded on every front, and that has really shown up when it comes to K-beauty,” Dang said.

K-beauty’s “first wave,” which hit the U.S. in the mid-2010s, was defined by “glass skin,” 10-step routines, snail mucin, cushion compacts and beauty blemish creams. Most products catered to lighter skin tones, and distribution was limited to small boutiques, Amazon sellers and early test placements at Ulta and Sephora, beauty experts said.

“The first wave had some penetration, but nothing like today,” Horvath said. “It was mostly people in the know.”

The second wave has been bigger, faster and far more inclusive. It has spanned color cosmetics, hair and scalp care, body care, fragrances and high-tech devices.

TikTok is the central engine of discovery, especially for Gen Z and millennial shoppers, who account for roughly three-fourths of K-beauty consumers, according to a Personal Care Insights market analyst report. Posts tagged “K-beauty” or “Korean skin care” draw 250 million views per week, according to consumer data firm Spate. And viral products with sleek packaging often vanish from shelves faster than retailers can restock — particularly those that combine gentle formulas and low prices, Dang said.

“TikTok has changed the game,” Horvath said. “It’s easier to educate consumers on innovation and get the word out. Brands are deeply invested in paying influencers, and TikTokers talk about textures, formulas and efficacy.” (...)

The trend is visible across the Americas: 61% of consumers in Mexico and nearly half in Brazil say K-beauty is popular in their country, compared with about 45% in the U.S., according to Statista.

“Traditional retail and e-commerce remain important, but TikTok Shop is the standout disruptor,” said Nielsen’s D’Ambrosia. “It’s not just about the direct sales on that one platform; it’s about how it’s changing the entire discovery and purchase journey.”

But the second wave brings its own risks. A heavy dependence on virality could expose brands to sudden algorithm changes or regulatory scrutiny, D’Ambrosia said.

“When you have so much growth concentrated on one platform [such as TikTok], algorithm changes could significantly impact discoverability overnight,” D’Ambrosia said. “We’ve seen what happens when platforms tweak their recommendation engines. ... There are definitely some caution flags we’re watching.”

Rapid innovation

K-beauty’s staying power, Dang said, is rooted in an intensely competitive domestic Korean market. Trends move at breakneck speed and consumers spend more per capita on beauty than in any other country, according to South Korean research firm KOISRA.

South Korea had more than 28,000 licensed cosmetics sellers in 2024 — nearly double that of five years ago — creating a pressure-cooker environment that forces constant experimentation, said Neogen’s Kim.

“We develop about hundreds of formulas each day,” Kim told CNBC. “We build the library and we test results with clinical individual tests. ... Everything that’s very unique and works really well for skin care, we develop.”

Korean consumers churn through trends quickly, fueling a pipeline of upstart brands that can go viral and, in some cases, get acquired. For example, when gooey snail mucin, a gel used to protect and repair people’s skin, took off globally, skin care brand Amorepacific acquired COSRX, the small Korean brand that helped popularize the ingredient, for roughly $700 million.

The next wave of products, analysts predict, are likely to be even more experimental.

Brands are betting on buzzy ingredients such as DNA extracted from salmon or trout sperm that early research suggests may help calm or repair skin. They are also expanding into biotechnology.

“K-beauty is very data-driven. [Artificial intelligence] helps us get fast results for content, formula development, and advertising,” Kim said. “In Korea, they started talking about delivery systems. They’re very good with biotechnology.”

by Luke Fountain, CNBC |  Read more:

Image: Avila Gonzalez | San Francisco Chronicle | Hearst Newspapers | Getty Images

Every Wrinkle is a Policy Failure

A lot of people blame their frown lines on their job, the tanning salon, or aging. I blame the government.

There’s a treatment for wrinkles—Botox and similar toxins that freeze your face in place.. It can be pricey. The average price of a Botox treatment is above $400, depending on how many doses or units you get injected. But Botox isn’t patented so why is it still so expensive?

 

Some of the cost comes from buying the chemical itself. Allergan which owns Botox doesn’t have a patent on it- but it does have a trademark for the brand name. And Botox isn’t just the botulism toxin that paralyzes your face- there are a few additive chemicals mixed in and Allergan’s manufacturing process is a trade secret.

But wholesale Botox is still kind of cheap- you can get it for $3.50 a unit but the price the consumer pays is around $20 in urban areas.

If you’ve ever gotten Botox or its equivalent, you know you are not getting highly tailored and personalized injections here- you can get a same-day appointment, walk in, get injected, and walk out.

This should not require a medical degree.

Unfortunately, in some states only physicians or nurses supervised by physicians are allowed to. The obvious solution is to just let more people inject Botox- I can’t imagine a state just fully deregulating injection rights, but allowing pharmacists (who already handle a huge share of vaccinations), pharmacy techs under pharmacist direction, or registered nurses could make getting Botox way cheaper and make the number of facilities where you could Botox way larger.

The cost savings to the consumer might actually be larger than what you would think given the difference in labor costs. There are already cheaper alternatives to Botox that work just as well like Dysport or Xeomin (which is pure toxin without the additives) . But in the U.S. where we’re already paying so much for labor, the cost difference of the injectable can be overlooked. But in other countries, Botox alternatives are outcompeting Botox.

Liberalizing injection laws would make Americans look younger and spend less per treatment.

Are You Using Tretinoin?

Botox regulations aren’t the only way the government tries to make us look our age.

I think most of my readers here are straight men but if I could give you some non-policy advice, it would be that you should consider using tretinoin. It’s a cream you can use for acne but unlike a lot of woo-based anti-aging products it actually works to reverse the effects of sun on skin aging. [ed. Retin- A, Avita, Renova, others]

Unfortunately, you need a prescription to use it even though it’s incredibly safe as long as you aren’t pregnant- and if it irritates your skin just stop using it. So every time I see an urgent care doctor for whatever reason at the end of the appointment, I always ask “could I have a prescription for this?” It has never failed.

Tretinoin is still pretty cheap but the necessity of the prescription drives up the price in terms of time and inconvenience. Federal rules require it to be prescription-only but states have a lot of discretion to make “prescription required” a fairly nominal requirement. For example, states could allow pharmacists to prescribe the cream so instead of scheduling a telehealth or doctor’s appointment, you just show up at the pharmacy and ask for it. States can also make laws friendly to telehealth.

While I think every state should do this as well as make it easy to inject Botox, Nevada or Florida seem like the perfect first-movers. Both attract a ton of tourists, both have a lot of sun (photoaging!), and both just have the Botox-friendly vibes. You could also throw in easy-to-prescribe finasteride rules to help out balding men.

by Cold Button Issues |  Read more:

Image: uncredited via

[ed. Botox and GLP-1's (Ozempic, Wegovy etc,). Everyone wants to look their best.]

Did Your Cancer Treatment Just Get Taken Away?

It starts with a little bump on your neck. You notice it when your hand brushes against it while you’re washing your hair, but at first you don’t pay it much attention. Then your spouse looks at your neck and asks you “What’s that?” It’s a little brown bump, maybe a mole. You think that maybe you should get it checked out by a dermatologist, but you forget to make an appointment, because work has just been so busy lately.

Then a few weeks later you look at the bump again, and it looks noticeably bigger. This time you call the dermatologist, but the soonest they can get you in is three weeks from now. By the time you’re in the doctor’s office, the bump is at least double the size it was when you noticed it. The doctor is tense and concerned, and he does a biopsy. Five days later you get the result over the phone: Melanoma.

“That’s cancer, right?” you ask, just to confirm, feeling something fall away in the pit of your stomach. “Yes,” the doctor’s assistant confirms. “That’s cancer.”

Cancer. The word is like the fall of an axe, cutting off the future you had imagined for yourself. Now instead, the days ahead are filled with surgeries, chemotherapy, radiation, CT scans, MRIs. You will never again entirely be free of the eternal gnawing fear of discovering that the cancer has spread. Your hair is going to fall out, you’re going to go under the knife, you’re going to be weak and sick. You’re going to to read everything there is to read about cancer, and it still won’t help. It may go into remission, or you may die, but your life will never read the same.

This story reflects the sad reality of life for millions of Americans. Cancer is the second most common cause of death, just barely behind heart disease, killing over 600,000 every year. And every year, almost 2 million Americans are diagnosed with new cases of cancer. Some kinds, like prostate cancer, are usually manageable; others, like pancreatic cancer and glioblastoma, are practically death sentences.

Now, there’s a common myth that cancer is an intractable disease that will never succumb to modern medicine. In 1971, President Richard Nixon launched the so-called “War on Cancer”; for many years, it was fashionable to say that cancer had won the war. But in fact, since around 1990, humanity has been making steady gains. Thanks to advances in early detection, screening, and various treatments, as well as the drop in smoking and a vaccine against a virus that causes cervical cancer, death rates have fallen at every age for almost every type of cancer. For a while this was masked by an increase in lung cancer from the smoking boom, but now that’s over too:

The problem is that since the population is growing steadily older, overall death rates are still higher than they were in Nixon’s day:

We’re delaying death from cancer, but not eliminating it.

In recent years, however, an explosion of new therapies has promised to accelerate our progress in treating the disease, changing the very nature of what it means to have cancer. The most promising of these are immunotherapies — medical techniques that use the body’s own immune system to attack cancer cells. And of those therapies, one of the most promising is mRNA vaccines.

Yes, mRNA vaccines — the same kind of technology that we used to vaccinate Americans against Covid during the pandemic. But it works a little differently. These mRNA cancer vaccines aren’t something that everyone takes in advance, to prevent themselves from getting cancer — instead, they’re a type of therapy that you take after you get diagnosed with the disease. Often, the vaccines are personalized, meaning that they develop a specific vaccine for your particular cancer.

mRNA vaccines, in combination with other therapies, promise to contain many cancers, turning them from a death sentence into a manageable, non-fatal disease. These vaccines are currently in development to fight all of the biggest killers: lung cancer, colon cancer, pancreatic cancer, breast cancer, and melanoma. They’re even being used against glioblastoma, the most aggressive and common type of brain cancer. There are even some tantalizing results suggesting that mRNA could soon be used to create a universal cancer therapy.

Imagine how the story I told at the top of this post would go in an age of highly effective mRNA therapies. Instead of being sentenced to years of gut-wrenching fear, possibly followed by an agonizing death, someone diagnosed with cancer would simply sigh and realize that they would have to spend a bunch of money on treatments for the foreseeable future. That is the world toward which science is taking us.

And yet now all of this is in danger. The MAGA movement, which now holds near-absolute political power in America, has gone to war against mRNA technology. RFK Jr., Trump’s Secretary of Health and Human Services and a prominent vaccine skeptics, just canceled a large amount of federal funding:

The Department of Health and Human Services (HHS) announced this week it is beginning a "coordinated wind-down" of federally funded mRNA vaccine development.

This includes terminating awards and contracts with pharmaceutical companies and universities and canceling 22 investment projects worth nearly $500 million. While some final-stage contracts will be allowed to be completed, no new mRNA-based projects will be initiated, the HHS said.

Officially, all of the cancelled funding is supposedly for mRNA vaccines for upper respiratory illness — basically, Covid and anything that looks remotely like Covid. So officially, cancer research isn’t being cancelled — yet. But cancer researchers are terrified that this move will derail their whole field, and with good reason. The chilling effect of this funding cancellation will cause a general loss of enthusiasm for the technology.

If you’re a researcher developing an mRNA treatment for lung cancer, how would you rate your chances of RFK Jr. approving your therapy for mass use when it has “mRNA” in the name? If you’re a private funding organization, do you really want to fund a technology that the government — and a large chunk of the American electorate — has an irrational vendetta against? What lab is going to want to allocate resources toward a field that’s marked for destruction? And what aspiring researcher is going to want to dedicate their career to it? (...)

So it’s very possible that thanks to RFK Jr., the Trump administration, and the MAGA movement writ large, cancer vaccines will not be available nearly as soon as it looked like they would just a few months ago. Eventually, the technology will be developed, with some combination of funding from Europe, China, private companies, and so on. But in the meantime, many people — including many Americans — will experience the nightmare of a traditional cancer diagnosis, like what I described at the top of this post.

Why is this happening? Why is the U.S. government attacking the technology that offers us the greatest chance to defeat one of humanity’s oldest and most terrible scourges?

It’s pretty easy to trace the reasons historically. During the pandemic, the antivax movement took over the American right — possibly because of fear of needles, possibly as a macho way to express bravery against the virus itself, possibly because of instinctive dread of modern technology or expert consensus or government recommendations. But whatever the reason, Trump — despite having authorized the project that created mRNA vaccines, and despite wanting to take some deserved credit for defeating Covid — was forced to accede to the wave of antivax sentiment, and to ally with it in order to win reelection in 2024. Part of that meant hiring RFK Jr. and putting him in charge of HHS — a political marriage of convenience.

But fundamentally, it’s hard to fathom just how America arrived at this juncture. We’ve certainly seen both sides of the U.S. political divide embrace blatant lies in order to express solidarity. For the right, the biggest lie was always that climate change isn’t happening, or isn’t caused by humans. Climate denial might seem like a lie without consequences — after all, the worst harms from climate change are going to arrive decades in the future. But because green energy technologies also happened to become cheap, the right-wing dogma that anything “green” is bad is causing the MAGA movement to oppose the cheapest and most reliable energy sources available:

Not having cheap energy is certainly bad. But dying of cancer? You’d think that would be a bridge too far, even for Trump’s followers. But recall how during the Covid pandemic, right-wing types died in droves because they refused to take the life-saving vaccine: 

by Noah Smith, Noahpinion |  Read more:

Image: OurWorldInData