The promise of GLP-1 drugs has always depended on people being able to afford them. These drugs still cost hundreds of dollars per month if you’re paying cash, at which point access becomes a privilege: The higher-income executive who wants to trim a few pounds might be able to afford them either way, but the low-income worker who needs the drug to lose significant weight might not be able to afford them — unless their health insurance covers it.

For a while, the trend lines for GLP-1 insurance coverage were positive. As of 2026, roughly two-thirds of private employer plans, which insure half of Americans, were covering GLP-1 medications for weight loss to treat obesity. Over the summer, Medicare launched a new $50-per-month prescription program. The US has struggled with an obesity epidemic for decades, but it looked like powerful drugs to treat it were finally starting to be more seamlessly integrated into the health system.

At least that’s how things appeared earlier this year. But now, private plans are pulling back from GLP-1 coverage. People are being left in the lurch, debating whether to try to pay for these drugs on their own or stop taking medicines they feel are making a real difference for their health.

The dilemma reveals one of the structural flaws in American healthcare. For working-age adults, your insurance depends on your job. Unfortunately, because people no longer stay at the same job for decades, there is not a strong financial incentive for employers to make investments that will benefit your health in the long term — but there is a strong incentive to minimize short-term costs as much as possible. It’s the kind of perverse rationale that could compel employer-sponsored health plans to stop covering a drug that, if taken over the full course of a person’s life, could help them not only lose weight but ultimately reduce their risk of heart disease, kidney disease and other chronic health problems, improving their health and saving all of us money as they get older.

“An employer or an insurer making coverage decisions doesn’t necessarily care if they’re saving Medicare money,” said Dan Sacks, a healthcare economist at the University of Wisconsin-Madison. “That’s a classic problem with the American health insurance system, and it’s certainly salient here.”

This mismatch between what’s good for people’s health and what’s good for the corporate bottom line has long been one of the underlying flaws in the US health system. Now access to GLP-1 drugs is shrinking just as these drugs were starting to make a real dent in the US obesity crisis. The stakes couldn’t be higher.

Why employer-sponsored health plans are suddenly dropping GLP-1 coverage

From the beginning, insurance coverage was the big question hanging over GLP-1s and their potential to revolutionize US healthcare. But recently, it looked like we’d turned a corner.

When I attended the Aspen Ideas: Health festival over the summer, pharmaceutical reps seemed visibly relieved that GLP-1 coverage had been picking up among private insurers. In 2026, about two out of every three employer-sponsored plans were covering some of these drugs for weight management, up from about 20 percent just the year before.

“They’re recognizing that this is an investment in their workforce,” said Laura Steele, who leads the cardiometabolic health unit at Eli Lilly, which manufactures Zepbound and Foundayo. “Yes, there is a budget, and there is a benefit design that every employer has. That’s real. That’s not going away. But they’re also recognizing the overall cost that they’re experiencing by not dealing with this too.”

But as employers and private insurers make coverage decisions for next year, they are suddenly pulling back. At least 10 percent of employer plans that currently cover GLP-1s for weight loss say they are likely to discontinue coverage in 2027, according to one survey by the Business Group on Health — and that number may still increase. A Mercer survey of large employers found that 6 percent had dropped coverage in 2026 and another 5 percent were planning to in 2027 or actively considering it. A separate report from the Health Policy Commission in Massachusetts found that the number of commercially insured people in the state taking a GLP-1 drug had fallen by 50 percent between 2025 and the first quarter of 2026 as private coverage started to drop off. 

Some of the biggest brands in the US are reportedly eliminating or reducing their coverage: PepsiCo, Starbucks, and Lowe’s among them. And their reasons are simple: It’s too expensive. The drugs still carry a high net price tag — $600 or more for a 30-day supply — and potential demand is high (two in every five American adults have obesity). 

When a lot of people start taking an expensive medication all at once, it’s going to raise costs for employer insurance plans — and they have to figure out how to adapt. Insurers set premiums at the start of each year, based on how many people are on the plan and how much healthcare they are expected to need. But if those estimates are off — say, if more people take an expensive GLP-1 drug than the insurer expected — they have to offset those costs somehow, and raising premiums the following year is a common solution. According to one estimate, premiums are projected to grow by 5 to 13 percent due to GLP-1 costs — and the burden of paying those higher premiums is likely to fall on the workers. The employer can also try to limit GLP-1 use by, for example, asking workers to pay more out of pocket for these drugs; according to Mercer, 27 percent of large US employers instituted some kind of utilization controls for GLP-1 drugs over the past year or plan to next year.

They also have the option to simply stop covering these drugs for weight loss altogether — and that’s the route more and more of them are deciding to take. The abrupt reversal has even caught economists like Sacks off guard.

“I was surprised that anyone would do an about-face because I thought they understood the trade-offs well,” Sacks said. “My guess is that it turned out to be more expensive than they anticipated: Take-up is higher, and possibly more people are sticking with it. That’s one reason that you might not want to continue to offer it.”

For employers, the short-term costs of covering a drug often outweigh the long-term benefits that medication may confer, at least from the employer’s POV. One analysis — notably produced by Blue Cross Blue Shield Kansas — concluded that covering GLP-1s for weight loss increased average employee health costs by $7,000 in the first year and another $4,200 in the second, largely due to the cost of the drugs themselves. And yet at the same time, there were no decreases in obesity-related medical events in that time period. Another study from Sacks and his colleagues at Indiana University and the University of South Carolina found that GLP-1 use did not lead to any cost savings over five years.

So in the short term, these employers are arguably making an economically rational decision — but one that may still come at their employees’ expense. “I’m completely screwed,” said one person on Reddit about Cigna’s plans to drop GLP-1 coverage for their own employees. They’re looking at at least $300 for one month’s supply at cash prices. 

They weren’t alone either: “I’m devastated,” said another person, commenting on Starbucks’s decision to stop covering GLP-1 drugs. They said they had an autoimmune condition that had made it difficult to lose weight — until this new class of medicines came along.

Where GLP-1 coverage goes from here

How could we end up here, where it makes good business sense for companies to make a decision that could potentially harm their workers’ health in the long term? It is at least in part a result of the haphazard way the US has ended up insuring people.

When employer-sponsored insurance started to arise in the mid-20th century, eventually becoming the primary way to cover the working-age population, people tended to stay at the same job for a long period of time. In theory, there was a synergy: Companies wanted their workers to stay productive, and so it was worth it for the company to invest in their long-term health via their insurance benefits. And research has found that people who stay with the same company — and the same insurance plan — tend to have better health than those who switch a lot.

But these days, people change jobs all the time or work various gigs to piece together an income. You probably don’t expect to stay at your job for 10 years — and your employer doesn’t expect you to either. Instead, they want to keep their own costs as low as possible in the short term. This leads them to cut GLP-1 coverage, even though doctors do believe that people could benefit tremendously long term from the weight loss these drugs help them achieve and all of its potential health benefits. 

“There are very real health benefits of these drugs,” Sacks told me. “The fact that we don’t find offsets or they’re even more expensive than we thought doesn’t necessarily mean that we shouldn’t cover them.”

In theory, the market is supposed to fix the price problem: Drug companies get a period of exclusivity for the drugs they develop, and then, once that time elapses, cheaper generic versions can come onto the market. But generic semaglutide won’t be available in the US until at least 2031 — and for some versions, the generic competitors aren’t going to debut until the 2040s. Offering GLP-1 coverage could become a competitive advantage for employers, a perk they can offer to entice potential workers as part of their benefits package.

Beyond that, though, the path to more affordable GLP-1s is not immediately obvious right now. A lot of people are already willing to pay cash for these drugs — and that may continue as long as people can afford to do it. But with inflation still steadily rising, these drugs could slip out of reach for more and more Americans.

The government could get involved, but, for now, the federal government’s negotiating authority only covers Medicare, not the private plans that are dropping coverage. Serious healthcare reform is probably off the table until at least 2028, and then only if Democrats win both Congress and the White House and decide to make a healthcare package their legislative priority.

But the lesson of these recent developments is that, at some point, the US may have to look seriously at the underlying problem creating this mess in the first place. A patchwork method of insuring people that privileges short-term cost-cutting over people’s long-term health isn’t a real healthcare system.

This story appeared in Today, Explained, a daily newsletter that helps you understand the most compelling news and stories of the day. Subscribe here.

The first hurricane of the fall season is expected to strike the Gulf Coast overnight, marking the latest onset of hurricane season in living memory. As of early Friday afternoon, Hurricane Isaias had grown to a Category 3 storm, with sustained winds of 120 miles per hour. It will strike along the shores of the Florida Panhandle, Alabama, and Mississippi, posing a threat to life and property for millions of Americans. Weather forecasters anticipate between 8 and 12 inches of rain in the areas near where the storm makes landfall.

Isaias’s imminent arrival signals the end of a period of unusual good luck when it comes to hurricanes striking the United States. Last year, no hurricanes reached the US mainland at all. And this year, Isaias is breaking a more than 100-year-old record: October 9 is the latest date since 1905 for the first Atlantic hurricane of the season to take shape. August and September have historically been the busiest periods of hurricane season.

Not lately, though. It’s a strange recent phenomenon, and it’s been even more fortuitous than it would ordinarily be. That’s because the Trump administration has slashed weather forecasting and emergency relief funding over the past two years, leaving us less prepared for a disaster. 

And now our luck seems to be running out — with even more rough weather on the way.

Hurricane season may be quieter than usual — but El Niño is on the way

Here’s the secret ingredient that’s pushed off hurricanes even as warming planetary temperatures raise concerns about more extreme weather events: El Niño. This notorious shift in global wind patterns, which occurs every two to seven years, moves warm water around the oceans, disrupting traditional weather patterns and leading to intense rain and sometimes disastrous flooding, as well as droughts. If there is an upside, however, it’s that this temporary change in ocean conditions prevents hurricanes from forming as frequently as they otherwise would.

The downside is, well, El Niño is still on its way. Forecasters expect this year’s version to be historically bad — using words like “super” or “Godzilla” to describe it. The worst of the bad weather is projected to arrive in December: The southern half of the continental US is expected to see unusually rainy and stormy weather, while areas of the Great Lakes and Pacific Northwest could see extreme dry spells. 

It will also serve as a crucial test of our reduced capacity for predicting and responding to disasters. Trump’s “big beautiful bill” cut funding for the National Oceanic and Atmospheric Administration’s weather forecasting and public alert programs by $200 million, and 17 percent of FEMA’s workforce left the agency in 2025 amid the administration’s DOGE purge. 

For now, if you’re in the danger zone for Isaias, please pay attention to local and national weather alerts this weekend. If you’re not, count yourself lucky — but there are storm clouds on the horizon.

One link for later

➨ These days, it feels like we’re all swimming in a sea of AI hype and hysteria — all the ways this technology will make our lives better, all the ways it could kill every single one of us. But what if the two are more related than we think? Eric Levitz’s new piece asks whether the AI companies themselves warning us about the apocalypse is part of their own marketing strategy. It’s a useful guide for how to think about all of these existential conversations.

Before you go…

• Did you know…the world’s largest penguin colony has declined by two-thirds since 2011? Scientists pin the blame on climate disruption and warming sea temperatures.
• Today’s trivia: What’s a three-letter abbreviation for the successor of tube TVs? (You can find this and other brain puzzles in Vox’s daily crossword. Look for the answer in tomorrow’s edition.)
• Yesterday’s trivia: Yesterday we asked you which fruit kills more people than sharks each year, according to long-standing urban legend. That would be the coconut, and the claim (which is unprovable, since there’s no systematic tracking of coconut deaths) appears to have been started by shark scientists.

The videos are astonishing. In one scene, a senior Chinese woman appears lost in the wilderness of dementia, unable to answer basic questions; in the next, she seems to be lucidly chatting and shucking beans for dinner. By all appearances, years of cognitive decline had been rapidly reversed after the patient underwent an experimental new surgery.

The only problem is: No one is sure if it’s real. 

It’s difficult to take any video at face value in the age of AI, and this experimental procedure happened in China, a country with a recent history of controversial science touting extraordinary but questionable claims. In the past few years, researchers there have published several papers reporting promising results from a procedure that purports to attack Alzheimer’s disease in a peculiar way: by connecting vessels from the lymph nodes in the neck to nearby veins in an attempt to drain the brain of harmful waste. But these have been small studies that did not include a control group. The doctor who first pioneered the surgery there has reportedly been placed under arrest, and the Chinese government has sought to stop most physicians from performing any more of these operations. 

Is that because it’s a scam? Or because it’s dangerous? Or could it be because there have not yet been proper randomized trials, tested against a placebo, to assess the procedure’s safety and efficacy? There are new studies being planned in China to more rigorously evaluate the surgery.

But scientists elsewhere in the world have a lot of questions. And now, a small group of researchers in the US and Europe are endeavoring to find the answers. Within the next few years, we should know whether this surgery really could be the miracle that the viral videos make it appear to be — or another much-hyped treatment that ultimately fizzles out.

Dr. Adnan Siddiqui, a neurosurgeon at the University at Buffalo who is leading an initial US-based study of this procedure, previously helped develop a new treatment for severe stroke patients. This gave doctors a valuable new technique for treating patients during an emergency, and he told me he saw it rapidly change the standard of care around the world. In an interview, he cautioned that a lot more work needs to be done to assess this proposed new Alzheimer’s treatment — but at the same time, he’s optimistic.

“The whole world’s paradigm changed in literally a blink of an eye. It can happen. And I’m hoping this might be that second home run,” he said. In “2027, we’ll start getting clear signals in one direction or the other. By 2028, 2029, we would know whether this is real or not.”

Why this Alzheimer’s surgery really might work

The promise of this controversial new procedure lies in the lymphatic system, which is essentially the body’s drainage system. According to scientists’ best current theories about Alzheimer’s, the brain’s filtration system gets worse as we age, and as a result, plaque made up of amyloid proteins as well as tangles of tau proteins can accumulate in people’s brains and eventually lead to neurological damage, leading to the severe memory loss of Alzheimer’s disease. Researchers have found evidence that those amyloid and tau proteins also accumulate, not just in the brains, but also in the lymph nodes in older people. 

So could a minimally invasive surgery to improve the brain’s drainage have such a dramatic impact on Alzheimer’s disease? 

Siddiqui, who also runs the Jacobs Institute at the University of Buffalo, which is focused on new technology for vascular and neurological disease, had been interested in the lymphatic system’s role in Alzheimer’s before he ever heard about this experimental work out of China from a colleague years ago. The colleague had gone to see Dr. Qingping Xie, the surgeon who started performing lymphatic surgery on Alzheimer’s patients about six years ago. To investigate further for himself, Siddiqui went to South Korea to meet a plastic surgeon, Dr. Joon Pio Hong, who was performing a new “more refined” version of the same basic procedure, as Siddiqui put it. But as in China, these were not proper randomized experiments. There was no placebo.

So Siddiqui wanted to see if he could test it himself. After performing proof of concept operations in 2025 with a new microrobotic tool (for a rare disorder involving constricted blood vessels in the brain), he and his colleagues decided to take an even bigger swing: testing this new technology to perform the lymphatic surgery for Alzheimer’s.

The researchers applied to the US Food and Drug Administration and received approval late last year for five initial procedures; over the summer, they got the green light to perform the procedure on 15 patients. Several operations have already been performed, and Siddiqui told me he had four more lined up next week.

The mechanism makes superficial sense: If Alzheimer’s is the byproduct of amyloid and tau building up in the brain because the body gets worse at filtering them out, bypassing a clogged “drain” in the lymphatic system could help to clear the proteins and relieve symptoms. It is, by a different method, the same therapeutic target as recent breakthrough drugs that slow down the cognitive decline of an Alzheimer’s patient.

But instead of an injection, the procedure involves a small incision in the neck, allowing surgeons to connect lymph nodes to a vein. The hope is that creating this new drainage route will help the brain clear amyloid and tau more effectively and “hopefully bypass whatever plugs that might be there in the system,” Siddiqui said.

This first round of US surgeries are part of what’s called an early feasibility study. “You’re just trying to prove that it’s definitely safe and definitely doable and maybe effective,” Siddiqui said. They’re measuring not only the patients’ cognitive performance but other data points — such as changes to their gait — for any sign of benefit or harm.

If results are promising, a second feasibility study will involve a larger number of patients — 50 or so. After that, if the evidence suggests they should move forward, the scientists would start to introduce placebos. In the case of surgery, that means some patients would receive “sham” surgeries that wouldn’t actually do anything. Then investigators would compare the experiences of the two groups: the people who received the fake surgery and the people who got the real thing.

If the latter group improves significantly more than the former, that would allow scientists to say definitively: Yes, this surgery actually works to treat Alzheimer’s.

“Obviously, this is exactly the kind of disease where there’s so much hype and so much hope,” Siddiqui told me. So it is essential to build out the careful research to substantiate it.

But let’s not get ahead of the science

Siddiqui has been in this position before — and he’s seen it go both ways. There was the new stroke treatment that proved successful and has since become the standard around the world. But he was also an early investigator of a multiple sclerosis treatment, somewhat similar to the Alzheimer’s surgery. After initial promise, it failed when the randomized trials began.

“I wouldn’t be a neurosurgeon if I was not an eternal optimist,” he said. “However, I’m a clinical trialist, and I always respect placebo.”

Placebos are essential, but they are also tricky. If somebody thinks they have received an active treatment in a study, they tend to think they’re going to benefit. This goes for surgical treatments as well. So following patients’ and their symptoms after the intervention is essential to seeing just how much of the effects can be attributed to the treatment and how much could be placebo effect. The latter of which could also be reinforced by loved ones who are desperate to see their parent or spouse get better. 

Alzheimer’s is also a complicated disease that we still don’t totally understand. While scientists think there is a relationship between amyloid and tau proteins and Alzheimer’s disease, other factors, such as inflammation and vascular health, could also have a role. Some prior drug candidates have successfully cleared amyloid plaque, but patients didn’t get better. Some people have amyloid build-up in their brains but never develop Alzheimer’s disease.

Dr. Bohdan Pomahac, division chief of plastic and reconstructive surgery at Yale School of Medicine, is overseeing studies designed to establish more of the basics of how these proteins pass through the lymphatic system. This research includes investigating whether obstruction actually occurs in Alzheimer’s patients, and if so, where exactly those blockages usually are. Only after they do this work, he said, would his team be comfortable proposing surgeries to relieve the blockage and see if that helps improve Alzheimer’s patients’ symptoms.

He told me about having seen Xie, the procedure-pioneering Chinese surgeon, speak during a plastic surgery conference a few years ago. (Plastic surgeons are experts in the kind of microsurgery necessary for the procedure, and several are involved in the ongoing Alzheimer’s trials.) 

“I think most people, including myself at the time, dismissed it as, ‘This is some sort of a charlatan.’” Pomahac said. “But he kept coming back to conferences every year and started to show more and more videos. We were not sure. Is it actors? You couldn’t tell what’s going on.”

Which is why he is dedicated to doing more of the foundational research to understand Alzheimer’s first. “Rushing to the operating room makes no sense in my mind at this point,” Pomahac said. “I think there’s a lot of work that needs to be done to really identify the site of surgery and what type of intervention would be most effective.”

Even if you set this surgery aside, this is an exciting moment for Alzheimer’s science. And although waiting any longer is excruciating for those watching loved ones with the disease progress, progress’ velocity by all accounts is increasing.

“We are finally doing the kinds of rigorous studies that will give us some degree of confidence that there’s something real here or not,” Siddiqui told me. “We’re not quite there yet.” But in just a year or two, we should know much more.

A woman’s death last week near a Russian facility studying the plague immediately put the world on alert. This is the plague, after all, responsible for the deaths of some half of the humans in Europe during the worst outbreak in the 1300s. And it happened in Russia, a country with a long history of bioweapon experimentation.

After the Covid-19 pandemic — which many people, including many scientists, genuinely believe started with the virus escaping from a Chinese laboratory — the worst-case scenario was obvious: What if this is another lab leak that seeds a global outbreak?

That’s not likely, for a number of reasons (the facility is very isolated, plague is not nearly as infectious as Covid, it’s easily treated if caught early). But that doesn’t mean our work with such dangerous pathogens has gotten any safer; in fact, it may be betting less so. The anxiety about the Russian outbreak is a window into two trend lines that do worry global health experts: In the six years since the Covid-19 outbreak, the world has been building even more bioresearch facilities, some in places where that kind of work has never been done before; meanwhile oversight of the science and the security measures at those facilities is struggling to keep up.

Every day, humanity is playing with fire, studying and tinkering with deadly viruses, bacteria, and parasites in laboratories all over the world. And despite the recent debates over rogue AIs or AI-assisted humans intentionally developing bioweapons to wipe out humanity, the Russian incident is a reminder that a simple accident — human error — could pose as much of a threat as malice. While it is hard to confirm the details, local reporting suggests the worker may have been infected after breaking a test tube. And if that’s true, this would, of course, not be the first time that a mistake at a highly secure lab has put people’s lives at risk.

“We are rolling back any progress we made post-Covid, in ways that are going to have long-term effects on our ability to respond to any kind of outbreak.”

Gregory Koblentz, co-founded the Global BioLabs project

Since the pandemic, there has been a dramatic uptick in facilities being built to handle some of the most dangerous pathogens in existence. At the same time, there is still no global authority in charge of oversight for these sites. The US, once the world’s public health leader, has pulled out of the World Health Organization, which issues security guidance for labs around the world and helps coordinate a response when there is a possible emergency, and cut funding for the federal agencies responsible for overseeing US biosecurity facilities. And even after something as global as Covid, the world is still struggling to cooperate and rapidly share information during a health crisis; even now, it can be hard to be sure what is happening in Siberia. Our only sources of information are a Russian government prone to withholding and distorting information, and local news reports that are difficult to verify.

Even if this Russian plague threat fizzles out as expected, one day, we may not be so lucky. 

“We are rolling back any progress we made post-Covid, in ways that are going to have long-term effects on our ability to respond to any kind of outbreak, whether it’s natural or deliberate or an accident,” Gregory Koblentz, who studies global biosecurity at George Mason University and co-founded the Global BioLabs project, told me. 

But there are clear things that can be done, before our luck runs out. 

Countries are building more high-level biolabs, but oversight is falling behind

One of the side effects of the pandemic was a biological laboratory building boom that followed in its wake. Global BioLabs, the research initiative Koblentz helps run, has sought to create a comprehensive survey of high-level labs around the world. Take Biosafety Lab, Level 4 facilities, for example; these are built to handle the most dangerous pathogens in existence, like ebola and smallpox. Global BioLabs noted in its 2023 report that “the number of BSL4 labs is rapidly increasing.” 

This is not the first time that a public health emergency has led to a biolab buildout: The post-9/11 anthrax scares and the first SARS outbreak in the early 2000s both led to countries constructing new facilities. In the late 1990s, there were fewer than 10 BSL4 labs in the world; by the late 2010s, there were almost 40. 

But the pandemic accelerated construction once again. In 2021, there were 59 BSL4 labs either in operation, under construction or actively being planned worldwide; by 2023, 10 more facilities had been completed or were in the works, according to Global BioLabs.

Part of the reason for the buildout is a harsh lesson of the pandemic: Developing countries realized they could not depend on wealthier countries to also prioritize their needs during a serious crisis. So they wanted the capacity to handle deadly biological material themselves in case, for instance, they have a local outbreak and want to be able to safely identify the cause. India alone is planning four new BSL4 facilities; at least five countries — including Brazil, Kazakhstan, Saudi Arabia, Singapore, and Spain— have started building or recently opened their first BSL4 lab. As a result, this construction is happening in places with less institutional experience doing this kind of work, where government oversight and stability have been weaker. 

“The more facilities that are working on this raises concerns about whether all this work is necessary,” Koblentz said. “And do they have the appropriate biosafety and biosecurity management systems in place?” 

That could raise the risks of unsound safety protocols — and ultimately of more high-stakes accidents. On top of that, according to the 2023 Global BioLabs report, about 75 percent of the existing operational BSL4 labs in the world are located in city centers, having at least 50,000 people living within 2.5 miles of the lab, “where dense populations could exacerbate the impact of an accidental release.”

And yet, even as lab construction takes off, national and international standards for governing these facilities and the research conducted there remain lax. There is no global organization that inspects or regulates these sites. One key voluntary group — the International Experts Group of Biosafety and Biosecurity Regulators — has actually gone defunct in recent years, Koblentz said. And national laws are patchy: Only one of the 27 countries with a BSL4 lab has comprehensive national legislation regulating “dual-use” gain-of-function research, in which scientists can tinker with pathogens to make them more transmissible or more virulent — and better understand how they work.

The WHO’s pandemic treaty initially included stronger biosecurity protections, but those were watered down during the debate over the document  — and either way, the treaty has still not been finalized. The US has of course also withdrawn from that and other international efforts to improve pandemic preparedness, further examples of the failure to forge more global cooperation in the wake of Covid. 

We need a more transparent approach to dangerous — but potentially life-saving — science

It could be easy to say we should simply stop studying dangerous viruses or enhancing them, even in highly controlled laboratory settings — but the situation is not that simple. Scientists do this kind of work to prepare for the next pandemic, to better understand how the viruses and bacteria that pose the biggest threat to humanity actually function, so that we can beat them back as quickly as possible. 

If you told somebody on the street that scientists are tinkering with a virus to see how it could become more dangerous, they would probably want the scientists to stop. But if you told them those scientists are doing work that could lead to faster therapeutics or vaccines during the next pandemic and avoid the need for lockdown and save millions of lives, they might be more open to this kind of research.

“The real question is: ‘What are the risks and what are the benefits?’” Beth Cameron, senior adviser to the Brown Pandemic Center at Brown University, told me. “We need to have a more rational conversation about what we’re actually talking about,” she said about these sorts of threats that are poised to have, as she puts it, “large-scale societal consequences.” 

And some of those are still circulating today. The reason Russia has this Siberian lab dedicated to plague research is because plague is still endemic in Russia.

“The dangerous pathogens are there already,” Koblentz said. The question is, he said: “How do you do it safely and securely?”

A starting point would be individual labs adopting new safety protocols, such as those from the International Organization for Standardization that were introduced shortly before the pandemic, Koblentz said. Additionally, as countries are building out their lab facilities, they need to develop strong oversight standards at the same time; the buildings may be flashy and have state-of-the-art equipment, but governments also need to address the mundane work of how to inspect and maintain safety once work begins as an equally important part of the process.

“If this is their first lab, in some cases, they don’t have very strong national legal and regulatory mechanisms for biosafety and biosecurity. They might not have the human capital,” Koblentz said. The regulatory side of the project unfortunately gets “short shrift,” he said.

Ideally, the world would have an international mechanism for auditing these sites, Koblentz said, something like an International Atomic Energy Agency but for biosecurity. There would be more transparent debates about what kind of research is done at high-security labs and whether it is truly important.

Better worldwide biosecurity will also likely require the US once again becoming a global health leader. The withdrawal from multinational groups like the WHO and cuts to government science funding have left everyone more vulnerable. Politics has consequences — including for our risks of a biosecurity catastrophe.

“Our level of preparedness for an outbreak, whether it is a lab accident or a natural outbreak of plague or anything else has been dramatically reduced in the last two years,” Koblentz said. “We’ve got a whole lot of problems that are self-inflicted at this point because of what the Trump administration is doing.”

The pandemic should have been a lesson in how important biosecurity really is. Instead, we’re unlearning its lessons in less than a decade. The Russian plague incident could be an essential wake-up call.

After moving to West Virginia last year, Steve Kuo signed up for a new insurance plan that would cost him $500 a month. But there was one upside: He knew he was entitled to a free preventive visit. He wanted to take advantage of it, so he made an appointment at a clinic near his new home.

But then when he got there, they asked about his medical history and he mentioned prior kidney problems. When he received a bill a few weeks later, he had been charged twice for the same appointment: Once as that free preventive visit, once as an “office sick visit” because of the kidney conversation. He was flummoxed — and very annoyed, as he shared on social media. “No copayment means no copayment, exactly as stated in the insurance guidelines,” Kuo told me over email. “What is written and agreed upon should be honored.”

He is far from alone. On Reddit, I easily found more than a dozen examples in just the past year of people getting a surprise bill for what they thought was going to be a free visit. 

One woman posted a nearly $1,000 bill she’d received for what she thought was going to be a preventive gynecology visit. Another woman said that she ended up facing roughly $3,000 bills because she was given an ultrasound (which she said she didn’t request) at a preventive visit, and then her blood draw was sent to an out-of-network lab. Another person lamented that they had been billed $170 for an office visit because they had briefly mentioned back stiffness.

It’s not supposed to be like this. Americans don’t get much when it comes to our healthcare, but most of us are supposed to be entitled to at least one thing: Once every year, no matter your health insurance, you can go to the doctor with the goal of preventing future health problems by discussing important vaccinations, cancer screenings, and cardiovascular health screenings. The Affordable Care Act made that the law in 2010.

But more than 15 years later, people all over the country are walking into their doctor’s office, thinking they’re entitled to that one free visit every year, and walking out being billed for a sick visit, blood labs, and more. Researchers estimate that Americans spend tens of millions, maybe hundreds of millions of dollars every year on services that are supposed to be free under the ACA.

Dr. Yalda Jabbarpour, a family physician in the Washington, DC, area and medical director of the Robert Graham Center for Policy Studies, told me she still deals all the time with people’s confusion about what a preventive visit really means.

“Every single time I’m in the clinic, this issue comes up with a patient. And it’s sad that it comes up,” Jabbarpour told me. “In my mind, the blame is not to be put on the patient. The blame is not to be put on the physician. Really, this points to a bigger system issue that we need to solve.”

How could a seemingly simple promise of one free annual doctor’s visit result in a situation so convoluted that patients and doctors are still struggling with it nearly two decades later? And how might we fix it?

Patients are getting surprise bills from their doctors — and they’re pissed off

The goal of the ACA was to expand coverage and make sure health insurance would be comprehensive to actually help people stay healthy. As part of that project, the authors of the law added a mandate for insurers to cover those services, including an annual wellness exam. The problem is, they did not define what the parameters of that preventive visit actually were, said Alex Hoagland, a healthcare economist at the University of Toronto. 

“It didn’t establish a clear definition of…all the diagnosis codes and procedure codes and how frequently you get that combination within a year,” he said. “They don’t define what actually is preventive care and what’s not.”

That has left each insurer to define a preventive visit on their own — and that’s where the perverse incentives that leave patients in a lurch begin. Preventive visits are supposed to be reserved strictly for screenings and talking about other preventive measures you can take to protect your long-term health, but you may get billed for an “office visit” or a “sick visit” if you talk about any specific symptom you’re experiencing, the same as if you had come in because you had the flu. 

Health insurers have an incentive to keep the definition of preventive care as narrow as possible, so they have to pay fewer claims without any contribution from the patient. At the same time, doctors want to be paid for the actual services that they are providing. If somebody does bring up a bigger health problem during a preventive visit, then the doctor reasonably wants to be paid accordingly. 

“I know, particularly in the healthcare space, it’s really popular to blame one party or another, and here I don’t think it’s a matter of corporate greed or physician incompetence or whatever,” Hoagland said. “It’s just a natural mismatch of incentives.”

So the reality is that “one free doctor’s visit” sounds straightforward, but, in practice, it’s much more complicated. You as the patient might think of it as one visit, but in our fee-for-service healthcare system, where providers bill based on each specific thing they do, it’s not. The conversation about your vaccination may be free — but asking about your back pain is not. If you get blood tests ordered, that’s another line item. The list goes on. “It’s not like you walk into a doctor’s office and it’s just one thing that happens, right?” said Sabrina Corlette, co-director of the Center on Health Insurance Reforms at Georgetown University. “It’s multiple different things that are happening when you go into a doctor’s office.”

Part of the problem may be that it’s one free visit. We Americans are consumers at heart: Tell us we’re going to get something for free and we want to take advantage of it. But having just one free visit may also lead to people bringing a laundry list of questions to that preventive visit, because they think of it as their only chance to ask everything of their doctor. 

That makes it easy for the discussion to tip over into a sick visit — and not only does that lead to a surprise bill, it can also crowd out the conversation about prevention that the visit is supposed to be focused on.

“What ends up happening a lot…is that a patient comes in for their annual visit, and in their mind, that is their time to bring up every single thing that’s been happening during the year, because they see it as the free visit to bring up everything that’s happened during the year. For some patients, that takes up the entire visit,” Jabbarpour told me. “They leave, and it’s like, ‘Oh my god, we forgot to do all the screening things: the vaccinations, the cancer screenings, and the cardiovascular risk screening.’ And then something happens down the line because you never address those screenings.”

A 2021 study by Hoagland and Paul Shafer, both of Boston University at the time, estimated that Americans with employer-sponsored insurance had in 2018 alone paid between $75 million and $219 million in medical bills that should have been free. They were more likely to be charged for things like contraception or cholesterol and diabetes screenings, with individuals sometimes paying hundreds of dollars for those services.

Hoagland told me he had been billed for preventive visits because he has type 1 diabetes and the system automatically categorized his appointment as a diabetic visit. Earlier this year, he co-authored a study that found people with chronic conditions were more likely to be charged for preventive care. Corlette said that she too had recently been charged for what was supposed to be a preventive visit after she mentioned an issue as an aside. And these are folks who study health care for a living.

“It was literally maybe a 10-second conversation where I would ask the doctor a question about something,” she said. “And that triggered it.”

Colonoscopies are another dramatic example of how this issue plays out in real life; Corlette told me the procedure was one of the first services where this fuzzy line between prevention and treatment under the ACA became obvious. People go under for what is supposed to be a preventive colonoscopy. But then their doctor finds a polyp and decides to remove it — good clinical practice, but as a result, their patient could end up being charged thousands of dollars because the colonoscopy was no longer preventive once that polyp was snipped.

“All of a sudden, that would trigger what the patient thought was a preventive service into a cost-sharing obligation,” Corlette said. “Colonoscopies can be thousands of dollars. That was when we were first like, ‘Oh, yeah, this is a more complicated area than I think the lawmakers that drafted this provision originally envisioned.’”

How the US could fix our preventive visit headaches

The ACA’s preventive visit promise was clearly well-intentioned and it’s worth remembering that, if you look in the aggregate, more Americans are getting more free preventive care than they did before the law was passed. The problem, as much as anything, is expectations: People think they’re entitled to a free visit and are understandably frustrated when they get billed for it.

“The difference is before the Affordable Care Act, maybe they anticipated some kind of cost-sharing,” Hoagland said. “But after, they expect it to be free.”

It doesn’t have to be this way. Corlette’s team at Georgetown University recently released a proposal that Americans be entitled to three primary care and two urgent care visits every year with no cost-sharing. This approach has two virtues, she told me: It will help people feel like they are actually getting value from their insurance — the very complaint that Steve Kuo raised — and, because we know primary care helps prevent problems down the road, it should also improve people’s health in the long term. Take the pressure off that one free visit and let people see the doctor a few times a year without worrying about being charged.

“In employer-based insurance, a lot of people feel like, ‘What the hell am I getting for my premium each month?’” Corlette said. “We wanted people to feel like they’re getting good value, and we wanted to get to better population health.”

Hoagland also endorsed the idea of at least one free physician’s visit every year, no matter what’s discussed. In the long term, Jabbarpour said she’d like to see copays eliminated entirely for primary care. 

But any payment reforms are not going to happen immediately. What can we do right now?

For one, doctor offices could make an effort to be as transparent as possible. Jabbarpour’s MedStar system has started calling people a couple of days before their appointment with a brief script that tells the patient that they could be charged if the conversation with their doctor touches on additional medical problems. If your doctor’s office doesn’t proactively bring it up, ask when you schedule your appointment or when they call you to confirm it. Worst-case scenario, ask your provider what they consider preventive care when your visit begins. You might also want to educate yourself on what services are generally considered preventive and should be available for free: Your insurer may make that information available on their website, or KFF has a database you can peruse.

It’s not a perfect solution. “What ends up happening is patients come in, and they say, ‘I know I’m not supposed to talk to you about anything else, so I’m not going to tell you about anything else.’ And you don’t want that to happen,” Jabbarpour said. You should ask your doctor directly: What do you consider to be preventive care? Establish boundaries at the start. That way, you can at least be aware if you are going to get charged because the conversation crossed the line to discussing an active health problem.

And if you want to see the underlying laws change, start organizing. Contact your state and federal reps and ask them what they are doing to ensure this stops happening. Things could be different: Jabbarpour said she hopes to one day work in a health system where the cost of a single primary care visit isn’t so high-stakes, where doctors and their patients can manage their health according to their particular needs, rather than worry about how to bill for one specific conversation that covers the whole range of somebody’s health — like primary care is supposed to do.

“I think some patients can be managed by seeing us once every year, once every two years, and some patients need to see us monthly,” Jabbarpour told me. “To put all patients in the same box and say you can only see your primary care physician once a year if you want it paid for, it makes zero sense.”

The AI freakout of the past few weeks has centered on nothing less than the risk of human extinction — on the possibility that artificial intelligence could wipe us all out. But the reality is, AI programs are already having a direct and sinister effect on people’s physical health: UnitedHealth Group, the largest health insurer in the US, has been accused of using AI programs to deny payments to people, despite their doctors saying the care was necessary, and is facing a class-action lawsuit. 

Humana and Cigna are facing their own litigation over similar allegations. Meanwhile, Medicare has launched its own AI tool that will help the government determine whether to approve prior authorizations, and doctors are sending the federal government reports of patients at their offices who are in tears because they can’t get the medicine to manage their chronic pain.   

The claims in the legal complaints are harrowing: Families are desperate for an elderly loved one who recently experienced a serious fall to be allowed to stay in a nursing home. Doctors are flummoxed when a patient who may need months of rehab is cut off by an algorithm after a couple of weeks. 

This is AI’s threat to people’s health right now. 

While the current conversation may be fixated on something more Hollywood, private insurers and the Trump administration are already deploying AI programs to vet people’s health insurance claims — and the evidence is growing that these programs are not always doing a good job and are instead putting people’s health at risk. Until these lawsuits are settled or policymakers can figure out a way to regulate how insurers use this new technology, it will be up to each of us to make sure that an AI program isn’t being used to cheat us out of insurance benefits that we’re entitled to.

“The type of care that clinicians deliver is very sensitive to the patient’s unique circumstances. That may not really show up as a number. There’s not a numeric value that tells you the completeness and connection of a patient’s social network,” said Mika Hamer, a health services researcher at the University of Maryland. “There really are a lot of factors that really can’t be quantified and so aren’t really suitable to go into these models. If we start to rely exclusively on the models, I think we run the risk of losing that human touch.”

Patients say private health insurers are using AI to deny claims

Insurers and patients fighting over medical claims is nothing new: Policyholders want the most coverage they can get and payers have a business incentive to pay as little as they can. Health insurers have also used algorithms for decades: Plug in somebody’s age, their weight, whether or not they smoke, and one of the old-fashioned algorithms could spit out a rough estimate of how much medical care they would need before they died. Simple — and comparatively transparent. 

When you submitted a claim or sought prior authorization, there was supposed to be a human doctor who could review all of the relevant information on behalf of the insurer and make the final decision, in theory with the patient’s best interests in mind. It didn’t always work that way in practice, of course, but that was the idea.

What’s different right now, according to Daniel Schwarcz, a law professor at the University of Minnesota who has looked at health insurers’ AI use, is that these newer programs can make very specific predictions about someone’s future health based on the information that’s fed into them, and those predictions are being used in the process of approving or denying medical claims. And exactly what went into making those predictions — and whether it is the AI or the human who ultimately holds the final authority — is often opaque from the outside.

“The reason we want human review is we want human substantive judgment. We want AI to be supporting that,” Schwarcz said. “But the difficulty is distinguishing between AI supporting meaningful human processing and AI basically replacing the human with the human just passively defaulting to the AI judgment. It’s just incredibly hard to distinguish between those two in practice, particularly in rules or regulations.”

And those questions are at the heart of the lawsuits brought against three major insurers in the past few years about their use of AI in processing claims.

In May 2022, Gene Lokken, then 91 years old, fell in his home. He was taken to the nearby hospital in Tomahawk, Wisconsin, and treated for a broken leg and a broken ankle. Less than a week later, he was placed in the health system’s hospice care because, according to the lawsuit filed by his family, he was “very weak, not communicative, and in constant pain.”

But a month later, after receiving skilled nursing care, Lokken started to improve. By late June, his doctor had removed his splint and placed his leg in a removable boot. In July, he started physical therapy to get up and walk again. And for a while, his Medicare Advantage plan sold by UnitedHealth covered all of the services he needed.

Until July 20. Around that time, according to the lawsuit, UnitedHealth denied any more services at the nursing facility where Lokken had been for the past two months. It insisted that he could be safely discharged and more time at the nursing care facility “was not medically necessary.”

The insurer’s decision left Lokken and his physician “dumbfounded.” The physical therapist notes from the time said Lokken was still suffering paralysis and weakness after only a couple weeks of rehab. His family appealed, but UnitedHealth continued to deny the claims, asserting that because Lokken could feed himself and did not require help to clean himself, he did not need nursing care and could go home. 

From July 2022 to July 2023, Lokken remained at the nursing home, but his family had to pay between $12,000 and $14,000 monthly to keep him there. And on July 17, 2023, Lokken died — having never left the facility.

The lawsuit alleges that the decision to stop covering Lokken’s nursing-home stay was largely made by an AI algorithm, called nH Predict, which UnitedHealth follows so unquestioningly that employees were allegedly at risk of being disciplined or fired if their claims decisions went against the AI’s projections. The complaint alleges that the AI model would typically start denying claims after two weeks of nursing home care — and the attorneys have more examples than Lokken.

Glennette Kell required emergency surgery after a fall in late August 2023 and was referred to a nursing home rehab center. By mid-September, UnitedHealth was denying her claims for nursing care, despite the fact that, according to the lawsuit, she still could not walk. Kell had to pay $10,000 of her own money to cover the rest of her bills. Darlene Buckner suffered a heart attack in October 2023 and underwent triple-bypass surgery. She was readmitted to the hospital in late November because she was experiencing complications, but less than two weeks later, UnitedHealth allegedly denied any further treatment at the hospital because it was deemed medically unnecessary. At the time, according to the class-action lawsuit, Buckner was experiencing “an open infected wound near her heart from the open-heart surgery, she was on blood thinners, and was receiving antibiotics through an IV.” 

UnitedHealth, in its responses to the plaintiffs, has asserted that federal laws and regulations already require all claims decisions ultimately be made by a human doctor, not an AI program, and raised several other technical legal objections (such as saying the plaintiffs have not fully exhausted their administrative appeal options). The plaintiffs, however, allege that UnitedHealth employees “are instructed not to deviate” from the AI model’s projections, and then tell patients the AI-generated information is proprietary when they or their doctor try to inquire about why their claims are being denied. 

And, to be clear, UnitedHealth is not the only insurer being sued for using AI programs to deny claims. Humana is facing its own lawsuit brought by other Medicare Advantage patients who allege the same nH Predict program also led to their claims being wrongfully denied. Joanne Barrows, then 86, fell in November 2021 and went to a rehab nursing facility after her hospital stay. And just two weeks later, Humana began denying her claims for further care, according to the complaint, leaving her and her doctor “bewildered” because she was under doctor’s orders not to put any weight on her leg.

And the third lawsuit, filed against Cigna, alleges the company used a different AI algorithm that allowed its doctors to deny claims in huge batches — hundreds or thousands at a time — if they did not meet certain predetermined criteria. One patient, Suzanne Kisting-Leung, had claims denied for two ultrasounds done by her doctor to check for ovarian cancer, putting her on the hook for more than $700 in medical bills because, the lawsuit alleges, Cigna’s AI program determined that the scans were not medically necessary. The plaintiffs say that their claims were instantly rejected, without their medical files ever being opened. As for the law that human doctors have to make the final call? According to the lawsuit, the algorithm “enable[s] its doctors to automatically deny payments in batches of hundreds or thousands at a time for treatments that do not match certain pre-set criteria, thereby evading the legally required individual physician review process.”

These people, many of them elderly, had no idea AI was being used to make decisions about their coverage — until it was too late.

“From their perspective, you might as well have been speaking Esperanto. They just had no idea what it was that was being said to them when they were being told. They usually heard about it for the first time when they were being told that they needed to leave,” Glenn Danas, one of the attorneys in the class-action litigation against United, Humana, and Cigna, told me. “They just had no idea what was going on or why this was being done to them.”

AI is now making decisions for traditional Medicare claims too

It’s not just private insurers either. The Trump administration is now pushing traditional Medicare and Medicaid to use AI to adjudicate insurance claims too. In June 2025, nearly two years after those lawsuits had been filed against Cigna, Humana, and UnitedHealth, the US Department of Health and Human Services announced it would deploy a new program called the WISeR (Wasteful and Inappropriate Service Reduction) model to make prior authorization decisions for about a dozen procedures for the people on traditional Medicare in six states — “leveraging enhanced technologies, such as Artificial Intelligence (AI) and Machine Learning (ML), along with human clinical review to ensure timely and appropriate Medicare payment for select items and services.” It would be a pilot program, before federal officials decide whether to take the program nationwide.

It was a quiet, massive change for traditional Medicare, which covers about half of the 66 million Americans on the program. (Medicare Advantage plans, in which private companies administer Medicare benefits under slightly different parameters and which were the subject of the earlier AI-related class-action litigation, cover the rest.) People on traditional Medicare had historically not been required to get prior authorization for most services; now they would be, and a novel AI program would play a significant role in which claims get approved and which ones don’t.

From the start, physician and patient advocates warned about the potentially adverse consequences of the WISeR program; the Center for Medicare Advocacy said the program would likely “complicate, delay and even outright deny necessary care.” According to media reports and internal government documents, that’s exactly what has happened since the model went live in January. 

The Washington Post first reported in March that physicians and their patients were experiencing approval delays or denials for medical services that should have been covered. One glitch led to a denial of payment for services that had been approved. Doctors noticed that certain procedures seemed to give the AI model problems — such as two competing treatments for incontinence — and were weighing whether or not to stop offering one of those services altogether. The Post reported on one Arizona patient who had been receiving steroid injections for chronic back pain before being denied multiple times after the AI program’s launch. The pain became so severe, he said, that he could not exercise at all.

Then this month, the Electronic Frontier Foundation released a trove of documents it received in response to a Freedom of Information Act lawsuit related to the WISeR model. The documents revealed aggressive denials — one company using the AI model had actually denied more prior authorization requests than it had approved — and there were delays even when the care was ultimately approved. One review took 83 days when the model was supposed to make a decision within 72 hours.

The direct feedback from doctors in the federal documents obtained by EFF was devastating.

“We have patients calling our offices crying in pain because their procedures are being delayed while awaiting approvals or guidance tied to this model,” one doctor wrote. “A 3-4 day delay for necessary pain procedures is already difficult for vulnerable patients, but when providers cannot obtain answers for weeks, the situation becomes unacceptable.”

According to the federal documents, the Trump administration was already discussing ways to expand the program. Despite the outcry from doctors and patients, and growing concern among their representatives in Congress, it doesn’t look like WISeR is going away.

How can we make sure AI doesn’t take over insurance claims?

AI is becoming a part of healthcare — it is already happening. And many of those uses could be truly beneficial. Anthropic recently announced an initiative to apply the theoretical findings of its AI models to real-life lab work that could lead to new drugs being developed in the future. In terms of scientific discovery and the potential to translate it into new treatments, the excitement among clinicians about its potential is palpable.

And nobody denies that health insurance administration is chaotic and burdensome and would benefit from being made more efficient and streamlined — tasks which AI is at least superficially well-suited for.

But as the past few years have already shown, rushed and sloppy deployment of AI to take responsibility for approving or denying payment for people’s medical care has created serious problems. The issue is that this technology is being adopted more quickly than any regulator can oversee it. We don’t really know how health insurers are using AI tools. We don’t have a good framework for what keeping a “human in the loop” of insurance decisions — which is what people want — would really mean, Schwarcz said. 

“I think everyone agrees at a high level of generality, ‘Yes, AI should be used to enhance human review and not to replace it,’ but no one actually knows how to write rules to enforce it,” he told me. “I don’t think that there’s anything I’ve seen that has effectively defined what it means for a human to be meaningfully in the loop in the sense of retaining independent judgment as opposed to just reviewing and deferring. It is incredibly hard to specify in rules or regulations a standard that is verifiable and enforceable. That is still, as far as I know, an unsolved problem.”

Some states have started adopting rules requiring transparency for AI use in insurance claims, and lawmakers in Congress have put forward proposals requiring human involvement, including the bipartisan Protecting Patients from Automated Denials Act. But these technologies are so ubiquitous and so flexible that rigorously regulating their use is going to be difficult. Meanwhile, the profit incentive for companies to adopt these tools and deploy them widely is extremely strong. We don’t even know how widespread their use really is.

Danas said he and his clients hoped their litigation would help with “putting the brakes” on AI’s use in insurance. Until we figure out what to do from a policy perspective, what can each of us do in the meantime? Hamer told me that the old advice is still the best advice: If your claim is denied, appeal it. An enormous number of denied claims end up getting overturned on appeal. 

“You do not necessarily have to accept that the first answer from your insurance company is the final determination,” she said.

For decades, research into Alzheimer’s disease has made painfully little progress. More than 7 million Americans are living with the disease, which is the most common cause of dementia. It’s incurable, and treatments have been hampered by groupthink, as well as by systemic fraud from some of the field’s most famous researchers.

But there are finally signs that the field is turning a corner, including two new drugs, rolled out in the last few years, that can treat Alzheimer’s directly.

“If somebody walks into a clinic right now and is diagnosed with Alzheimer’s disease,” Vox senior correspondent Dylan Scott tells Today, Explained co-host Sean Rameswaram, the drugs “will hopefully have some effect in slowing down their cognitive decline.” 

As Scott says, “The drug development pipeline is also starting to look much more robust” — even “revolutionary,” to quote one doctor he spoke with.

The two talk about why researchers are more optimistic than they have been in years, whether GLP-1 drugs might help prevent Alzheimer’s, and an experimental surgery pioneered by doctors in China that has produced striking — but if unproven — reports of improvement in people with the disease.

Below is an excerpt of their conversation, edited for length and clarity. There’s much more in the full podcast, so listen to Today, Explained wherever you get podcasts, including Apple Podcasts, Pandora, and Spotify.

You mentioned two treatments. Tell us what they are, Dylan?

We have two drugs right now that have been approved by the FDA: lecanemab and donanemab. And these are drugs that target the amyloid plaque in the brain that scientists have long thought might be associated with the development of Alzheimer’s disease.

The amyloid hypothesis [the belief that Alzheimer’s is caused by the buildup of deleterious amyloid proteins in the brain] has been very controversial for a while, in part because there were these years and years where we weren’t seeing any progress despite this being the dominant hypothesis about the disease. But we do have these two drugs that in clinical trials have been shown to both clear out the amyloid plaque in somebody’s brain and they do seem to lead to slower cognitive decline for those patients.

And the hope is that this is the ground floor. These are the worst drugs, hopefully, that we’re ever going to have and continued scientific discovery and progress with developing drugs will lead to even better treatments in the future.

“The hope is that five, 10 years from now, we’ve got a much more robust suite of treatments that can help somebody who’s been diagnosed with Alzheimer’s.”

Tell us more about the scientific discovery. You mentioned that there’s promising research beyond amyloid plaques?

It’s not like the amyloid hypothesis has been invalidated, but I think our understanding of the disease has become more complex. 

We’re realizing that there’s probably also a role for a different kind of protein called tau. There may also be a role with chronic inflammation, your vascular health, your body’s ability to just pump blood through your body may also be playing a role in the development of Alzheimer’s disease. And so now we’re starting to see treatments that target these other things. 

The way I’ve been thinking about it is if we used to be putting all of our bets on amyloid, we’re still putting some bets on amyloid, but we’re also putting bets on these other things. And so now there are treatments in the works targeting, for example, these tau proteins.

They’re still in the early stages of clinical trials — really at the stage where they’re just checking the safety of these drugs and making sure that somebody can take them without getting really sick, or God forbid, dying or something like that. But even when they’re doing those safety checks, they do start to collect qualitative data about, well, are we starting to see any effects? 

Some of the preliminary results from some of these tau targeting treatments that are in the works have looked pretty promising. And so that’s encouraging, obviously. It’s possible that we’re moving towards a future where not unlike cancer treatment, there’s not just one drug for Alzheimer’s disease, but maybe you take a combination of different things that work on different mechanisms for the disease and the collective cumulative effect is that it stops the progression or even reverses it. 

The hope is that five, 10 years from now, we’ve got a much more robust suite of treatments that can help somebody who’s been diagnosed with Alzheimer’s.

Five, 10 years from now sounds nice, but is there anything else that’s in the cocktail now that people are discovering could be promising for Alzheimer’s?

There are also, yes, drugs that millions of people are taking right now for other reasons that might also be able to help with Alzheimer’s disease. And GLP-1s in particular are the big ones.

No way!

Yeah, I know. These drugs — it seems like every day you see some new headline about this miraculous thing that they can do.

Weight loss, smoking, my poker addiction, and…?

And it might prevent dementia down the road. 

If you step back and think about it, the theory does make some sense. Like I said before, scientists increasingly think there’s an association between your vascular health and your cognitive health, especially as you age. And what do these GLP-1 drugs do? They help people lose weight. 

Losing weight helps to lower your blood pressure, lowers your risk of vascular problems, whether it’s heart disease or pulmonary disease or stroke or something like that. So if more and more people take these, they take them earlier in life, they lose weight, they keep it off, they don’t develop these heart or vascular problems, it does make some sense that that may also reduce their risk of developing Alzheimer’s disease. 

It’s still sort of theoretical, but the Alzheimer’s Association is putting $100 million behind some research projects to investigate this possible link. We may learn five, 10 years from now, as millions of people are now on these GLP-1 drugs — maybe we start to see Alzheimer’s less often. And that would be another reason to be optimistic that the future for this disease is looking brighter.

How about reversing it? Is that still a pie in the sky?

It’s out of reach for now. Certainly some of the scientists that I’ve talked to have said, “In theory, it should be possible. Your brain is really resilient. It’s really good at rebuilding itself if you give it the chance.” It seems like it should be possible to stop the progression of the disease eventually, and maybe ultimately reverse it. 

Now, there has been some really intriguing, but also mysterious developments around reversing Alzheimer’s, not from scientists based out of the United States, but from scientists in China. People may or may not have seen that there have been videos of these patients who underwent an experimental surgery and the before and after of these videos is incredible.

In the before, you’ve got somebody who clearly has Alzheimer’s disease, doesn’t recognize their loved ones, has trouble with their train of thought. In the after videos, it’s like they’re a completely different person. They recognize their loved ones, they’re talking articulately. And so that has, as you can imagine, generated a lot of excitement, also a fair bit of skepticism.

Are these videos real? Do we know?

We don’t know for sure if they’re real or not. What’s intriguing about this surgery is that the theory of it, at least to me as a lay person, makes some sense. 

The gist of this surgery is the surgeons create a drain in the patient’s brain and the drain is supposed to help the brain get rid of these amyloid and tau proteins that we think are associated with Alzheimer’s disease. On a hypothetical level, it makes some sense. And scientists in the United States and Europe and elsewhere have been intrigued enough about these videos and the findings that have been reported in academic journals to set up their own studies to try to replicate these findings. 

Now, it’s a crazy story because this scientist in China who pioneered this idea has actually been arrested by the Chinese government. And as I understand it, he’s currently in detention.

For what?!

The reporting I saw was these seem to be kind of flimsy charges of insurance fraud. The Chinese government has also tried to ban the surgery, at least outside of clinical trial settings. So that’s obviously complicated the story a little bit.

But nevertheless, you do have scientists in the US and outside of China who are like, “Well, we at least want to try this for ourselves and see if it works.”

It does feel like it’s something that could get people’s hopes up who have been waiting for this for decades.

Exactly. I mean, I think this is like the holy grail. Can we find a way, whether through surgery or through pharmaceuticals, to actually reverse these symptoms and restore the person to who they were before Alzheimer’s took over?

Because that’s the thing that I think everybody recognizes but is worth emphasizing, is, as one doctor put it to me, and I’ve never forgotten it, Alzheimer’s is a disease unlike any other because it robs you of your identity. 

To be able to restore people’s identity through whatever means, that is the goal that all of these scientists are chasing.

When we think about the stakes in healthcare, we tend to think of them in terms of life and death, being sick or being healthy. The conversation is about your physical well-being and maybe your mental health — and it pretty much stops there.

But health affects so much more than your body’s biology or even just you personally, as a new survey from Gallup and Pivotal, a philanthropic group founded by Melinda French Gates, shows. That’s especially true for women, who frequently report negative experiences with the health system and ongoing struggles to get their concerns taken seriously; poor health affects the trajectory of their careers and their ability to be engaged with their families, friends, and wider community.

It starts at the doctor’s office or hospital: 51 percent of women say they have had a negative healthcare experience in the past five years, versus 39 percent of men. About one in three said that a doctor did not take them seriously when they said they were feeling pain or other symptoms, versus 21 percent of men, and 33 percent said that they either were misdiagnosed or did not receive a diagnosis. The cost of paying for care is another deterrent: 32 percent of women said they have skipped or delayed care in the past year because of the cost, compared to 25 percent of men.

“To see that half of women in the United States who sought care in the last five years came out feeling like they hadn’t gotten the help or care they needed, that’s frankly staggering,” French Gates told me in an email. “It says a lot about how little we’ve invested in women’s health and how much we expect them to just push through pain or accept uncertainty.”

And the effects of those experiences, the failure to receive proper treatment, ripples out into the rest of the women’s lives. More than half of US women, 54 percent, said they had experienced at least one health-related impact on their family life or relationships; 42 percent said their health had led to a negative effect on their career or work. It also affects their community: 32 percent said their health had affected their ability to participate in civic life.

The toll is not only physical but mental: 48 percent of women said they’d dealt with a mental health condition like depression or anxiety. And socioeconomic disparities abound. Black and Hispanic women are more likely to report being in poor or fair health. Women who have lower incomes are more likely to face career struggles because of their health than those who make more.

I had the opportunity to interview French Gates, who has made women’s health a priority in her work, over email about the survey; its findings on community engagement, menopause, caregiving, and more; and what could be done to address the problems that it reveals. Our exchange is below, lightly edited for clarity and length.

Which of these survey findings surprised you most and why?

The number of women [54 percent] who said they experienced a mental health challenge during or after pregnancy should stop us all in our tracks. And the fact that less than one in three women who sought care found it helpful is really concerning. It’s why I feel so strongly about integrating women’s mental and physical healthcare, especially during pregnancy and postpartum. Mental and physical health are so linked together.

Too much of the burden is placed on women to get answers. All of us deserve so much better.

Nearly one-third of women said in the survey that health problems limited their ability to be involved in their community. What does that look like in practice, and what do communities lose when women can’t fully participate?

Women are so often the backbones of their communities, whether they’re rallying their neighbors around a cause, leading the PTA, or serving in elected office. Without having women — and their ideas and voices — in those roles, we’re missing half of the conversation. Issues that affect women and families are less likely to get on the agenda. They’re less likely to be solved.

When a woman has a health challenge, and she has to spend so much of her time and resources chasing down answers, that makes it harder for her to show up in those spaces. We saw that in the survey: 30 percent of women said their health limited their ability to be involved in their communities. And when women couldn’t get the care they needed, that percentage doubled.

Women’s health is often talked about as a personal issue, but this data is helping us prove that it’s also an economic issue, a family issue, a community issue — it affects all of society.

Caregiving and family responsibilities prevent many women from getting medical care, in particular Hispanic and Black women. That seems to create a vicious cycle: Women are often so busy being the caregivers in their families that they neglect their own health. Eventually, they are the ones who will need care.

What do you think can be done to break that pattern? Is there a philanthropic solution? What public policy changes could be made?

Women are often taught to put themselves last and minimize their own needs. They don’t always have time to care for themselves because they’re so busy caring for others. And they might not be able to afford childcare or home health support for their aging parents. Our survey showed one in six women delayed healthcare because of their responsibilities caring for their family members. For Black women it’s one in five, and Hispanic women one in four. Too many women are facing an uphill road to even just get to a doctor’s office.

It’s possible to make it easier for people to balance healthcare and family responsibilities — but it’s going to take action from many angles. That’s exactly why I invest in both women’s health and in caregiving, and I’d encourage more philanthropists to do the same. Businesses can also support employees with good paid leave policies and reliable but flexible schedules.

But for women everywhere to benefit, we need government leaders to prioritize increasing access to affordable childcare, home health supports, and paid family medical leave. These are policies that have the support of large majorities of Americans because these are issues that affect everyone. So there’s a real opportunity here to offer meaningful help to families.

I am struck by our collective failure on menopause: Women report that they aren’t aware of menopause symptoms until they experience them on their own, that they struggle to get their doctor to take menopause symptoms seriously, and that their menopause experience has held them back in their career. What are some short-term and long-term steps we can take to address those problems?

“Right now, women need better care at critical moments in their lives.”

If more than a third of women only learn about menopause symptoms when they go through them, the system is clearly not working. Women need to learn about menopause from their doctors before they experience it. But doctors aren’t getting the education and training they need on menopause while they are in school. One doctor told me she got just one lecture on menopause across all her years in medical school. One said it was mentioned one time. They are seeking out better training but it can be hard to find. That’s why Pivotal is partnering with the Menopause Society to expand physician training on menopause so doctors, nurses, and other healthcare providers can access the information they’re looking for to better help their patients.

Because menopause isn’t just about being uncomfortable; it can also bring anxiety, heart palpitations, insomnia — significant symptoms that can really hold women back. More than a quarter of women who’ve experienced menopause or perimenopause said it made it harder to live up to their full potential at work. One in 10 had to take leave or leave their jobs entirely. That just shouldn’t be. Women shouldn’t have to step back right at the moment when they could be stepping into leadership roles.

The most immediate steps can come from policymakers, especially at the state level. They can include menopause care in insurance and Medicaid coverage and offer workplace protections to women in menopause the way they do for pregnancy, so women can get the care they need without losing their jobs. I’m also focused on longer-term solutions, like expanding training for healthcare providers and investing in research to accelerate treatment options.  

Women are at the forefront of a lot of wellness trends these days and yet, as the survey reveals, women also report encountering a ton of health misinformation on social media. Why do you think women are so often the targets of this kind of content? What can be done to point women toward and build their trust in sound medical information?

One in three women said she left an appointment without a diagnosis, with her pain being dismissed, or with no answers or next steps. You can understand why those women would start looking for information online. And because women’s health has been underfunded and under-researched, there just isn’t as much reliable information out there as there should be, which leaves a lot of room for people to come in with misinformation. Investing in credible scientific research to fill that vacuum will give both women and their doctors more information going into their appointments.

In terms of your own organization’s work, which investments are you making that you think can make progress on the underlying problems revealed in this survey?

We need to address the right now and we need to address the longer term. Right now, women need better care at critical moments in their lives.

One way we’re investing in that at Pivotal is by making it easier for women to get the mental healthcare they need during and after pregnancy. So we are investing in integrated models that put mental and physical healthcare under one roof. I visited a health clinic in Alabama earlier this year where they identify issues like depression and anxiety right at the outset and then help the mom all the way through her pregnancy care, all in the same place. That model is something we strongly believe in.

Better care for menopause will require better training, which we are thinking about in both the immediate and long term. I mentioned that we’re making more menopause training available to doctors who are currently practicing. That is something I’m really excited about because I’ve heard from physicians who really want to better support their patients and are looking for better information so they can do that. And longer-term, menopause needs to be a much bigger part of the curriculum at medical schools moving forward.

Another longer-term focus of ours is trying to make up for decades of lost time in research. We are funding medical research focused on how diseases specifically impact women, in partnership with an innovative organization called Wellcome Leap. They are working to accelerate progress in women’s health on everything from autoimmune diseases to cardiovascular disease in years, not decades, which is how long health breakthroughs usually take. That’s the kind of urgency women need and deserve.

A decade ago, insulin became the poster child for America’s out-of-control drug prices. The 2017 death of Alec Smith, who was rationing his insulin before he died, and repeated price hikes for a 100-year-old medication (the patent for which was originally sold for $1 to a university to prevent it from being exploited commercially) sparked widespread outrage that a lifesaving medication could be unaffordable to the people who depend on it to survive.

And then politicians actually acted. Starting with a Colorado law passed in 2019, states began passing laws capping the out-of-pocket costs for many people who take insulin; 27 states (plus Washington, DC) now have such a policy. Then in 2022, Congress included a provision in the Inflation Reduction Act that established a $35 per month cap on insulin prescriptions for people on Medicare. Given the national response — drugmakers also made splashy public announcements about reducing the cash price that uninsured people pay — you would be forgiven if you thought this was the one health care cost crisis that the US had genuinely managed to solve.

But the diabetes community has a dire warning: It’s not over. Millions of people continue to struggle to pay for their insulin and having their long-term health put at risk because of, in the words of one advocate who put it bluntly, pharmaceutical greed.

“There has been so much attention and promise to action around the insulin price crisis. … There has been so much action,” said Shaina Kasper, executive director of T1 International, a global nonprofit that advocates for people with diabetes. “And shockingly, frustratingly, critically, the data from our 2024 survey showed that the rationing rates were worse than ever. Ultimately we’re facing such immense and monstrous corporate greed. … When we put a Band-Aid on one hole, another one’s going to find a way to pop out and keep profits high.”

Fixing the insulin crisis will require a multifaceted approach: drug pricing reform, insurance mandates, and possibly even public manufacturing. Out-of-pocket caps, Kasper said, were always a temporary fix for a very broken system. There is still a lot more work to do.

Why so many Americans still struggle to afford insulin

Both national and local surveys indicate that the policy changes of the past decade have not had the desired effect.

A study published last year from researchers at the Yale Diabetes Center found that people treated there were rationing insulin at the same rate in 2024 as they were in 2017; about one in four people reported some rationing due to the cost of the drug in both years. When you added in the people who rationed because of insurance delays or supply limits, more than one in three people — 38 percent — were still having trouble keeping this lifesaving medication on hand in 2024. A 2024 T1 International survey likewise found that nationwide, 34 percent of the Americans who use insulin reported rationing the medicine. (About 8.4 million people in the US rely on insulin to survive.)

Dr. Kasia Lipska, an endocrinologist and researcher who treats patients at the Yale Diabetes Center and who co-authored that study, was surprised by their findings.

“I was surprised because I’ve been looking at the policy and advocating for policy change; you think things are moving, they should be really improving,” Lipska said. “But if I talked to the nurses and our staff at the Yale Diabetes Center, they told me, ‘Of course they haven’t changed. We’re still hearing these stories.’”

How could this be? The explanation is multifaceted, according to Lipska and Kasper. 

“There’s just still a lot of holes in one who is covered by various protections and then how they’re covered and how they access this,” Lipska said. “It’s not as simple as just showing up at the pharmacy and asking for your insulin, and the sticker price is there, and that’s what you pay. It’s extremely complicated.”

For starters, millions of Americans remain uninsured and have to pay the cash price for drugs. While drugmakers make flashy announcements about helping those people, the process of enrolling for savings cards to get those lower prices can be a nightmare; one congressional investigation found in 2023 that uninsured patients were still paying an average of nearly $100 for insulin despite Eli Lilly’s pledge that its generic product would be available for $25 per vial. Even if you manage to get your discount card, the same investigation found that Lilly introduced several restrictions based on geography and needs, and that the specific insulins that are subject to these voluntary price caps are often out of stock at the pharmacy when people go to fill a prescription (while the more expensive brand name version is consistently available).

And then there are the loopholes in those existing federal and state laws. The federal $35 cap applies only to Medicare; the private insurance that covers half the country is excluded. (There have been bills proposed to extend the cap to private coverage, but they have not gone very far in Congress.) The state laws that do exist typically apply only to small-group and individual plans that are subject to state regulations; larger self-funded plans are exempt from state mandates and currently have no enforced limit on out-of-pocket insulin costs. One national estimate found that around 775,000 people who use insulin and had private insurance were protected in 2025 by the caps in states where they’d become law. But more than 1 million people in those states were not, nor were the 2.1 million commercially insured insulin users in states without a cap.

Even for people who benefit from the mandatory out-of-pocket caps instituted by Medicare and state laws, some of them still struggle to come up with $35 a month, given all of the other price hikes Americans have faced since the pandemic. They may have to navigate a complex process in order to actually receive the promised discount. And while a $35-per-month cap sounds straightforward, in practice, people can still face higher costs. Each individual person requires a unique amount of insulin and, for some of them, they might need two different kinds; the pharmacy may not have the right version and will make substitutions that lead to higher costs. That’s how one of Lipska’s patients ended up paying $140 per month for his insulin — despite being on Medicare.

“These things really add up…and frustrate people,” she said, “because what seems like a great idea is not actually how things work on the ground.”

The consequence is that, despite all the legislative activity and self-congratulations, millions of Americans are still at risk of serious health problems because they can’t get insulin.

The worst-case scenario is what happened to Alec Smith: Somebody is forced to spread their insulin so thin that they put their life is in danger. When diabetics have their blood sugar spike without insulin on hand, they can go into diabetic ketoacidosis, “which literally means your blood is turning into acid,” Kasper said. “I can speak from experience: it feels like you’re dying.”

To recover from an episode, they may have to go to the emergency room and end up taking even more insulin while eating in order to get their body back to equilibrium. But even short of an emergency, Kasper said, people who resort to rationing insulin can experience significant side effects. Prolonged high blood sugar due to rationing could lead to serious vision and nerve problems that were supposed to be a thing of the past once insulin became available.

Those were the scenarios that lawmakers wanted to prevent as they tried to make insulin more affordable. But they remain a very real threat for too many people.

The big idea that could make insulin truly affordable

If there’s good news to be found, it’s that the advocacy community is not giving up. They are sounding the alarm about the ongoing affordability crisis and urging Congress to act. But they do worry that the issue has become less urgent: The truly comprehensive mandate for insulin out-of-pocket caps, which is typically introduced every Congress, was delayed this time. “This year, neither bill was introduced for over a year, and it was very concerning,” Kasper said.

But they are also placing bets on something much more profound than a price cap: the government itself procuring or even producing insulin and making it available to people at the lowest possible cost. 

“This idea that medicines should be for people and not for profit I feel like is really catching,” Kasper said. 

Some states are taking baby steps in that direction: Oklahoma passed a bill this year that would offer government funding for private companies that pledge to produce insulin and sell it at a low price. 

Others are going bigger. As I reported in 2023, California has launched a program that is eventually intended to lead to government-owned facilities producing insulin to be sold on the cheap, though it will take years until publicly owned production begins. The New York state Senate approved a similar plan this year, although funding for it didn’t make it into the state’s budget. Kasper said that she is optimistic the project will make it into next year’s spending plan, and says a lot of work is currently being done to ensure it happens.

In the future, public manufacturing could also help to address the supply problems that continue to pop up. There are only three insulin manufacturers in the US right now. As those for-profit pharmaceutical companies place more emphasis on GLP-1 production — which often takes place in the same facilities as insulin production — nonprofit initiatives could fill in the gaps.

“In this time of tariffs even, with these concerns around shortages and rising prices and the corporations having this monopoly and price gouging ordinary Americans for decades now, as we’ve seen on insulin, let’s just make it ourselves,” Kasper said.

This is a long-term vision; if you need help right now, T1 International has resources to help people get health insurance, access discount programs, and even find emergency insulin. But a more affordable future for insulin will only be possible if lawmakers feel compelled to act. Public outrage created one round of reform, but the risk of political complacency is real. So if you care about this issue and want to get involved, T1 International also has a tool kit for people who want to advocate for policy changes, including around public pharma.

“The general communication that we’ve been hearing is that the insulin price crisis is over,” Kasper said. “Everyone should have access to a $35 copay for insurance. As the data shows, as we’ve been talking about, that is just not true.”

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I don’t know about you, but whenever I go to see my primary care doctor, my mental health isn’t usually at the top of my list of things to talk about. But it should be. In fact, experts say that all of us could benefit from more candid conversations with our doctors about our mental health.

(This story discusses mental health issues and suicide. If you or someone you know is struggling or in crisis, help is available. You are not alone. You can call the national 988 hotline for support.)

For years, the United States has been trying to figure out “parity” for mental health care — to have it treated and paid for like any other medical need, not something that is carved out and separate. A big part of that has been pushing primary care doctors and OB/GYNs to do more screenings, to make your mental state a part of your well-being that you discuss with your doctor the same as your blood pressure or any physical ailment.

But that is easier said than done. A lot of people may not even realize that their depression or anxiety or stress is something they should talk about with their primary care doctor. Others might fear being judged, and for good reason — national policymakers warn there continues to be a stigma toward mental health conditions among doctors.

About one in three Americans say they have never been asked about their mental health by a doctor, which is unsettling considering that the nation has been going through a collective mental health crisis for several years. Men are significantly less likely to be asked about their mental health than women — perhaps a reflection of a culture that expects men to “tough it out” when it comes to their feelings. But those attitudes come with a price: Men are diagnosed with depression at half the rate as women, but die by suicide much more frequently.

Much of the burden for starting these conversations should fall on your doctor to be more curious and accommodating during annual exams. But you don’t have to wait to be asked to bring it up. Regularly talking to your provider about your mental health is the best way to get ahead of any problems and get treated if you need to be. In honor of Suicide Prevention Month, I reached out to a handful of doctors who have studied why it’s sometimes so hard for patients and doctors to talk about depression, anxiety, and stress — and learned some novel strategies for how you can take charge, push through any stigma, and start having more honest talks with your doctor about your state of mind. Here’s what you should know.

Know the relevant symptoms before you talk to your doctor

One of the tricky things about depression or any serious mental health problem is that it isn’t always easy to identify when you’re the one experiencing it. “Patients need to recognize their distress…as potentially emanating from depression,” Dr. Richard Kravitz, a general medicine professor at UC Davis who has studied depression screening in primary care, told me.

There is a checklist of sorts that you can go through on your own to understand whether you’re just having a tough couple of days or there’s something more serious at work, said Dr. Maria Garcia, an internal medicine physician at UC San Francisco. You might be feeling down or unmotivated or have a lack of energy, or be more agitated, angry, or irritable than usual. Sometimes there are less obvious signs, like trouble with money or problems at work. 

“If you’re not getting enjoyment from your normal hobbies or talking to the people that you would normally really enjoy talking to, if you find yourself isolating from people that you normally really enjoy spending time with, I think those are certainly triggers,” she said. Consider the duration of your symptoms, too: “If it’s every day for a couple of weeks, that definitely isn’t normal.”

And oftentimes, depression symptoms can mirror symptoms of other ailments or problems, like a lack of sleep, low appetite, or physical aches and pains. This is one reason why it is so important to talk with your doctor about it, Garcia said. Is that fatigue a result of depression — or is it a problem with your thyroid? Your primary care physician is best positioned to help you figure that out. One of the benefits of a long-term relationship with a physician is that they may be able to help you recognize symptoms of depression even if they aren’t obvious to you.

It’s hard to be that self-aware; I’m certainly not all the time. But the more you pay attention to your mood and how it’s affecting your life, the more you can tell your doctor about what’s really going on. You don’t have to know all the fancy clinical terms, said Paul Duberstein, a clinical psychologist and professor of health behavior, society, and policy at the Rutgers School of Public Health. “The language that people are most comfortable using are words like stress or frustrated or impatient or something like that,” Duberstein told me. “Those are the kinds of things we really do want to incentivize and encourage people to talk to their doctors about.”

How to bring up your mental health with your doctor

Okay, you feel like something might be off and you have a doctor’s appointment coming up. What do you do?

You might not have to do anything. These days, you are likely to be given a depression screening by your physician’s office before you ever arrive (usually as part of your pre-visit paperwork). Garcia said it’s important to be honest and to be thorough when answering those questions, as that will tell your doctor that your mental health should be a focus for your upcoming visit.

But if you aren’t proactively screened for depression and you have some of the symptoms described above or you just have a hunch that something might be wrong, try to alert your doctor in advance that your mental health is something you want to talk about. If that’s not possible, tell your doctor early on in the appointment that your mental state is something you want to discuss. Garcia said that, rightly or wrongly, doctors can sometimes be reluctant to dive deep into a discussion about mental health late into a visit; they only have so much time with individual patients, and they might balk at trying to squeeze in a mental health discussion at the end. The conversation is more likely to be productive if you proactively start it before your physician is sidetracked with your blood sugar. 

During this conversation, you can ask for a depression screening outright. Doctors have become adept at recognizing code words; if you say your mood has been off, they may pick up the signal that you may be experiencing mental health struggles. But there is a good argument for being very direct about how you’re feeling, Kravitz said.

“My advice…is just simply to say to the doctor, ‘I’ve been feeling down’ or ‘I’ve been feeling irritable’ or ‘I’ve been losing sleep’ or ‘Something’s wrong and I don’t know what it is. Do you think it might be depression?’ Just ask,” Kravitz said. If you aren’t sure if it’s a mental or physical issue, tell them that. Activate your doctor’s curiosity, Kravitz told me. Get them invested in figuring out what’s going on with you.

Once the conversation starts, your doctor is likely to ask how long you have been experiencing symptoms and how they are affecting your day-to-day function. When that happens, you should be as thorough and truthful as possible.

“Is it affecting your ability to take care of your family? Is it affecting your ability to go to work, get up in the morning, cook dinner, get out of the house, go grocery shopping?” Garcia said. “Those things are really helpful because then we can tailor the treatments for the amount of functional impairment.”

Talk to your doctor about your sleep, too, Duberstein said. Not only is it an important indicator of your physical health, but it will also tell your doctor something about your mental well-being. And it doesn’t require any special emotional vocabulary: You probably know if you’re sleeping well or not.

“If you think about major depression as a collection of, say, nine symptoms and you ask, ‘Well, what symptoms appear first? Is it the depressed mood? Or the difficulty concentrating?’ The first thing that appears typically is sleep,” Duberstein told me. “Disrupted sleep is something that I think people do feel comfortable talking with their doctor about.”

How to talk to your doctor about a treatment plan

If you have a productive conversation with your doctor and they recognize symptoms of depression, they’ll want to establish a treatment plan. This has historically been another barrier to honest conversations between doctors and patients about mental health: Patients don’t want to be prescribed antidepressants or referred to therapy, so they don’t bring it up.

But ignoring your symptoms is, of course, not the solution. Instead, use your appointment as an opportunity to ask all of your questions to make sure that you are fully comfortable with the doctor’s proposed treatment plan and can get on the road to better mental health.

Many Americans have doubts about antidepressants, which have been egged on by high-profile figures like US Health Secretary Robert F. Kennedy Jr. If you’re hesitant to take meds, you should tell your provider about the things that you’ve heard that give you pause, the negative experiences people have shared, or whatever major questions or concerns you have. They can help you understand the very real trade-offs that come with taking an antidepressant, Kravitz said. Your doctor can also debunk some of the misconceptions that make people hesitant to take these drugs even when they are struggling.

“The duration of therapy sometimes surprises people. But no, it doesn’t mean that you’ll have to be on it forever. No, most people don’t have serious withdrawal symptoms. Those can usually be managed by careful tapering if necessary and so on,” Kravitz said. He said you can ask your doctor outright: “What can I expect to happen over time? How long will I need to be on this?” 

If you’d rather not go on medication immediately, that’s totally valid. Your doctor may instead be able to help you find a therapist with a referral, Duberstein said. Therapists have historically been hard to find in the US — but one positive outcome of the pandemic was the proliferation of online mental health services.

“I think it’s important for the public to know that one of the major barriers to getting into psychotherapy or even seeing a therapist — like getting into your car, driving, finding a bus, finding a subway, whatever — that those barriers are gone,” he told me. “Because you could see a therapist online now in all 50 states.”

The goal is that you leave your doctor’s office feeling heard and feeling on-board with the approach, even if you still have some trepidation (which is very common). And if you don’t feel comfortable talking to your doctor about these issues, that may be a sign you need to find a new provider whom you feel you can trust with those sensitive discussions, Duberstein said.

The point is, your doctor should be your ally in pursuing whatever treatment you need for whatever ails for your mental health. Nobody has to go through it alone.

This story was originally published in The Highlight. To get access to member-exclusive stories like this every month, become a Vox Member today.

Every day it seems scientists are making breakthroughs in Alzheimer’s disease. 

New treatments that actually slow the disease’s progression — lecanemab and donanemab — have finally appeared on pharmacy shelves in the past few years, delivering real-world results for patients and their families. New blood tests promise to identify at-risk patients earlier in their lives, giving them the chance to make lifestyle changes and potentially start treatment to stave off symptoms. 

The media and wellness influencers are always reporting on new diets, workouts, or hobbies that can combat dementia. Just last month, there was even a report out of China about an experimental brain surgery that allegedly reverses the symptoms of Alzheimer’s disease — the Holy Grail that researchers have been pursuing for generations.

But hype has outpaced the science of treating Alzheimer’s disease before. Promising treatments have gotten a lot of attention before only to fizzle out a short time later. Less than a decade ago, many scientists were wondering whether we had the theory of Alzheimer’s disease completely wrong. 

For those of us who don’t work in the field, that confusing history can make it hard to make sense of these recent developments. It sounds like we are entering a new age for Alzheimer’s prevention and treatment — but are we actually? And, if we are, how can people benefit from it?

I called a couple of leading experts to find out.

Here’s the good news: They say scientists are genuinely shifting the paradigm for treating, detecting, and ultimately preventing Alzheimer’s disease. The two drugs on the market can actually slow down cognitive decline for many patients, something that had been out of reach for decades. And more treatments are coming.

“Diagnosis and treatment of Alzheimer’s has changed in a way that is revolutionary compared to, say, four or five years ago,” said Dr. Jason Karlawish, co-director of the Penn Memory Center.

At the clinic where he sees patients, “people are feeling a sense of hope and promise,” he said.

For a long time, the science on Alzheimer’s disease felt stuck. Now it’s moving. There’s only one thing that could stop it, according to experts: the Trump administration’s anti-science agenda.

Scientists are getting closer to game-changing Alzheimer’s treatments

In 2023, the approval of two drugs transformed the landscape of Alzheimer’s care: lecanemab (sold as Leqembi) and donanemab (sold as Kisunla), two IV treatments that target amyloid plaque in the brain of a person with Alzheimer’s. Before these two drugs — and the approval of aducanemab, a similar but less effective and riskier treatment — it had been decades since the last new Alzheimer’s treatment had come onto the market.

They are not perfect treatments. They are effective only for people with mild cognitive impairment, not more advanced stages of the disease. They can only slow the progression of Alzheimer’s for those people, not stop or reverse it. And they do come with the risk of serious side effects, particularly brain bleeds.

“The good news is, we have these two drugs that can help people,” said Tara Spires-Jones, professor of neurodegeneration at the University of Edinburgh and author of the forthcoming book, Fighting for our Minds: The Neuroscience of Defeating Dementia. “The bad news is, you don’t get any better. You’re still getting worse — you just get worse more slowly.”

These drugs are a start, not the endpoint. Researchers are already working on the next generation of treatments. The drug pipeline is becoming more robust because scientists are finally coalescing around a theory of the disease that’s more complex — and, crucially, opens more potential targets for new drugs. 

For a long time, Alzheimer’s research was dominated by the amyloid hypothesis. The theory posited that the buildup of plaque made from amyloid proteins was responsible for disrupting brain signals and creating the telltale loss of memory and identity associated with Alzheimer’s. Scientists are still confident that amyloid plays a role in Alzheimer’s — and the success of these amyloid-targeting drugs supports that interpretation. But there is also a stronger consensus that other mechanisms must be at work. Some people who have evidence of amyloid plaque building up in their brain nonetheless never develop Alzheimer’s disease. 

Another type of protein called tau seems to be associated with the disease. Scientists also increasingly believe that inflammation may play a role. Part of the breakthrough of the past few years is that scientists are no longer arguing about whether they even understand this disease at all. Instead, the mission is to pursue different drug targets and increase the chances of delivering new treatments.

“I don’t think people in the field are fighting over, ‘Your mechanism is wrong and mine is right,’” Karlawish said. “I think there’s a kind of general democratization. There are multiple promising mechanisms.”

New tau-targeting treatments are moving through clinical trials. Biogen has a drug called diranersen that aims to stop the production of the tau proteins moving through clinical trials. Preliminary results showed that the drug did appear to reduce tau and improve cognitive symptoms — although, curiously, the most effective response was at the lowest dose. Further research is needed before the drug could receive FDA approval. Another tau-targeting drug from Eisai has also entered clinical trials and is in the earlier safety-check phases. And new amyloid-targeting treatments aim to better penetrate the brain-blood barrier and deliver more effective relief for patients.

In the short term, scientists hope these drugs can slow or even stop cognitive decline better than the currently approved medications. In the longer term, these new approaches — and potentially a combination of different drugs with different targets — could eventually allow scientists to reverse Alzheimer’s. (As for that experimental surgery in China, as Nature reported, scientists say its results will need to be replicated in other clinical trials before we’re confident that it really works.)

“The brain is amazing. You can make new synapses,” Spires-Jones said. “If we could stop the insult, it’s theoretically possible in the future that we could have treatments that not only slow the progression but actually let you get better. But I think we’re pretty far from those. What I think is much closer is really, really meaningful treatments that will slow or even stop disease progression. We’re probably going to see something coming out in the next couple of years.”

How patients can get the most out of these new treatments

But even a “cure” in the long term will be conditional. Because Alzheimer’s eventually causes the brain to die (thus its 100 percent fatality rate), there may still be a point of no return once the disease is too entrenched. “A cure for people in the late stages is practically impossible because too much of the brain has died,” Spires-Jones said.

And that reality makes early detection all the more important. That’s the way patients can get the most out of the current medications and their eventual successors.

It used to be that doctors couldn’t confirm whether somebody had Alzheimer’s disease until the person died and they could perform an autopsy. But the new treatments can give people more time with their loved ones before the disease’s worst symptoms kick in. 

That means waiting is not an option. Patients are demanding better methods of detection.

“Treatment attracts patients, for good reason, and treatment demands diagnosis,” Karlawish said. “Treatment really does drive the business model for a disease.”

So, scientists are designing new blood tests that can detect the presence of tau proteins and predict the later onset of Alzheimer’s disease with impressive accuracy. And they are learning more about pivotal periods in a person’s life where their risk of Alzheimer’s might start to grow — and when interventions might therefore be more effective. New research has suggested that menopause may be an accelerant for Alzheimer’s progression, and therefore may represent an important point in someone’s life. 

These developments are shaping what the near-term future of Alzheimer’s care will look like. As a person ages, they will be able to take one of these blood tests to see if there are signals they are at a higher risk of the disease. If they are, they will have a growing number of medications that they could take to delay or potentially prevent dementia from setting in. For a woman at risk, for example, hormone replacement therapy has been associated with a reduced risk of dementia. Clinical trials are also underway to test whether existing drugs like donanemab and lecanemab can delay the onset of symptoms for somebody who is at higher risk but has not yet started to experience cognitive decline.

“We couldn’t get the right people at the right time early on — and now we can,” Spires-Jones said. “That’s a problem that’s almost solved now.”

Prevention may also be where GLP-1 drugs ultimately prove most useful. As scientists come to better understand the intimate relationship between vascular health and brain health, there is growing reason to think these medicines could help reduce dementia risk decades before symptoms appear.

That would make GLP-1s a complement to drugs such as lecanemab and donanemab, rather than a competitor. Those treatments are designed for people who already have early-stage Alzheimer’s. GLP-1s, by contrast, have so far shown little ability to slow the disease once cognitive decline has begun. In a disappointing clinical trial involving people with mild cognitive impairment or early Alzheimer’s, researchers found that the drugs had a negligible effect on the progression of the disease.

But that result doesn’t mean there isn’t a role for Ozempic and the next generation of GLP-1 drugs in the fight against Alzheimer’s. 

Scientists increasingly believe that chronic inflammation, obesity, and poor vascular health can all accelerate cognitive aging. GLP-1 drugs reduce inflammation, while their effects on weight and metabolic health can substantially lower cardiovascular risk. If US obesity rates continue to fall as these medicines become more widely used, their most consequential effect on Alzheimer’s may therefore be indirect: improving the health of millions of people long before the disease takes hold.

“I think where we’re going in the future is those semaglutide-type drugs will probably be very good for prevention,” Spires-Jones said. “If we can keep people’s obesity in check, that will probably more likely be a preventative treatment. That trial pretty conclusively told us that once you have symptoms, at least, that drug is not going to help.”

This summer, the Alzheimer’s Association announced a $100 million research project to examine whether lifestyle changes plus a GLP-1 medication could reduce the risk of dementia in at-risk older adults.

If you’re worried about your own cognitive health or that of a loved one, you have options, and those options are only going to grow. Talk to your doctor. There are FDA-approved blood tests you can already take. Ask about lecanemab and donanemab. You may also be a good candidate to help scientists in the most active areas of development. Researchers need people to participate in their clinical trials. The Alzheimer’s Association and the federal government have online tools to help people find clinical trials that you or someone you love could be a candidate for. 

Science funding cuts could slow down this progress

All the optimism about the future of Alzheimer’s treatment is based on research and clinical trials. When I asked Karlawish and Spires-Jones about where the story goes from here, they shared one concern: that science becomes so politicized that it would be difficult to get grant funding for research projects that could lead to additional breakthroughs.

“In some sense, the biggest threat is outside the science,” Karlawish said. “There’s deep concern that this politicization of the grant process will essentially wreck American science. We can’t sustain that kind of environment and still demand the results that we’ve come to expect.”

President Donald Trump and US Health Secretary Robert F. Kennedy Jr. like to present their crusade to reform American science as being targeted at frivolous DEI projects. But there are already examples of serious dementia studies being affected: Last month, the Trump administration canceled $15 million in grants for studies to evaluate how discrimination affects long-term brain health.

This is another place where we have more agency to impact what happens next: the ballot box. Use your individual political power to support lawmakers who defend the scientists and researchers doing critical work. 

“You can vote for people who will fund and support science as an endeavor,” Spires-Jones said. “Advances in science don’t happen on their own. We need all of society to get involved.”

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The trial of Lindsay Clancy, the Massachusetts mother accused of killing her three children, is laden with painful what-ifs: What if she had more support? What if she had more people to confide in? Could all of this suffering have been avoided?

Those are urgent questions, whatever the outcome of this particular case, because millions of women experience postpartum depression. Severe postpartum psychosis may be extremely rare, but every year at least one in eight women who give birth in the US experience some depression symptoms — and that is likely an undercount. 

A jury will ultimately decide whether to convict her for her children’s deaths; by Tuesday morning, the jurors were still unable to reach a unanimous verdict but the judge in the case ordered them to keep deliberating. Their verdict will rest in part on whether they believe that Clancy was in her right mind when she killed her children — the defense does not contest the underlying facts — or whether, as her attorneys are contending, she was experiencing severe psychosis that should render her not culpable for her actions.

Clancy’s case has become a national flashpoint for maternal mental health — a gripping courtroom drama that also exposes how new moms’ mental well-being has been neglected by the health system and researchers for years. 

It’s easy to feel hopeless in the face of such a tragedy, and much of the coverage has — rightly — focused on the gaps it exposed in the system for women getting the care they need. But even now, there’s good reason to feel optimistic.

Doctors and health workers across the United States are experimenting with strategies that can improve postpartum mental healthcare. They have found a secret ingredient that can help new mothers when they are struggling: other moms who have been through the same thing before.

“You just had a baby. You’re responsible for a new human life. And it’s really hard to juggle everything in your life,” Dr. Jessica Gaulton, a pediatrician who founded FamilyWell Health, a postpartum mental health support service that incorporates peer coaches into its program, told me. “Oftentimes what women need is just somebody to be there and have their back.”

Postpartum depression is a health system problem, a public health problem — but it’s also a deeply personal one. Helping people make connections that make them not feel so alone is one way we can start to improve the postpartum outlook for American mothers.

And a wave of local programs — and research showing that they really work — is offering some promising new ideas about how to deliver more compassionate and effective care for postpartum depression.

How to help new moms with postpartum depression right now

During the Clancy trial, the Maternal Mental Health Alliance has listed five steps that could be taken to improve postpartum care. One of their top priorities is better care coordination among the different healthcare providers who see a new mom after she’s given birth. 

The so-called collaborative care model has been building momentum for years now, since it was first introduced for postpartum care for Medicaid patients in Seattle’s King County more than a decade ago. The model has since spread to other places, but the basic tenet is this: It takes a whole team to care for a new mother and watch out for her mental health, and they need a point person to help manage their care.

In Los Angeles, for example, where a group of nonprofits is wrapping up a five-year pilot program based on the collaborative care model, new mothers are assigned to a behavioral-health care manager. The manager performs assessments and brief interventions, works with a psychiatric consultant to continually assess how the patient is doing, and cooperates with the OB-GYN or primary care doctor to manage the patient’s treatment. Rather than waiting for a psychiatrist to have an open appointment when she’s struggling right now, the new mom’s preexisting healthcare providers can step in with support from a mental health professional to manage postpartum depression symptoms. 

In evaluations, the model has consistently outperformed other standards of care in reducing symptoms. But while we have started to see collaborative care spread to other parts of the US, its progress has been halting for various logistical and financial reasons. The Maternal Mental Health Alliance is urging health systems and health insurers to invest in more care coordination programs.

And now some providers are building on the collaborative care model with an important new element: peer support. In Washington, the MomCare program is now experimenting with peer “navigators” to help their patients figure out the appropriate place to get the care they need. In Massachusetts, Gaulton’s FamilyWell Health, which works with OB-GYN practices to provide mental health services, launched a pilot program that added certified behavioral health coaches. 

These people were recruited because they had their own life experience of giving birth and having postpartum depression symptoms; the coaches were frequently doulas, nurses, and midwives. Patients would talk once or twice a week with their coach to set goals and receive positive feedback, while the coaches had a protocol to follow if it seemed their patient required more serious support. A study published in April found that this new coach-driven approach was successfully reducing depression and anxiety symptoms. Patients experience remission of their depression symptoms within an average of nine sessions with a peer coach, versus eight sessions with a licensed therapist. In other words, the mothers assigned to a peer got better almost as quickly as those who saw a professional.

Gaulton said she introduced the peer-coach concept to FamilyWell Health because of her own experiences as a new mom. She struggled to recognize her own depression symptoms. When she did, she leaned on a friend and fellow neonatologist at the hospital where she worked for help. Then during Covid, she saw moms with otherwise healthy babies struggling during that world-altering public health emergency. 

“What I realized was that we were underutilizing coaches,” Gaulton said. “For decades, we’ve been using peer groups, peer coaching in this field to support, but it has never been formalized. There was no formal training.”

So she decided to found a new company dedicated to supporting new mothers’ mental health — and she brought those lessons with her.

This idea — training experienced moms to help new moms — has been gaining traction across the country. In Colorado, researchers from the University of Colorado launched a program called Alma, which connects new moms with another woman who has been through the same experiences and received specialized training to provide emotional support. The program’s mentors receive 80 hours of training and then meet up to 10 times with a new mother, either in person or virtually, to talk about what makes them feel good and how to incorporate it into their day, following long-held protocols for depression treatment called “behavior activation.” 

“There is a special kind of trust that can develop when someone feels that the person sitting across from them understands something about their life and their community — someone who has walked the same path,” Sona Dimidjian, a University of Colorado clinical psychologist who helped found the program, said in an email. “A peer can often say, in effect, ‘I have been there too, and I know how hard it can be.’ That shared experience can also help reduce the stigma and shame that many women feel about depression during pregnancy or the postpartum period.”

The concept was based on research from India that found “lay counselors” were effective at reducing mental health symptoms. With the US in a permanent mental health provider shortage, being able to tap into the general population to support new moms was an appealing idea. And evaluations of the program found that it significantly reduced symptoms of depression, anxiety and stress among the Spanish-speaking Latina women who were its initial focus.

The biggest endorsement of a peer-support approach like Alma or the peer coaches in FamilyWell Health’s coordinated care program is its target audience. A nationwide survey of new and expecting Latina mothers in the US found that the vast majority thought talking to a peer would make them feel less isolated and more understood compared to a mental health professional. And providers and policymakers around the United States have started taking notice: English and Spanish-language versions of the Alma program are now being implemented in California and New Jersey. 

There is no panacea for postpartum depression. As Amritha Bhat, who has worked on the MomCare program at the University of Washington, explained it to me: “Having a multipronged approach is a good way to ensure that treatment reaches those most in need.”

There are big-picture institutional-level changes that need to be made. The Diagnostic and Statistical Manual of Mental Disorders, the bible of American psychiatry, currently does not categorize postpartum depression as its own distinct diagnosis. As NPR reported, primary care doctors and pediatricians often do not receive sufficient training to help them recognize the signs of postpartum depression and provide patients with the support they need. There is never enough funding for research or for programs for maternal mental health: The Maternal Mental Health Alliance has been pushing Congress to add millions of dollars in funding for the federal programs that focus on new moms. Peer coaching has not traditionally been covered by health insurance; figuring out how to pay for programs like this is another system-level challenge. 

But connecting moms to other moms can help the people who need support right now. Sometimes that can happen through organized programs like Alma or FamilyWell; the experts working on those initiatives want to make them an integrated part of post-delivery medical care. But that support might also be found informally in a new parent’s everyday life. There are a lot of social media and in-person groups for new moms to get together, sometimes at a local library or other community organization. Gaulton leaned on a friend when she was struggling after her own pregnancy.

As Gaulton emphasized to me, most cases of postpartum depression never escalate into a tragedy. This is a scary condition — but it’s treatable.

“I just want laypeople to know that the typical case is someone like me who had some symptoms of depression, anxiety,” she said. “I found help. I got better.”