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

Please Hold

She called 911 for an ambulance. She got a nightmare instead.

When Pamela Hogan phoned 911 from her Seattle apartment, she was suffering from knee pain so intense she couldn’t stand up. She had been trapped in her bed all day, unable to eat, drink or get to the bathroom. Worried and alone, Hogan thought an ambulance would come quickly and take her to the hospital.

She was mistaken.

Seattle no longer is capping ambulance wait times for certain 911 patients, tracking those waits or penalizing its ambulance contractor when they run long.

Rather than send Hogan help right away, the Fire Department routed her to a nurse in Texas who determined her crisis didn’t need immediate attention.

So the 71-year-old, a retired executive assistant who loved cooking casseroles, watching “Judge Judy” and listening to The Pointer Sisters, waited one hour for a nurse-ordered ambulance, according to call recordings and court documents.

Two hours. Three hours. Four hours, phoning 911 back several times and telling the Fire Department about a heart condition. Ten hours.

By the time an ambulance arrived at Hogan’s building, it was the middle of the night and she wasn’t answering her phone. The ambulance left without her.

Weeks later, her body was found decomposing on the floor of her bedroom.

It’s not clear Hogan’s wait is what killed her, but her estate has sued and her experience raises questions about Seattle’s relationship with its for-profit ambulance contractor, American Medical Response, which also provides the city’s 911 nurse line.

“More checks and balances and accountability need to happen,” said Josephine Ensign, a professor emeritus at the University of Washington School of Nursing who called Hogan’s case concerning and upsetting. “Seattle can do better.”

Seattle and AMR have denied the lawsuit’s wrongful death allegations and say the nurse line is generally working as intended. They say it’s reducing strain on hospitals and ambulances by diverting low-level patients to more appropriate care.

But most Seattle callers triaged by the nurse line are still being sent to hospitals in AMR ambulances, rather than being diverted, program data reveals. And officials have exempted those nurse-ordered rides, like Hogan’s, from city standards that normally require the company’s ambulances to arrive on time.

It’s possible that Hogan’s experience was an aberration. But the city stopped tracking ambulance waits like hers in 2022, so officials have no way to know. [...]

***

Hogan’s wait started when she dialed 911 on the afternoon of April 8, 2022.

“I’ve got really bad knees because of rheumatoid arthritis and there is damage to them as well, and I’ve gotten to the point where I can’t get up,” she told the Fire Department dispatcher who answered, according to a recording of the call obtained through a public records request. “I’d like to go to the ER and have them look at my knees.”

Hogan had used 911 for emergencies before, assuming this time would be the same. Instead, her call was transferred to the nurse line operated by AMR’s parent company, Global Medical Response, from a call center outside Dallas.

“I’m going to bring the nurse on the line here and let them kind of help figure out the best course of action,” the Fire Department dispatcher said.

Hogan told the nurse she had been stuck in bed all day and had completely filled an adult diaper, according to a recording disclosed by AMR in the Hogan litigation. She described her pain intensity as 10 out of 10.

“I will get someone out to you,” the nurse said. “To get you to the hospital.”

Then the nurse ordered an ambulance, recommending care within four hours, according to another recording disclosed in the Hogan litigation. An AMR dispatcher in Seattle said it would take three to four.

Neither of them told Hogan, who was no longer on the phone.

Strained system

In the years before Hogan’s emergency, the Seattle Fire Department and AMR were dealing with a mounting number of 911 calls from patients with low-level needs, said Michael Sayre, the Fire Department’s medical director.

A sore throat. Anxiety. A stomachache. Patients who don’t really require emergency transport and care. The city received 44% more low-level medical calls in 2021 than in 2017, according to Fire Department records.

Few 911 patients receive lifesaving interventions and most emergency room visits are for nonemergency issues, national research has shown. People sometimes dial 911 not because they’re in imminent danger but because they’re not sure whether they’re sick or not, Sayre said.

These patients put pressure on the Fire Department’s dispatchers, who work long, grueling shifts. Such calls often involve homeless people or other patients without regular doctors, noted Ensign, whose decades of Seattle-based work has focused on health and social inequities.

“They don’t know what else to do, so they call 911,” Sayre said.

For acute 911 calls, the Fire Department sends its own highly trained crews. They can transport patients in red Medic One ambulances or hand the patients off to AMR emergency medical technicians in white ambulances.

For less-acute calls, the department may simply send AMR. One way or another, the company handles most of Seattle’s ambulance responses, approximately 50,000 annually. [...]

New program

Like other cities that use ambulance contractors for 911 callers, Seattle allows AMR to bill patients. In return, the company must meet standards for patient care: For years, its ambulances were supposed to arrive within 11½ minutes for more-urgent calls and one hour for less-urgent calls, at least 90% of the time.

But in the wake of the COVID pandemic, AMR was struggling with ambulance staffing in Seattle, arriving late for many of its 911 patients and paying a price, Fire Department records show. The city assessed the company almost $1.4 million in contract penalties for ambulance delays in 2021.

Enter the Nurse Navigation program, which Seattle and AMR leaders said would relieve that strain and improve ambulance response times in the city by diverting low-level callers to cheaper, better solutions. When it launched with fanfare in February 2022, then-Mayor Bruce Harrell called it “a strong example” of how to make a system “more efficient and ensure better care at the same time.”

The idea wasn’t new: King County had been using a 911 nurse line on a smaller scale for years, and cities across the world were experimenting. When implemented well, these programs can deliver real benefits, many experts say.

Seattle preferred not to hire its own nurses, said Sayre, the medical director, citing the costs involved. So the Fire Department turned to AMR, which agreed to triage the city’s callers almost for free. AMR had launched Nurse Navigation in Washington, D.C., in 2018 and had been attracting positive attention. [...]

Requirements removed

Before Nurse Navigation, patients like Hogan could expect assistance in under an hour. That changed in 2022 with an amendment to AMR’s contract that gave nurse-ordered ambulances a reprieve from any response-time standards.

Seattle and AMR officials say this made sense, because the nurse line is allowing ambulances to prioritize critical patients over stable ones. The company is no longer incurring late penalties for its Seattle responses still subject to time standards, a representative said, citing the nurse line and better recruiting.

But the city removed a significant guardrail when it removed standards for an entire category of ambulance rides, experts contend. Last year, more than 4,600 rides ordered were completely exempt from time standards and contractual penalties.

“Your community’s leaders may think 10-hour waits are OK,” said Matt Zavadsky, a nationally recognized health care administrator who managed a 911 system and helped start a nurse line in Fort Worth. “If your community’s leaders are not OK with that, you need a contract that prevents that.”

Instead, Seattle has left itself in the dark. Response times for nurse-ordered ambulances are excluded from AMR’s monthly reports to the Fire Department, so the city doesn’t know how long patients like Hogan are waiting.

by Daniel Beekman, Seattle Times |  Read more:

Image: Jennifer Luxton / The Seattle Times

The Plastic Surgeon Summit

We’re in a plastic surgery “renaissance period.”

Dr. Yannis Alexandrides: It is busier than ever. There’s a remarkable year-on-year demand increase that we see in surgical procedures, especially for the face, but also for the body. This is a trend that we have seen through the pandemic, but it has accelerated the last year.

Dr. Akshay Sanan: I think plastic surgery is in a renaissance period right now because of people publicly talking about it. Plastic surgery is now part of your wellness armamentarium. People used to flex what gym they went to, that they had a trainer, and now plastic surgery is part of that flex. People love to rock that they had their eyes done or their face and neck done or their body done. It’s just part of the cultural shift that we’re seeing.

Dr. Jason Champagne: This is where social media comes into play, camera phones and Zoom meetings. You see yourself from all these different angles nowadays that maybe you didn’t notice in the past.

Dr. Emily Hu: I find it very generational: Those who grew up in the social media era with a lot of sharing and openness are also very open about telling their friends [about the work they’ve had done].

Sanan: There’s a shift in consumer or patient habits. More people in their late 30s, early 40s, they’re choosing surgery earlier to age gracefully instead of waiting until things are advanced. They’re like, “I’m not going to wait until it drops down further. I just want to be hot in my 40s.”

Dr. John Diaz: It used to be that not everyone had access to a plastic surgeon. That was reserved within the realm of the elite. Well, not anymore. I have celebrities, executives, and business owners come in — but also teachers and waiters. There’s this democratization of attractiveness.

Dr. Paul Afrooz: Patients are very educated these days. They know what they’re looking for, they know what realistic results are, and they have the ability to do a lot of background research and understand who does things at an elite level. [...]

Let’s get into it: Why are we talking so much about facelifts this year?

Diaz: Facelifts have absolutely exploded for a few reasons. A lot of women see celebrities and influencers suddenly looking incredible, and they want to know how. Think about Kris Jenner — she had a huge impact when her pictures came out. And now it’s brought awareness to the fact that we have the technology to be able to take a young-looking woman and make her look better with surgery, without making her look fake. That was a real challenge 20 years ago.

Alexandrides: Kris Jenner was a very hot topic the last few months. Definitely a lot of the patients I see here take her as, let’s say, a model on how they want to look, because she looks fresh, but she doesn’t look pulled. She looks younger, and she looks happy, and you cannot see the scars, at least not in these pictures that we see.

Hu: I can’t tell you how many of my patients are like, “Yeah, my mom had a facelift. She was so scary. I’m never doing a facelift.” I mean, that was their response because they see their mom all bruised and scary looking.

Dr. Mark Murphy: Facelifts historically had a stereotypical “plastic surgery” look. Now people have realized, “I can look like myself 15 years ago and not have to look like a circus freak for it.” It’s become very digestible for patients. Social media is a huge driver behind it. Well, that, and the techniques are better.

So what’s actually new or changing about facelifts?

Dr. Mark Mani: We call it the golden age of facelift surgery. It’s primarily because of the success of the deep plane facelift.

Dr. David Shafer: There’s nothing new about [the deep plane facelift] as a procedure. It’s just very sophisticated marketing that’s being done now, and there are refinements to the procedures. But it’s not some plastic surgeon who’s marketing it now as some magic procedure that he came up with that nobody else does.

Mani: [A version of] the first deep plane lifts was performed in the late 1960s by a surgeon named Tord Skoog in Sweden [though the name came later]. I have his textbook and can show you results that would stand up to the best deep plane surgeons today. It’s not the procedure, it’s the surgeon, and facelift surgery, among all surgeries in plastic surgery, is an art form.

Afrooz: A surgeon named Sam Hamra — he just passed, but a wonderful human being, an extraordinary thinker, an extraordinary surgeon — first coined the phrase “deep plane facelift” in a 1990 paper and laid out some building blocks of the procedure. Just like everything else in plastic surgery, we stand on the giants before us.

Dr. Michael Stein: There are two main facelift techniques: deep plane and SMAS plication. The deep plane facelift is where you cut the layer under the skin called the SMAS, dissect underneath it, and tighten it in addition to the skin. In the SMAS facelift, instead of cutting and elevating the SMAS, you suture it to itself to tighten it from over top.

Dr. Amir Karam: The majority of surgeons, up until recently, have been doing the traditional SMAS technique, which is more or less horizontally pulling the face sideways, and that was leading to a very unnatural look.

Mani: I was the surgeon who wrote the most-read facelift academic article that convinced other surgeons to do deep plane facelifts. It was an article in Aesthetic Surgery Journal in 2016, where I detailed the specific anatomic reasons that deep plane is better.

Stein: The people who only do deep plane facelifts say they have a more longitudinal result, and vice versa. But the truth is, a good result is a good result. It depends more on the surgeon versus technique. A good facelift is a good facelift.

Facelifts aren’t done evolving.

Karam: The consumer is driving surgeons to create better and better results. So there’s been a massive increase in interest for surgeons to level up their strategies surgically and learn new techniques that are not new but new to them.

Afrooz: Even my facelift today is better than my facelift was one year ago. When you hone in on one thing as your career, you’re just constantly looking for ways to improve. It’s the cumulative effect of small subtleties over time and practice that you notice nuanced improvements to your results. One might assume that a deep plane facelift in one surgeon’s hands is the same as it is in another’s, but I’m here to tell you that it’s very much not the same.

Dr. Daniel Gould: There are new layers that we’re adding into the surgery. We’re recognizing the importance of the mid-face and volume position there. I’m recognizing adding fat to the mouth and the areas around the mouth, the chin, because all these areas have been neglected. We are now nailing all the low-hanging fruit: We’re nailing the neck, we’re nailing the face, we’re nailing the temple and the brows. Now it’s time to move forward and continue to innovate and push the limits of what we can really do in facial rejuvenation.

Mani: What I’ve developed is called the scarless lift, and it’s basically a deep plane facelift without a scar in front of the ear, with an endoscope. The endoscopic procedure involves a hidden incision within the hair, a short one behind the ear, and sometimes one under the chin. I still do about 60% open [non-endoscopic], but a good percentage of my facelifts are scarless endoscopic. The results are more beautiful because you don’t have to worry about the scar, and the vectors of lifting are better.

Alexandrides: I don’t think this will be now, “OK, let’s forget about facelifts, let’s move to something else.” What will probably happen is that people will discover intricate little different techniques and say, “You have the facelift that is done like that.” I have patients who ask me very technical questions: How do you design your scar around your ear?

Stein: Facelift surgery has survived the test of time. Every year there are new machines designed to tighten skin, and for some patients with mild laxity, they may see nice results. The truth is though, if you have jowls or droopy skin of the face and neck, the only thing that’s really going to give you the best bang for your buck and directly address your laxity is a facelift.

by Bustle Editors, Bustle |  Read more:

Image: uncredited

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

Embryo Selection Company Herasight Goes All In On Eugenics

Multiple commercial companies are now offering polygenic embryo selection on a wide range of traits, including genetic predictors of behavior and IQ. I’ve previously written about the methodological unknowns around this technology but I haven’t commented on the ethics. I think having a child is a very personal decision and it’s not my place to tell people how to do it. But the new embryo selection company, Herasight, has started advocating for eugenic societal norms that I find disturbing and worth raising alarm over. Because this is a fraught topic, I’ll start with some basic definitions.

What is eugenics?

Eugenics is an ideology that advocates for conditioning reproductive rights on the perceived genetic quality of the parents. Francis Galton, the father of eugenics, declared that eugenics’ “first object is to check the birth-rate of the Unfit, instead of allowing them to come into being”. This goal was to be achieved through social stigma and, if necessary, by force. The Eugenics Education Society, for instance, advocated for education, segregation, and — “perhaps” — compulsory sterilization to prevent the “unfit and degenerate” from reproducing:

A core component of defining “the unfit” was heredity. Eugenicists are not just interested in improving people’s phenotypes — a goal that is widely shared by modern society — but the future genotypic distribution. The genetic stock. This is why eugenic policies historically focus on sterilization, including the sterilization of unaffected relatives who harbor genotype but not phenotype. If someone commits a crime, they face time in prison for their actions, but under eugenic reasoning their law-abiding sibling or child is also suspect and should be stigmatized (or forcefully prevented) from passing on deficient genetic material.

A simple two-part test for eugenics is then: (1) Is it concerned with the future genetic stock? (2) Is it advocating for restricted reproduction, either through stigma or force, for those deemed genetically inferior?

Is embryo selection eugenics?

I have publicly resisted applying the “eugenics” label to embryo selection writ large and I continue to do so. Embryo selection is a tool and its use is morally complex. A couple can choose to have embryo screening for a variety of reasons ranging from frivolous (“we want to have a blue eyed baby”) to widely supported (“we carry a recessive mutation that would be fatal in our baby”), none of which have eugenic intent. Embryo selection can even be an anti-eugenic tool, as in the case of high-risk couples who have already decided against having children. If embryo selection technology allows them to lower the risk to a comfortable level and have a child they would otherwise have avoided, then the outcome is literally the opposite of eugenic selection: “unfit” individuals (at least as they see themselves) now have an incentive to produce more offspring than they would have. In practice, IVF remains a physically and emotionally demanding procedure, and my guess is that individual eugenic intentions — the desire to select out unfit embryos with the specific motivation of improving the “genetic stock” of the population — are exceedingly rare.

Is Herasight advocating for eugenics?

While I do not think embryo selection is eugenic in itself, like any reproductive technology, it can be wielded for eugenic purposes. The new embryo selection company Herasight, in my opinion, is advocating for exactly that. To understand why, it is useful to first understand the theories put forth by Herasight’s director of scientific research and communication Jonathan Anomaly (in case you’re wondering, that is a chosen last name). Anomaly is a self-proclaimed eugenicist [Update: Anomaly has clarified that this description was not provided by him and he requested that it be removed]:

Prior to joining Herasight, Anomaly wrote extensively on the ethics of embryo selection, notably in a 2018 article titled “Defending eugenics”. How does Anomaly defend eugenics? First, he reiterates the classic position that eugenics is a resistance to the uncontrolled reproduction of the “unfit” (emphasis mine, throughout):

Darwin argued that social welfare programs for the poor and sick are a natural expression of our sympathy, but also a danger to future populations if they encourage people with serious congenital diseases and heritable traits like low levels of impulse control, intelligence, or empathy to reproduce at higher rates than other people in the population. Darwin feared that in developed nations “the reckless, degraded, and often vicious members of society, tend to increase at a quicker rate than the provident and generally virtuous members”

Anomaly goes on to sympathize with Darwin’s position and that of the classic eugenicists, arguing that “While Darwin’s language is shocking to contemporary readers, we should take him seriously”, later that “there is increasingly good evidence that Darwin was right to worry about demographic trends in developed countries”, and that we should “stop allowing [the Holocaust] to silence any discussion of the merits of eugenic thinking”.

Anomaly then proposes several potential eugenic interventions, one of which is a “parental licensing” scheme that prevents unfit parents from having children:

The typical response is for the state to step in and pay for all of these things, and in extreme cases to remove children from their parents and put them in foster care. But it would be more cost-effective to prevent unwanted pregnancies than treating their consequences, especially if we could achieve this goal by subsidizing the voluntary use of contraception. It may also be more desirable from the standpoint of future people.

The phrase “future people” figures repeatedly in Anomaly’s writing as a euphemism for the more conventional eugenic concept of genetic stock. This connection is made explicit when he explains the most compelling reason for supporting parental licensing:

The most compelling reason (though certainly not a decisive reason) for supporting parental licensing is that traits like impulse control, health, intelligence, and empathy have significant genetic components. What matters is not just that some parents are unwilling or unable to take care of their children; but that in many cases they are passing along an undesirable genetic endowment.

What are we really talking about here? Anomaly has proposed a technocratic rebranding of eugenic sterilization: instead of taking away your reproductive rights clinically, the state will take away your reproductive license and, if you still have children, impose “fines or other costs” (though Anomaly does not make the “other costs” explicit, eugenic sterilization is mentioned as an example in the very next sentence). How would the state decide who should lose their license? Anomaly explains:

For a parental licensing scheme to be fair, we would need to devise criteria that are effective at screening out only parents who impose significant risks of harm on their children or (through their children) on other people.

A fundamental normative principle of our society is that all members are created equal and endowed with unalienable rights. What Anomaly envisions instead is a society where the state can seize one of the most intimate of human freedoms — the right to become a parent — based on innate factors. How does the state determine whether a future child imposes significant risk on future people? By inspecting the biological makeup of the parents and identifying “undesirable genetic endowments” that will harm others “through their children”. This is a policy built explicitly on genetic desirability and undesirability, where those deemed genetically unfit are stripped of their rights to have children and/or fined for doing so — aka bog-standard coercive eugenics.

Today, Anomaly is the spokesperson for a company that screens parents for “undesirable genetic endowments” and, for a price, promises to boost their genetic desirability and their value to future people. It is easy to see how Herasight fits directly into the eugenic parental licensing scheme Anomaly proposed. Having an open eugenicist as the spokesperson for an embryo selection company seems, to me, akin to hiring Hannibal Lecter to do PR for a hospital, but perhaps Anomaly has radically changed his views since billing himself as a eugenicist in 2023?

Herasight (with Anomaly as first author) recently published a perspective white-paper on the ethics polygenic selection, from which we can glean their corporate position. The perspective outlines the potential benefits and harms of embryo selection. The very first positive benefit listed? The “benefits to future people”. While this section starts with a focus the welfare of individual children, it ends with the same societal motivations as classical eugenics: the social costs of the unfit on communities and the benefits of the fit to scientific innovation and the public good: [...]

When eugenics goes mainstream

Let’s review: eugenics has as a goal of limiting the birthrate of the “unfit” or “undesirable” for the benefit of the group. Anomaly describes himself as a eugenicist and explicitly echoes this goal through, among other policies, a parental licensing proposal. Anomaly now runs a genetic screening company. The company recently published a perspective paper advocating for the stigmatization of “unfit” parents who do not screen. Anomaly, as spokesperson, reiterates that their goal is indeed eugenics — “Yes, and it’s great!”. With any other person one could argue that they were clueless or trolling; but if anyone knows what eugenics means, it is a person who has spent the past decade defending it.

I have to say I am floored by how strange this all is. My personal take on embryo selection has been decidedly neutral. I think the expected gains are limited by the genetic architecture of the traits being scored and the companies are mostly fudging the numbers to look good. As noted above, I also think a common use of this technology will be to calm the nerves of parents who otherwise would have gone childless. So I have no actual concerns about changes to the genetic make-up of the population or genetic inequality or any of the other utopian/dystopian predictions. But I am concerned that the marketing around the technology revives and normalizes classic eugenic arguments: that society is divided into the genetically fit and the genetically unfit, and the latter need to be stigmatized away from parenthood for the benefit of the former. I am particularly disturbed by the giddiness with which Anomaly and Herasight have repeatedly courted eugenics-related controversy as part of their launch campaign.

Even stranger has been the response, or rather non-response, from the genetics community. Social science geneticists and organizations spent the past decade writing FAQs warning against the use of their methods and data for individual prediction and against genetic essentialism. Many conference presentations and seminars start with a section on the sordid history of eugenics and the sterilization programs in the US and Nazi Germany, vowing not to repeat the mistakes of the past. Now, a company is openly advocating for eugenics (in fact, a company with direct connections to these social science organizations) and these organizations are silent. It is hard not to conclude that the FAQs and warnings were just lip service. And if the experts aren’t raising alarms, why would the public be alarmed?

by Sasha Gusev, The Infinitesimal |  Read more:

Image: Anselm Kiefer, Die Ungeborenen (The Unborn), 2002

[ed. With neophyte Nazis seemingly everywhere these days, CRISPR advances, and technocrats who want to live forever, it's perhaps not surprising that eugenics would be making a comeback. Update: Jonathan Anomaly, director of scientific research and communication for Herasight and whose articles I criticize here, responds in a detailed comment. I recommend reading his response together with this post. Anomaly’s role in the company has also been clarified. See also: Have we leapt into commercial genetic testing without understanding it? (Ars Technica).]

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:

The Century of the Maxxer

Most people, being average, do not understand what maxxing really means. Look at me! they squeal. I’m sleepmaxxing! They mean that they’re trying to get eight hours a night. Or they’re proteinmaxxing, which means they’ve bought a big tub of whey powder. I’m such a houseplantmaxxer, they tell the fiddle-leaf fig they ordered online. It’s fun to play around with a new word. But sleepmaxxing does not mean getting a red light and taping your mouth shut; it means putting yourself in a medically induced coma. There is only one way of proteinmaxxing, which is to get one hundred percent of your daily calories from lean protein. Anything else would, by definition, be less than fully maxxed. Doctors will tell you that eating only protein causes something called ‘rabbit starvation,’ and if you keep at it you’ll experience vomiting, seizures, and death in fairly short order. They’re right, but the proteinmaxxer accepts his fate. Meanwhile the houseplantmaxxer has thick mats of algae sliming over every surface, the walls, the ceilings, swallowing the sofa, digesting the bookshelf and all its contents, blobbing and dribbling, wet in the middle of the bed, green on the windowpanes, covering everything except the UV lights and the massive pans of water left on a constant boil in every room, so the air stays oppressively, Cretaceously thick.

This is what it means to be a maxxer. We are a long way away from the optimisation of the self; to maxx is an intense form of asceticism. The maxxer is the person who willingly sacrifices every aspect of their lives except one, the maxximand, which is extended to infinity until it begins to develop the distance and vastness of a god.

Probably the world’s most prominent maxxer is a man called Braden Peters, who calls himself Clavicular. Clavicular is a looksmaxxer; his austerity is to make himself as beautiful as possible. If you’re good looking enough, you can ascend, break out of your genetic destiny and into a new order of being, where the subhumans will crawl after you with lolling tongues. Clavicular started looksmaxxing at the age of fourteen, injecting himself with testosterone. He also shoots anabolic steroids, human growth hormone, peptides, botox, and crystal meth. He’s had multiple plastic surgeries. His other secret is bonesmashing, which is exactly what it sounds like: he smashes his own cheekbones with a hammer so they grow back bigger. It’s impossible to know what he would have looked like if he hadn’t done all this, since his ‘before’ pictures all show a prepubescent child, but it’s hard not to conclude that he’s utterly ruined his body. He didn’t go through a normal puberty; his glands are completely incapable of producing testosterone by themselves, and if he ever stops taking the hormones he’ll rapidly decompose into a genderless lump. The various injections have also left him totally sterile; his balls are almost certainly fucked up in ways we can barely imagine. He is a meth addict. And while he really does have legions of lesser beings crawling after him with lolling tongues, they do all seem to be men.

Clavicular lives in a sort of nightmare clown world, where he is constantly being approached in ordinary shopping centres by small, strange, awkward men who say things like ‘I’m known in Orlando as the Asian Mogger. I would have the honour if you could verify me as the Orlando Asian Mogger.’ There are various misshapen freaks of nature, men with shoulders wider than they’re tall, sinister stalking giants on artificially lengthened legs, who travel across the country to stand next to him and compare physiques. Like a mythical gunslinger, the great mogger needs to constantly watch the horizon for whoever’s coming to mog him. Other men adore him in more nakedly eroticised ways. In one video, he’s live-streaming a fun casual hangout with Andrew Tate, Tristan Tate, Nick Fuentes, a bunch of other people sitting in silence looking at their phones, and menial staff vacuuming in the background. One of the men is berating a woman sat in Clavicular’s lap. ‘You are not an 8. You’re not an 8. You’re a thirsty 7, you’re asking for validation, and you’re sitting in a 10’s lap.’ ‘That’s kinda rude,’ she says. ‘That’s kinda rude,’ agrees Tristan Tate. ‘Clavicular’s at least an 11.’ Clavicular doesn’t say anything. What gives the scene its particularly haunting resonance is that throughout this exchange, he seems to be eating soup.

In all his interactions with women that aren’t directly supervised by a Tate brother, Clavicular is painfully passive and awkward. The women who like him are all of a type: hot but autistic beyond belief, brainrotted, barfing up a constant stream of overenthusiastic tryhard 4chan nazi jargon that he seems to find deeply embarrassing. Normal women treat him with undisguised contempt. He is constantly having his cortisol spiked by foids. It turns out that being maximally beautiful is not actually the same as maximising your chances of getting laid. Clavicular will never be a female sex symbol; that role goes to men like Slavoj Žižek and Danny DeVito. But maxxing is not optimisation. The maxxer is not trying to have an enjoyable life. He’s trying to reduce himself to a single principle.

Things get confused when the maxximand is also a generally upheld value like beauty. But every maxxer has his shadow, the person maxxing the opposite principle. Clavicular’s shadow is someone who calls himself The Crooked Man. The Crooked Man is a looksminimiser, which is another way of saying he’s an uglymaxxer. His strategy has been to spend a year working out only one side of his body, which has left him with an enormous bulging trap on one shoulder and nothing at all on the other. He looks like a cartoon monster. He stands around shirtless in his empty millennial-grey house, adrift in some suburb somewhere, grey walls, grey carpet, no decorations except cables snaking around on the floor, making video content. He is a kind of Platonic ideal of the maxxer, far more than Clavicular. The Crooked Man’s house appears to get zero natural light. All his gym equipment is at home; you can see him benching 225 on one side only in one of its many large and empty rooms. Plastic Venetian blinds. It’s night outside. It’s always night outside. The sun never shines on The Crooked Man. Incredible things are happening in America.

There’s a reason Clavicular has become the media’s go-to symbol for maxxing, even though The Crooked Man is a much better exemplar. He keeps things on a very comfortable terrain. Maxxing, the line goes, is an outgrowth of incel culture. It’s about men, the problem with men, the crisis of masculinity; it’s about how men are now facing the kind of toxic body politics that women have had to deal with forever, and how they’re developing their own hysterias in response; it’s about online extremism, it’s about the harmful narratives that seduce young men into various forms of misogyny; before long it’s about how we all need to put the kettle on and have a proper talk about our men’s mental health. They’re not entirely wrong; there really is a crisis of masculinity, it really is expressing itself through the mainstreaming of misogyny and the proliferation of a diseased relation to the self. It’s just that maxxing comes from something else entirely.

Despite what you might have heard, the word maxxing is not originally incel slang. Incels might have appropriated it, but it began with another kind of loser altogether, the tabletop role-playing gamer.

by Sam Kriss, Numb at the Lodge |  Read more:

Image: Cassidy Araiza for The New York Times
[ed. See also: Handsome at Any Cost (NYT); and, From “Mar-a-Lago face” to uncanny AI art: MAGA loves ugly in submission to Trump (Salon).]

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).]

The Questionable Science Behind the Odd-Looking Football Helmets

The N.F.L. claims Guardian Caps reduce the risk of concussions. The company that makes them says, “It has nothing to do with concussions.”

The first time Jared Wilson, a New England Patriots offensive lineman, is seen on the Super Bowl broadcast on Sunday, some viewers may wonder why he has such a big helmet.

It’s called a Guardian Cap, and Mr. Wilson is among about two dozen National Football League players who have worn the helmet covering in games this season. Not for comfort or style. Even the company that makes the cap acknowledges that it’s bulky and ugly. Rather, Wilson and others have worn it for its purported safety benefits.

The N.F.L. claims the cartoonish caps reduce the risk of getting a concussion, convincing some players that they are worth wearing. The company that designed and manufactures Guardian Caps, though, makes no such claim.

“No helmet, headgear or chin strap can prevent or eliminate the risk of concussions or other serious head injuries while playing sports or otherwise,” the product’s disclaimer warns. Instead, the company says its caps blunt the impact of smaller hits to the head that are linked to long-term brain damage.

“It has nothing to do with concussions,” said Erin Hanson, a co-founder of Guardian Sports, the Atlanta-area company that makes the cap. “We call concussions ‘the C word.’ This is about reducing the impact of all those hits every time. That’s all that was.”

The disconnect between the N.F.L.’s claims about the Guardian Caps and what the company promises is emblematic of the messy line between promotion and protection, and the power of the N.F.L. to sway football coaches and players trying to insulate themselves from the dangers of the sport.

An endorsement by the N.F.L., the country’s most visible and powerful sports league, can generate millions of dollars in sales for equipment makers, including Guardian Sports. The N.F.L.’s embrace of the caps, beginning in 2022, has led to a surge in orders from youth leagues to pro teams. About half a million players at all levels now wear them, Guardian Sports said.

“Anything I can do to save my brain, save my head,” said Kevin Dotson, an offensive lineman on the Los Angeles Rams who has worn the cap in games since last season.

The league claimed that the Guardian Cap had helped reduce concussions by more than 50 percent, which has put the company in the awkward position of embracing the spirit of the endorsement while distancing itself from the facts of it. Further complicating the situation: The model worn by pro and college players, the NXT, is not the same as the company’s mass-market product, the XT, which retails for $75. That model has less padding than the NXT, and may be less effective at limiting the impact of hits to the head, studies have shown.

Ms. Hanson said the company had struggled with whether to promote the N.F.L.’s claims about concussions. It decided to do so because the N.F.L.’s boasts might persuade young players to use the product, even if the benefits are not comparable. (...)

Guardian Caps are the latest in a wave of products that have emerged since researchers linked the sport to the progressive brain disease known as chronic traumatic encephalopathy, or C.T.E. Scores of companies have introduced equipment that purports to prevent head injuries, from a silicone collar worn around a player’s neck, known as the Q-Collar, which is promoted as a way to give the brain an extra layer of cushioning, to G8RSkin Shiesty, a head covering that is worn under helmets and promises to significantly reduce concussion risk.

Independent neurologists are generally skeptical, if not outright dismissive, of the benefits of any product claiming to reduce concussions because few rigorous studies have been done to demonstrate their effectiveness.

Few products have received as much publicity as the Guardian Cap, though. Sales of the caps, which were introduced in 2012, took off after the company won the N.F.L.’s HeadHealthTECH Challenge in 2017 — two years after the league settled a lawsuit brought by more than 5,000 former players who accused the N.F.L. of hiding from them the dangers of concussions.

Guardian Sports received $20,000 from the league for additional testing, but the N.F.L.’s endorsement was priceless.

Orders for the caps from colleges, high schools and youth teams poured in. Nearly every college team in the top ranks practices with the caps. In 2021, researchers, including some affiliated with the N.F.L. and its players’ union, published a paper that said Guardian Caps reduced “head impact severity” by 9 percent.

That year, Guardian Sports introduced its NXT model, with an extra layer of padding for bigger, stronger players. The N.F.L. required linemen, tight ends and linebackers to wear them in training camp. In 2023, the mandate expanded to all contact practices, and running backs and fullbacks were added. Starting in 2024, wide receivers and defensive backs had to wear them in practices, and players could wear them in games. (...)

Researchers at Virginia Tech, which runs a well-regarded helmet-testing laboratory, found that players who wore the NXT version of the Guardian Cap experienced a 14 percent decline in rotational accelerations — basically, the turning of the head — and that their concussion risk was 34 percent lower than for players who wore only helmets.

The benefits were significantly lower for players who wore the XT, the model worn in youth leagues and high schools. Rotational acceleration was only 5 percent lower, and the concussion risk was reduced by 15 percent.

Stefan Duma, who leads the lab, said the smaller reductions, combined with better helmets and fewer full contact practices, suggested that the benefits of wearing the XT were negligible.

“We tested it thoroughly, and the benefits are just not there,” Dr. Duma said. “It’s all noise, no statistical difference in youth.”

Most parents and coaches, though, do not read research reports from testing labs, and there is little information on the Guardian Sports website that explains the difference in performance between the XT and NXT models. But looking at the testimonials on the website from Mr. Goodell and other N.F.L. luminaries, parents and coaches might believe they were buying the cap worn by the pros.

by Ken Belson, NY Times |  Read more:
Images: Audra Melton, NYT; Cooper Neill/Getty

What Actually Makes a Good Life

Harvard started following a group of 268 sophomores back in 1938—and continued to track them for decades—and eventually included their spouses and children too. The goal was to discover what leads to a thriving, happy life.

Robert Waldinger continues that work today as the Director of the Harvard Study on Adult Development. (He’s also a zen priest, by the way.) Here he shares insights on the key ingredients for living the good life.

via:

[ed. Road map to happiness (or at least more life satisfaction). Only 16 minutes of your time.]

If You Want That Tattoo Erased It’s Going to Hurt and It’s Going to Cost You

Colin Farrell’s had it done — many times. So have Angelina Jolie and Megan Fox. Heck, even Bart Simpson did.

Whether it’s Marilyn Monroe’s face, Billy Bob Thornton’s name, a sultry rose or even Bart’s partially inscribed homage to his mother, some tattoos simply have to go for one reason or many others.

But the process of taking them off is longer, much more costly and ouch — extremely more painful than getting them put on, according to professionals in the industry.

Also, due to health reasons, some souls who braved the ink needle, should be wary of the laser when having their body art erased or covered up.

Tattoos have been around for centuries

The oldest known tattoos were found on remains of a Neolithic man who lived in the Italian Alps around 3,000 B.C. Many mummies from ancient Egypt also have tattoos, as do remains from cultures around the world.

Tattoo removal likely is almost as old as the practice of inking and included scraping the skin to get the pigments off or out.

A more “civilized” method evolved in the 1960s when Leon Goldman, a University of Cincinnati dermatologist, used “hot vapor bursts” from a laser on tattoos and the skin that bore them.

Many choose tattoos to honor someone

A 2023 survey by the Pew Research Center determined that 32% of adults in the United States have tattoos. About 22% have more than one, according to the survey.

Honoring or remembering someone or something accounts for the biggest reason Americans get their first tattoo. About 24% in the survey regret getting them.

Tracy Herrmann, 54, of Plymouth, Michigan, just west of Detroit, has eight tattoos and is in the process of getting four phrases, including “One step at a time,” “Surrender,” and “Through it all,” removed from her feet and arms.

She started inking up about six years ago and says she doesn’t regret getting tattoos.

“Maybe a different choice, maybe,” Herrmann said following her fourth tattoo removal session at Chroma Tattoo Studio & Laser Tattoo Removal in Brighton, Michigan.

“There was a period in my life that I felt I needed some extra reminder,” Hermann said. “I thought I would just embrace the period in my life, so that helped and then just to surrender and give it over to God. So, half of them were really, really pivotal to getting me over a hump in my life.”

Boredom among reasons to remove tats

Herrmann says the four getting lasered are part of her past and that’s where she wants them to stay.

“Now, I just want to move forward and go back to the original skin I was born with,” she said. “But the other four I’m going to keep. They still mean a lot to me, but they’re more hidden.”

Reasons for getting a tattoo removed are as varied and personal as the reasons for getting them in the first place, says Ryan Wright, a registered nurse and owner of Ink Blasters Precision Laser Tattoo Removal in Livonia, Michigan.

“A lot of people, when they get a new tattoo that makes some of their old tattoos look bad they get (the older tattoos) removed or reworked,” Wright said.

Chroma owner Jaime Howard says boredom plays a role, too.

“They got a tattoo off a whim and they’re like ‘hey, I’m really bored with this. I don’t want this anymore,’” Howard said. “It’s not about hating their tattoo, it’s about change for yourself.”

Like snapping a ‘rubber band’ on your skin

Howard and Wright, like many who perform laser removals, use something called a Q-switching, or quality switching, laser. It concentrates the light energy into intense short bursts or pulses.

“It’s very painful. Nine out of 10,” Wright said. “It kind of feels like a rubber band being snapped on your skin with hot bacon grease.”

Howard has had some of her tattoos removed and admits the procedure is painful.

But “you get through it,” she said. “A couple of days later you’re still feeling the sunburn, but it’s OK. If you want it bad enough, you’ll take it off because that’s what you want.”

Light heat from the laser breaks the ink into particles small enough to be absorbed by the body and later excreted as waste.

It’s not a “one and done.” Wright said. Tattoo removal can take eight to 12 treatments or more. A new tattoo can go over the old one once the skin has had time to sufficiently heal.

Howard consulted with Herrmann as her fourth session at Chroma began. They spoke about the previous session and how far along they were with the ink removal. Both then donned dark sunglasses to protect their eyes from the brightness of the laser. Herrmann winced. Seconds later, it was done. But she still has more sessions ahead.

“Oh gosh, it’s a 10 when you’re getting it done,” Herrmann said of the pain. “It’s pretty intense. It’s doable. I know price is sometimes an issue, but it’s worth it.”

Removal can be costly

Howard says the minimum she charges is $100 per session. Wright says that on a typical day he does about a dozen treatments and that cost depends on the square-inch size of the tattoo.

“The cost is really the technology in the laser,” Wright said. “It’s not like a time thing. Most treatments are under a minute. You’re paying for the technology and the person who knows how to use the technology. You can damage the skin if you don’t know what you’re doing.”

by Corey Williams, AP |  Read more:
Image: the author

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).]