When I think of heroic doctors, I think of the physician in the hospital who’s presented with a patient suffering bizarre or vague symptoms and pulls out the right diagnosis just in time. It’s the basis of almost every medical procedural TV show, from House, MD to The Pitt. It’s the mystique that has made doctors among the most revered professionals in society. 

But what if a machine could make that call just as well or even better? What should we do about it here in the real world?

That question is becoming more urgent. According to a major new study published in Science, advanced artificial intelligence programs often outperform human doctors when diagnosing people seeking emergency medical care.

AI has already, for better or worse, become a part of modern medicine. Different programs are being used to do everything from collate physician notes to identify promising new candidates for drug development. The authors of the Science study portrayed their findings as strong evidence that AI could be valuable in the emergency room as well — as long as it is fully vetted in clinical trials for specific uses.

Lest the hype outpace the science, the authors made a point to say that they feared their research would be cited to justify replacing human doctors with software programs: “I get a little bit queasy about how some of these results might be used,” said co-author Dr. Adam Rodman, a general internis­­­t and medical educator at Beth Israel Deaconess Medical Center. They warned against taking such a simplistic view of their findings.

“No one should look at this and say we do not need doctors,” Rodman said in a call with reporters.

At the same time, the researchers did argue that AI had reached the point where it could be a genuine asset for doctors in certain situations — especially in the ER, where physicians are frequently dealing with imperfect information. They called for clinical trials that would properly assess the safety and efficacy of using AI for those tasks, serving as a second pair of virtual eyes that could act as a gut check for human physicians, or help them when they encounter a case that is outside their experience or expertise.

AI can clearly be a force for good in health care, they said — so long as we recognize its limitations and use it in conjunction with, rather than as a replacement for, our human doctors.

“We’re witnessing a really profound change in technology that will reshape medicine,” Arjun Manrai, who studies machine learning and statistical modeling for medical decision-making at Harvard Medical School, said.

AI outperformed human doctors in making emergency diagnoses

The researchers evaluated OpenAI’s o1 reasoning model, which is a more specialized AI program than, say, ChatGPT. It works more deliberately and with an emphasis on internal logic. They ran the program through several experiments, evaluating its accuracy in both simulated and historical cases that have been used in medical training to test physicians’ critical thinking as well as real-world emergency cases from the Beth Israel hospital. The study then compared how the o1 model performed against human doctors, ChatGPT, and human doctors using ChatGPT.

Assessing the training cases allowed the researchers to compare o1’s performance to a very large sample of existing data from human doctors who took the same tests. And across those different scenarios, the AI consistently outperformed those physicians and offered the correct diagnosis or a helpful plan for patient management in the vast majority of the cases studied.

But its accuracy when evaluating raw electronic health record data from real-world ER cases was especially impressive. This is closest to the messy reality that emergency doctors must often perform in: they are dealing with a person who is in serious need of speedy treatment, and have incomplete and unfiltered information, if they have much information at all. In reviewing those cases, the o1 model identified the exact or a very close diagnosis 67 percent of the time during the patient’s initial presentation at triage (versus 50 and 55 percent respectively for two expert doctors that the AI was measured against) and 81 percent of the time once the patient was ready to be admitted to the hospital (versus 70 and 79 percent for the human doctors). 

“We can definitively say…reasoning models can meet that criteria for making diagnostic reasoning at the highest levels of human performance,” Rodman told reporters.

Two experts I consulted who were unaffiliated with the study — Dr. Sanjay Basu at UC-San Francisco and Nigam Shah at Stanford — praised its rigor, but they also noted its limitations. The preexisting training cases studied have been curated specifically for evaluating physicians’ accuracy, so they may overstate how well the model would perform in the real world. In one of the case study experiments that included a set of “cannot-miss” diagnoses when the patient is at risk of serious harm or death, the AI model did not perform any better than ChatGPT or human doctors.

Even the ER findings, which come closest to assessing the o1 model’s performance under true-to-life conditions, were retrospective reviews of existing cases; the model was not actually asked to diagnose or manage patients in real time. 

That is why, as even the Science study’s authors argued, the next step should not be immediately putting Open AI’s model in charge of emergency triage at hospitals across the country. Instead they called for clinical trials that could assess the model’s performance — in both accuracy and safety — under real-world conditions.

“Medicine is high stakes… and we have ways to mitigate these risks. They’re called clinical trials,” Rodman told reporters. “What these results support is a robust and ambitious research agenda.”

AI could be valuable for doctors — but patients should be cautious

AI hype, especially in medicine, is high right now. While listening to the authors discuss their findings, what struck me was their own awareness that their research could be used as a justification for cutting the human medical workforce — and the risks that could end up creating for patients.

“There’s a lot of these so-called AI doctor companies out there that are trying to either cut doctors out of the loop or have minimal clinical supervision,” Rodman said. “As one of the senior authors on the study, I do not think that these results support that.”

The authors emphasized that based on their results, they would envision AI models in the ER being overseen by an actual doctor. Making a diagnosis is only part of treating a patient; it also includes figuring out a treatment plan and monitoring for developments — as well as the human element. “Humans want humans to guide them through life-or-death decisions,” Manrai said. 

Basu and Shah said they supported narrowly defined uses for AI in the ER based on the collective research so far. It could offer second opinions when a patient is being handed off to another clinician or weigh in on specific high-risk situations (such as a patient presenting with sepsis infection or stroke symptoms) where time is of the essence. It could also reduce paperwork for doctors, an application featured in the most recent season of The Pitt. Shah pointed to prior authorization, documentation, and scheduling as obvious areas where AI could help. 

At the same time, AI models should absolutely not be deployed to autonomously diagnose and manage treatment, Basu said.

Individuals should also be cautious about using AI to make medical decisions. Other studies of AI diagnosis have found worrying results, especially for consumer-facing models like ChatGPT. A paper published in Nature Medicine earlier this year evaluated how ChatGPT did when presented with scenarios that ranged from non-urgent to emergent and found the model underestimated the seriousness of the patient’s condition in 52 percent of cases; patients who were on the verge of diabetic shock or respiratory failure were instead referred to 24- or 48-hour monitoring. The model repeatedly failed to identify clear signs of suicidal ideation.

As Shah put it to me, the Science paper represents a “ceiling” for using AI for diagnosis, while the Nature Medicine paper represents a floor. The two studies show how precise we need to be when considering AI’s use for making clinical decisions: While the more sophisticated o1 model did well in the Science study reviewing curated cases, the consumer-facing ChatGPT — developed by the very same company, Open AI — underperformed in the other paper.

“Both can be true,” Basu told me. “Both are.”

In the call with reporters, Manrai described both “green” (low-risk) scenarios where an AI might genuinely be helpful even to a lay person and “red” (high-risk) cases where you should always involve a medical professional. A green use would be, for example, asking a model about a diet that could help manage your hypertension or stretches that could alleviate a recent back injury. Think of it more as lifestyle advice than hard clinical guidance. 

A red use, on the other hand, would involve serious medical situations with life-or-death consequences: chest pain, to give one of many possible examples, is cause to go straight to a doctor or the hospital, not to consult ChatGPT.

We are getting closer to unlocking the awesome potential of these powerful programs to improve medical care, to make what was once science fiction a reality. But even these researchers at the cutting edge agree that we need to move cautiously — and keep the real experts, the doctors, in the loop.

Peptides seem to be everywhere — and there are more on the way. Adherents promise these tiny chains of amino acids can help you lose weight, keep your skin clear, and slow down the aging process. While a person who really wants to acquire peptides right now can do so fairly easily, they are not, strictly speaking, legal — which might be why a peptide “club” with a 300-person waitlist has popped up in San Francisco. 

But access could soon expand: Peptides have support from the nation’s wellness influencer-in-chief, US Health Secretary Robert F. Kennedy Jr., and the Food and Drug Administration is expected to relax restrictions for a dozen peptides. 

“Peptide” is maybe the buzziest word in health care right now — but, as usual, the social media mania masks a much more complicated scientific reality. Peptides are not inherently bad, but not all of the peptides being hawked by wellness influencers are the same. Here’s what you should know.

What the heck are peptides?

To be clear, you have peptides in your body right now: Peptides are naturally occurring groups of amino acids that regulate a variety of physiological processes. There is nothing inherently strange or shady about a “peptide.”

“They help our body work,” Dr. Daniel Drucker, an endocrinologist at the University of Toronto who conducted some of the basic peptide research that helped lead to the development of GLP-1 drugs, told me. “They help us digest our food and absorb our nutrients. They send information to various organs to tell it how to utilize energy. They’re important for control of our heart and our blood vessels and our blood pressure and how our brain functions.”

And human beings have been harnessing the awesome power of peptides to protect themselves against illness for decades. Insulin itself, the diabetic treatment, is a peptide that is produced by the pancreas; back in the 1920s, two scientists removed insulin from a dying dog’s pancreas, injected it into a diabetic dog, and kept the latter alive for more than two months. With that, diabetes was no longer a death sentence for people, but a treatable condition. Scientists later learned to develop synthetic peptides; the insulin that people take today doesn’t come from dogs, it’s the result of a complex manufacturing process. 

Once we had harnessed the power of the peptide, it led to more breakthroughs. And a century later, another peptide-based diabetes treatment is leading a new medical revolution.

The GLP-1 revolution made peptides mainstream…for better or for worse

Semaglutide — the active ingredient in Ozempic and Wegovy — is a synthetic peptide that was initially developed to help people with diabetes produce insulin. It mimics the function of GLP-1, a naturally occurring hormone that regulates people’s insulin production and slows down their digestion. 

About one in eight Americans have now tried a GLP-1 drug and those figures are expected to grow with the debut of pill versions of the medications, so it’s safe to say that people have gotten more familiar with peptides in the past few years.

But that success has opened the door for unscrupulous actors to take advantage of the hype.

The problem starts with the GLP-1 treatments. In late 2022, just as Ozempic and Wegovy were starting to see more widespread usage for weight loss, there was a shortage that would last for all of 2023, 2024, and into 2025. People still wanted to lose weight, though, so they sought out alternative GLP-1s on the black or gray markets. Because these drugs use naturally occurring peptides, compounding pharmacies — businesses that create custom-made medications — are able to produce their own bootleg versions. The GLP-1 peptides produced by major pharmaceutical companies have been subjected to years of clinical and safety testing, and their manufacturing is subject to FDA oversight. That isn’t true for the peptides, GLP-1 or otherwise, that are produced by compounding pharmacies. 

Still, many patients flocked to these, despite the safety concerns and warnings from regulators about the risks.

Even though the sanctioned drug supply has recovered, the GLP-1 peptide market is robust, and often drafts off legitimate drug development breakthroughs. Right now, you can find doctors on TikTok pitching knockoff versions of a new weight-loss medication that’s shown promising results in clinical trials but is not yet approved by the FDA.

Dr. Eric Verdin, president and CEO of the Buck Institute for Research on Aging, pointed out to me that if you look closely at the bottles for these products, they frequently feature words that should be taken as a warning: “Not FDA approved. For research purposes only.”

“So if you decide to inject this, you have the right to do it from my standpoint, but good luck with it,” he said. “Not tested, not proven, not certified in terms of sterility and so on.”

Many peptides have weak evidence — so proceed with caution

What experts really worry about is that the success of some legitimate peptides have effectively served as a gateway drug to a whole new range of “treatments” with not only purity concerns, but flimsy evidence of their clinical value.

As compounding pharmacies attracted new customers during the GLP-1 shortage, they also seized the opportunity to push a range of other peptide treatments. Today, there is a whole universe of acronyms and scientific-sounding names that influencers and even some doctors are promoting as a new generation of treatments: BPC-157, TB-500, CJC-1295, and ipamorelin.

Some of these products have actually been around for years. Dr. Spencer Nadolsky, a weight-loss specialist, told me that he had actually tried BPC-157 a decade ago to help with injuries he was dealing with. (“It didn’t help me,” he said.) But they began seeing new interest after the public became familiar with peptides through GLP-1s.

There’s one big problem: Many of these other peptides have extremely limited or nonexistent evidence for their effectiveness in human beings — despite what you may hear on an Instagram reel or a TikTok video.

Just because a peptide works for a mouse doesn’t mean it’ll work for you

Proponents of peptides will sometimes point to preliminary or preclinical evidence of their benefits. Sounds good, right? But that evidence is often limited to animal (typically mouse or rat) trials. 

There are several important reasons to be skeptical that a successful result in a mouse will be replicated in humans. To state the obvious, mice and people have different physiologies. The rodents also tend to be alike in age and health, and they’re being tested under optimal clinical circumstances. By one recent estimate, although 50 percent of the drugs tested in animals do go on to be tested in humans, only 5 percent are ultimately approved for use by people.

“Just because the mouse or rat did not die in the experiments that were done, you can’t assume that a human will not get sick and get into trouble,” Drucker said.

That is why FDA-approved medications go through years of safety and efficacy testing. By taking an unapproved peptide, you’re putting something in your body that skipped almost all of the rigorous, difficult drug development process, which many promising potential treatments fail for one reason or another.

Once the normal drug development process is over, people can have faith that they know what they’re putting in their body. You have no such guarantees taking off-market peptides. 

“We really don’t know the extent of what it’s doing. We don’t know. We don’t know what dose to use,” Dr. Nir Barzilai, director of the Einstein Institute for Aging Research at Albert Einstein College of Medicine, told me. “It’s crazy. It’s really another snake oil.”

The experts I spoke with worry that people will have to learn that lesson the hard way. They are expecting more stories like the two people who became seriously ill after being injected with peptides at a Las Vegas longevity convention by someone who did not have permission to practice medicine or dispense prescriptions in Nevada. In our new DIY era of health and wellness, that seems to be the only way some people learn. (See: the former anti-vaxxers who are turning to measles shots as the disease takes root in communities across the US.) If you are going to insist on taking a peptide, Barzilai said you should consider getting it tested by one of the lab companies that have popped up amid the peptide craze. That way, you can make sure it is what you think it is.

Americans’ cavalier attitude toward health and wellness and what we put in our bodies will come at a cost, the experts told me. As peptide use grows, it becomes more likely something will go wrong.

“There’s going to be a backlash,” Verdin said. “Unfortunately, that often seems like the only way we can learn collectively is for something tragic to happen. Then we kind of have a wake-up call and get back to a little more reasonable place.”

Robert F. Kennedy Jr. is entering his influencer era as US health secretary.

Last week brought two telling developments that appear to mark a new phase of Kennedy’s leadership at the US Department of Health and Human Services. First, Kennedy launched The Secretary Kennedy Podcast with an inaugural episode focused on his efforts to overhaul the country’s food supply. And second, President Donald Trump nominated Dr. Erica Schwartz, a conspicuously conventional public health official, to lead the Centers for Disease Control and Prevention under Kennedy.

Those moves might seem contradictory, but they actually signal a new role for Kennedy within the Trump administration. The latter move is especially telling. When Kennedy was promising to dismantle the medical establishment that he blamed for so many of America’s health problems, overhauling the CDC was at the top of the list. And during his first year as Health secretary, hundreds of CDC employees have been laid off. Four leaders have come and gone in a matter of months — one after a high-profile clash with Kennedy. It has been an agency in crisis.

But with the nomination of Schwartz, who has notably been an advocate for routine vaccinations in the past, to lead the CDC, Kennedy looks increasingly sidelined on policy by the White House. 

Still, they don’t want him totally out of the public’s eye — not when Republicans are counting on Make America Healthy Again voters in the upcoming midterm elections. Instead, Kennedy’s job description now looks more like health influencer-in-chief, a podcast host with an undeniably enormous platform but not the policymaking sway that he once sought.

The White House has been disempowering RFK Jr.

After promising during the presidential campaign to let Kennedy “go wild” on health, Trump and his team have instead started to hem Kennedy in.

It starts with an issue that has been a priority for Kennedy for decades: pesticides. Trump recently decided to expand the use of the pesticide glyphosate, a chemical that Kennedy had called out for its potential negative health effects in his initial Make America Healthy Again report. For the past year, Kenendy has been fighting a losing battle against Environmental Protection Agency administrator Lee Zeldin, who is friendly to the corporate interests that the Health secretary decries. Zeldin has rolled back a broad range of environmental regulations that were implemented by the Biden administration to protect people’s health.

And even on the issues where he’s had more freedom to act, Kennedy has been constrained.  He has scaled back his plan for a baby formula overhaul after opposition from the industry, according to a Wall Street Journal report. Despite making big promises to crack down on the use of antidepressants and statins, action has failed to materialize, at least so far. After Kennedy’s FDA initially refused to review a new universal flu vaccine from the mRNA developer Moderna, it quickly backtracked in the face of public and industry backlash.

Even the vaccine guidance changes he’s overseen, a clear example of Kenendy’s personal agenda at work, have run into practical limits. The health policy think tank KFF recently reported that more than half of US states are now abiding by their own vaccine recommendations, not the CDC’s. The American Academy of Pediatrics and other medical groups have aggressively pushed their alternatives. Kennedy’s actions have been criticized even by Senate health committee chair Bill Cassidy (R-LA).

Amid all the turmoil, several of Kennedy’s close allies left their administration posts earlier this year. And now, Schwartz, who served as deputy surgeon general during Trump’s first term, is set to take over the CDC.

The whisper circuit in Washington, DC portrayed the move as a rebuke of Kennedy’s agenda. As Kennedy has taken contentious high-profile action on vaccines, he has grown less popular, as poll after poll has shown. A January YouGov survey found 34 percent of Americans approved of his nutrition policies as Health secretary, while 44 percent disapproved. For vaccines, the data is similar: 33 percent approve of Kennedy’s policies and 46 percent disapprove.

“We just need someone who’s not crazy,” an anonymous White House official told CNN of the Schwartz nomination, echoing commentary in the New York Times. 

Some of Kennedy’s most vocal supporters were disappointed by the CDC pick — but it’s moving ahead anyway. The signal seems clear; MAHA isn’t in charge anymore.

The White House wants Kennedy’s supporters to stay MAGA

Even as his decision-making power diminishes, it appears Kennedy still has a role to play for the White House: podcast host and wellness influencer. 

It is, in a way, a more natural role for Kennedy than policy heavyweight, despite his last name. He hosted a podcast during his own presidential run in 2024. He has gone viral for weightlifting videos and other social media stunts. He’s always had a knack for getting attention; this is the same man who once served 30 days in prison for protesting US military bombing exercises in Puerto Rico. 

Heading into the midterm elections, Trump may not want Kennedy attracting headlines for his wackier policy prescriptions, but he does want voters who are attracted to those ideas. Letting Kennedy launch a podcast seems like a way to keep the US Health secretary engaged with the MAGA base, even as Schwartz takes over the CDC. Kennedy has seen his popularity take a hit while in office, but his personal approval rating remains higher than Trump’s.

And it seems telling that the first episode of his podcast focused on the issue where Kennedy has perhaps enjoyed the most bipartisan support: food. “We need to change our diet, or we’re going to lose our country,” he said in his opening preamble.

In a matter of moments, Kennedy was weaving his telltale conspiratorial rhetoric — ”the government has been lying to us for 50 years” — with the benefits of eating whole foods and touting the administration’s efforts to address the issue. His guest, former British Royal Navy member and chef Robert Irvine, personifies the image of masculine wellness that Kennedy himself has tried to cultivate in recent years. After the pair discussed how they might steer people toward more healthy foods at a lower cost based on Irvine’s own attempts to improve military food offerings, the guest leaned into the idea of Kennedy as a transformational figure for the nation’s health as the episode wound down.

“Imagine the history books, when somebody picks up a history book and says, this is what RFK Jr. did,” Irvine said. As he signed off, he implored Kennedy to “keep shaking the tree.”

Now, whether this bet on Kennedy’s podcast pays off remains to be seen. As of Monday morning, The Secretary Kennedy Podcast ranked 58 among the health and fitness shows on Apple Podcasts.

The alliance between Kennedy — scion of a Democratic dynasty — and Trump has been a strange one, despite their shared skepticism of medical experts. It’s been a rocky road so far, but both sides seem intent on squeezing a little more out of it — a big platform for Kennedy and a critical bloc of voters for Trump — before it ends.

A lot of people are looking for ways to improve, preserve, and prolong their brain’s health. Just look at the seemingly endless amount of self-help books, podcasts, phone apps, TikToks, and Instagram Reels dedicated to the subject.

And, frankly, it makes sense. Alzheimer’s disease and dementia — conditions that fundamentally involve the loss of one’s sense of identity and sense of time and place — are distinctly terrifying compared to physical ailments. They rob a person and their loved ones of what should be a special period of their lives. After all, Americans are living longer than ever. It’s only natural that we want to be as present as we can be to enjoy it.

But despite the many promises you may hear about how to “exercise” or “train” your brain to improve your cognition long-term, there’s still a lot we don’t know. In fact, when I reached out to experts about how to exercise your brain, I received a fair amount of skepticism. Multiple studies that have used tailored tasks or games to test whether they can improve a person’s longer-term general intelligence have found negligible benefits; here’s one from 2019 and another with markedly similar results in 2025.

“It seems to be the case that no one has discovered a way to do cognitive training that transfers from the training task to anything general or interesting,” said Michael Cole, an associate professor in the Center for Molecular and Behavioral Neuroscience at Rutgers University and author of Brain Flows: How Network Dynamics Compose the Human Mind.

Still, the science of brain health has come a long way in the past 20 years, and we have better, evidence-based strategies for staying sharp as you age. There are no simple answers, but by combining frameworks from leading experts on learning, flourishing, and cognitive aging, there is a playbook. Making a point to do these things can make life right now more fulfilling — and it could also pay off as you get older.

Eat right and exercise

First things first: If you want to have a healthy brain, you should take good care of your overall health in the boring-but-effective ways you’ve heard a million times by now: Eat a healthy diet, exercise regularly, do your best to reduce stress, and try to get enough sleep. 

High blood pressure is associated with a higher risk of dementia. Chronic inflammation, another modern fixation, could also play a role in cognitive decline. On the flip side, exercise does seem to be associated with cognitive benefits: One major meta-analysis of the relevant research concluded that “exercise, even light intensity, benefits general cognition, memory and executive function across all populations.” 

Scientists have also repeatedly found that exercise seems to protect against the risk of Alzheimer’s or dementia. One study published last year found that the adults who are active in the middle and later periods of their lives had a more than 40 percent lower risk of all-cause dementia.

So, a heart-healthy diet and exercise are the first steps toward taking care of your mind’s hardware.

Learn smarter

But what about exercising your brain itself?

If you do want to know how best to learn anything, you should get familiar with the concept of “desirable difficulty.” Advanced by Nate Kornell, a psychologist focused on memory and learning at Williams College in Massachusetts, the basic idea is this: If something comes too easily, it won’t stick. You need some friction when learning new skills. To do that, you should space out learning and mix it up; Kornell proposes the notions of “spacing” (taking a break from new material and returning to it) and “interleaving” (mixing new material with old material) as effective strategies for learning.

These frameworks are about not improving your cognitive health, per se, but they could make it easier for you to learn something new when that is what you want to do.

“As a larger point in terms of cognitive health, it’s really not changing how your mind processes things,” Kornell told me. “It’s just putting yourself in situations that are more advantageous.”

But even if narrowly defined brain “training” may not have any established long-term benefits, that doesn’t mean we shouldn’t try to challenge ourselves mentally or intellectually. We should just have realistic expectations about what those exercises can do. At the same time, developing new interests is still part of a healthy aging mindset, because it helps nurture some of the good habits that are solidly linked with less cognitive decline, like social connections and curiosity.

Cultivate curiosity

Learning a new skill demonstrates curiosity — and research continues to show that curiosity has benefits for the aging mind. Take one paper from last year, co-authored by Alan Castel, a professor in the Department of Psychology at UCLA and author of Better With Age: The Psychology of Successful Aging.

The researchers uncovered a nuanced relationship between aging and curiosity. They did find that what scientists call “trait” curiosity — your innate interest in seeking out new things to discover — does tend to drop with age. But at the same time, your “state” curiosity — your interest when presented with new or unexpected information — tends to start increasing in your fifth and sixth decades compared to middle age.

“We think that has some implications for cognitive health and brain health,” Castel told me, “that those individuals who are stimulating their brain, who are focusing on hobbies, or interested in lifelong learning, continued engagement with life and learning new things, are less likely to get dementia.”

These findings could lead to more productive forms of “brain training” than a random computer game supposedly designed to improve your intelligence. Instead, based on their findings, an older person may find their curiosity more piqued by something that is relevant to their own self-interest or something they already know about. For example, a person who’s gardened in the past might be stimulated by reading a book or magazine about gardening, joining a gardening club, and learning some new gardening skill — and the research suggests they’ll reap cognitive benefits from that curiosity.

“If you’re interested in gardening and you’re out and doing it and you’re trying to cultivate a new plant or determine how much rainfall there’ll be in the next week, this is all very stimulating, and you’re interpreting it at almost a different level than the novice person,” Castel said. “We think that this sort of engagement is really important as we get older to stimulate knowledge structures that are in place.”

So don’t get stuck in your ways as you age. Castel writes in his book that even changing up your old habits — hiking a familiar trail in the opposite direction, taking your dog for a morning walk, or even shopping at a different market — can benefit your brain.

Find your purpose

Despite experts’ initial skepticism, I would still encourage you to learn a new game or pick up a hobby — but think of it less as “training” your brain in a way that will lead to a perceptible increase in your intelligence. It’s more about trying to form connections with other people and feel a sense of purpose as you age.

Experts at the University of Wisconsin’s Center for Healthy Minds have characterized this mindset as “flourishing” — and it could also have the long-term benefits to our cognition that so many of us are seeking.

“Cultivating these positive qualities of the mind changes the brain in ways that are very clearly conducive to increased brain health,” Richard Davidson, founder and director of the Center for Healthy Minds, told me. “We know, for example, that objective metrics of brain aging are changed by these practices.”

Davidson and his colleague Cortland Dahl recently wrote a book called Born to Flourish: New Science Reveals the Four Practices of Thriving. In it, they say flourishing has four main components:

• Awareness (being attentive to what’s happening around you right now)
• Connection (to other human beings)
• Insight (into yourself and why you feel the way you do)
• Purpose (feeling as if you have something to strive for)

Each of these qualities can have benefits for your long-term cognitive health, Davidson said, but purpose is a particular area of interest. As Davidson and Dahl write in their book, based on research from their group, “a strong sense of purpose supports healthy aging, particularly in brain regions tied to learning and memory that are susceptible to stress.” People who feel they have a purpose generally experience less severe cognitive decline and better longevity overall. “Having a strong sense of purpose is probably the most important psychological predictor of longevity,” Davidson said.

And as I think about these different strategies for nurturing your mind, both right now and for the long term, I see the ways that learning new skills and taking on new hobbies is good for a healthy mind as you age because it will stoke your curiosity and relieve stress. And if it’s something you can do in conjunction with other people, it may help you feel that sense of connection and purpose that is associated with better cognitive well-being over the course of your life. The synthesis across these neuroscientists was striking at times: Davidson spoke of the value of purpose, while Cole has outlined how pursuing goals that align with your values can lead to more effective learning. Castel, in our conversation, emphasized that stimulating your curiosity is even better when done with a dose of human connection, another pillar of the program Davidson and Dahl laid out. So don’t just dive deeper into birdwatching on your own, but consider joining a nature walking club.

Think of this work less as taking your brain to a mental gym and more as cultivating the strange and wondrous garden that is your mind. You’re training your brain not to be “smarter,” but to be more present, more connected to other people, and more attuned to what gives you an all-important sense of purpose. 

I’ve been playing chess lately, for the first time in my life. I do find it prods my brain to think differently. But after reporting for this story, I’m thinking of finding a local chess club. The game itself may not be a prophylactic for my brain, but finding the community of like-minded people, a sense of connection, and a sense of purpose that stokes my curiosity, just might.

We’ve been bringing the 1980s back — including, unfortunately, the cocaine. 

While opioid overdose deaths are mercifully on the decline, more Americans are now using and dying from stimulants, particularly cocaine and methamphetamine. A decade ago, in 2016, there were 10,375 deaths from cocaine overdoses; in 2023, there were 29,449. Meth has seen a similar spike in fatalities, from 9,438 deaths in 2017 to 33,283 in 2023. The drug of choice varies depending on where in the US you are: Cocaine is still king in some parts of the Northeast, while methamphetamines are more commonly used elsewhere.

The surge in stimulant use at the same time the opioid overdose crisis has started to ebb is a warning that drug use doesn’t simply end — it evolves. And the image of somebody being solely a heroin user or a cocaine user is outdated: People use multiple drugs, and they choose different ones for different reasons — which can also increase their risk of death. The drugs themselves are now more complex and likely to be synthetic, adding to the risk that you could be taking something without fully understanding what’s in it.

These shifts present real challenges to the public health system and public health messaging. The United States spent a generation building treatment and recovery programs to address the opioid crisis. The focus was on prescription painkillers, heroin, and later fentanyl; dependence was managed through proven medications like methadone and buprenorphine, and overdoses could be stopped with a spray of naloxone. There was a dedicated effort to get treatment into the hands of primary care doctors, first responders, and ultimately, people in need.

We have none of the same interventions for cocaine or methamphetamine addiction, or for preventing death once an overdose has started. 

“There is no medication for cocaine or methamphetamine,” said Keith Humphreys, professor of psychiatry and behavioral sciences at Stanford University. “Everything under the sun has been tested and nothing has worked.”

The behavioral treatments that do exist are still largely reserved for specialty clinics and aren’t available in the primary care offices that are often people’s first stop in the health care system. The signs and symptoms of a stimulant habit or overdose are not the same as they are for opioids, which means people who use these drugs and their loved ones might not be as likely to recognize them. 

If we want to prevent the next drug crisis from becoming as devastating as the last, we’ve a lot of work to do on the specifics. But we can — and should — adopt the same principles that have led to our recent successes in bringing down opioid deaths.

“The technical specific treatment intervention might be different,” Dr. Brian Hurley, an addiction physician and immediate past president of American Society of Addiction Medicine, told me. “But the principles of working with the community, helping create connection, giving people access to evidence-based options are the same.”

How drug use in America is changing

The story of America’s relationship with hard drugs goes something like this: Heroin surged in the post-Vietnam era; cocaine and later crack cocaine became a scourge in the ’80s, provoking the harsh and unforgiving response during the Reagan era; and meth appeared on the scene in the ’90s. By the 2000s, powerful prescription painkillers had seeded the next drug crisis, while cocaine and meth use dropped off sharply. Before stimulants made their recent comeback, opioids — first prescription meds, then heroin, and finally powerful synthetic iterations like fentanyl — were the dominant concern for the better part of two decades.

“Many of the doctors who were out providing treatment in the late 2010s and early 2020s, they had only ever dealt with opioids,” said Richard Rawson, a long-time addiction researcher who is affiliated with the University of California Los Angeles and the University of Vermont. “They really had no idea what to do with this thing.”

But dating back to the mid-2010s, experts say, cocaine and meth have seen a resurgence. Meth has also gotten more potent in the past decade, after its production was taken over by drug cartels. One of the most striking trends in recent drug overdose deaths has been the more recent rise in deaths involving both a stimulant and an opioid. 

The experts that I spoke to put the simultaneous use of opioids (particularly fentanyl) and stimulants including cocaine and meth into three different buckets:

• Unintentional co-use. Some people think they are buying cocaine, but they are actually getting cocaine laced with fentanyl. (When researchers have sampled drugs that were confiscated off the street, they have found that a small but meaningful amount of cocaine in the US contains one of those powerful synthetic opioids that sent overdose deaths skyrocketing last decade.) And ingesting even a tiny amount of fentanyl can have deadly consequences, especially for people who have no tolerance for it. 
• Intentional recreational co-use. Some people take opioids and stimulants at the same time on purpose because that’s the high they are chasing. 
• Symptom management. This is the scenario that has shattered existing beliefs about people being a user of one specific type of drugs. Researchers say that people will take both stimulants and opioids intentionally to manage their addictions. For example, they’ll take a little cocaine to avoid nodding off on fentanyl. If they are going through opioid withdrawal, they will take methamphetamine to reduce the pain and convulsions.

Whatever the reason is, taking opioids and stimulants at the same time puts an even greater strain on your health. Your body can oscillate between different extremes — sometimes going from a sedate state with shallow breathing to being overly amped with heart palpitations — in a matter of minutes. Over the longer term, this kind of frequent drug use taxes your heart and can lead to chronic health issues aside from overdose that we should account for when thinking of the toll of the drug crisis.

We need better tools to address cocaine and meth abuse

The public health system is now trying to adapt to the resurgence of stimulants.

Right now, the most proven treatment for stimulant dependency is called contingency management: In essence, it’s a rewards system that offers people an incentive not to use drugs, and it has been effective in randomized trials. Participants will come to a clinic, give a urine sample, and if their urine is drug-free, they receive a gift card. California received approval in 2021 to launch a pilot program that’s treated more than 10,000 people, Rawson said, with folks staying in their treatment longer and testing negative more often than in the behavioral therapy programs of the past.

Funding has been scarce elsewhere, however: Access to contingency management through Medicaid and most private insurance benefits is limited. Some states, like Rhode Island and Vermont have tapped into their opioid lawsuit settlement money to set up their own programs. But more fundamentally, the concept has drawn opposition from some policymakers and even doctors who don’t like the idea of “rewarding” drug users for not using, Rawson said. Even with political support, it will still require serious time and financial resources to implement.

As the public health system works to scale up contingency management programs, we should be doing more to advance medication-assisted treatment. Success is typically measured by whether patients fully abstain from using drugs. But some experts told me they think that’s misguided.

“The only benchmark right now for getting a treatment approved is whether people stop using for a sustained period at the end of the trial,” said Karla Wagner, a behavioral scientist at the University of Nevada Reno. “But those medications do produce some meaningful impacts on other outcomes that are not abstinence-based.” For example, some clinical trials that involved using a prescription drug to manage cocaine or methamphetamine addiction found that a subset of people do feel fewer cravings and engage in less risky behavior, even if they didn’t always completely hold off on taking narcotics. 

“All of those things can be really meaningful and impactful and improve quality of life,” Wagner said.

She took heart in a blog post last year from the director of the National Institute on Drug Abuse, which argued for considering measures other than abstinence when evaluating medications for substance abuse. And the American Society for Addiction Medicine has endorsed the off-label use of stimulant medications that have shown some effectiveness in managing cocaine and meth dependency.

What everyone should know about the rise in stimulant use

Finding a Narcan-like solution that can stop cocaine and meth overdoses once they start is a problem for medical science. But more public knowledge about the symptoms of a stimulant overdose and what to do if you’re with someone who’s experiencing them could still help avert the worst outcomes. 

These are the signs to be alert to, according to the experts I spoke with:

• Heart palpitations
• Rise in body temperature
• Erratic behavior, including hallucinations
• Sensitivity to light and sound

If you’re with someone who experiences these symptoms, there are things you can do to help, said Pia Marcus, director of overdose prevention at OnPoint NYC. First, she said, if it’s someone you know well, try to calm them down. Turn off the lights or any sources of sound to create a more peaceful environment. She said you should also try to physically cool them, and recommended ice or ice packs to do that. 

“You have to rely on soothing mechanisms to help ground this person,” Marcus said. “It’s a person that’s not necessarily rooted in space and time, and your job is to try to root them.”

It is possible to bring somebody back from danger with these interventions in a community setting, Marcus said. But if these measures don’t appear to be working, the person seems to be having a cardiac event, or if it’s not someone you know well and you don’t feel capable of soothing them, you should call for emergency medical care.

The lesson of the falling opioid death count is that public health interventions can make a real difference. Now is our moment to try to use a similar playbook to get ahead of the cocaine and meth crisis before it gets any worse.

The newest Bachelorette season is canceled, right on the cusp of its premiere — and it may inadvertently spell the end of the franchise. 

It probably should.

This season was slated to debut on Sunday with Taylor Frankie Paul, star of the Hulu reality show The Secret Lives of Mormon Wives, in the title spot. Everything about the 22nd season’s marketing signaled that it was a new era: Paul is an established reality TV star on another Disney-owned franchise, not a veteran of The Bachelor, as almost all of her predecessors were. And the show was moving from its typical weeknight slot to a coveted Sunday primetime airing.

Then allegations against Paul of domestic violence resurfaced in the week leading up to the premiere. ABC appeared to be doing its best to salvage the season, sending Paul out on Good Morning America on Wednesday  morning. (“I’m a person that will always speak my truth,” she told host Lara Spencer in the interview. “That’s what I’m known for. So when the time is right, I will be.”) But after TMZ published a 2023 video on Thursday that showed Paul throwing a chair during an argument with her former partner Dakota Mortensen while her child cried nearby, the network decided to cancel the season three days before it was supposed to start. (Later on Thursday, Mortensen filed for a restraining order against Paul.)

So what was supposed to be a fresh start for The Bachelor franchise — a series that helped usher in reality TV’s golden era when it debuted in 2002 — has instead spiraled into one of the worst PR debacles yet for a show that seems to specialize in them. As its ratings fall and other shows take up the mantle of must-see reality TV, I find myself as a viewer asking: Is it time for the Bachelor to be over?

The Bachelor has been besieged by controversies and audience disinterest for a while

The first season of the Bachelor franchise that I watched was Colton Underwood’s in 2019 — in which the lead became so exasperated by the pressure he was under that he literally leaped over a fence to try to escape. It was riveting television and so memorable that it was still inspiring thoughtful essays from high-minded cultural websites like Bright Wall/Dark Room years later.

But, with the benefit of hindsight, Colton’s season may have also been the beginning of the end of a franchise that has become too toxic to continue.

He ended the season with Cassie Randolph, but their relationship quickly ended and the situation then turned dark: Randolph alleged Underwood had been stalking her, even putting a tracker on her car, and she filed a restraining order. The Bachelor universe was always premised on a fairly traditional view of gender roles and sexuality — it was, after all, centered on pushing young heterosexual couples into an engagement within a matter of weeks — and audience interest dwindled as the world moved forward, particularly once we entered the Me Too era that challenged long-held relationship norms.

Meanwhile, the show had always been blindingly white, and in the years that followed Colton’s season, the Bachelor’s uncomfortable relationship with race also made it seem increasingly out of touch. The season with the franchise’s first Black Bachelor, Matt James, ended with him choosing Rachel Kirkconnell…who, as it turned out, had attended a plantation-themed party while in college. Longtime host Chris Harrison came to Kirkconnell’s defense and made his own racially insensitive comments in the process, in an interview with franchise veteran Rachel Lindsay, the first Black Bachelorette, who herself has accused the show of being a toxic environment. A fierce backlash followed — and Harrison was forced to step down.

The last time I wrote about The Bachelorette was in 2024, when the show put its lead, Jenn Tran, through an embarrassing and shameful spectacle after her engagement to Devin Strader disintegrated. The treatment of Tran, the first Asian American lead of the show, made it feel like the show was nearing the point of no return.

Paul’s casting was, in my eyes, a desperate last grasp for relevance. The culture that franchise helped to create seemed to have passed it by. Love Is Blind and Love Island command much more attention. The audience for the Bachelor shows has shrunk to less than half the size they were a decade ago and a fraction what they were back in the 2000s. Meanwhile, The Secret Lives of Mormon Wives had such a strong debut after its first eight episodes dropped on Hulu in 2024 that the network renewed it and ordered 20 more within a month of the premiere. It makes sense that ABC thought Paul could pull in viewers, despite the fact that she was arrested for domestic violence in 2023, and despite rampant fan speculation that she was secretly in a relationship or at least emotionally unavailable while filming The Bachelorette. 

Now that franchise reboot is over before it had even begun. The Bachelor franchise has always been a problematic farce, but at its best, the drama was low stakes — over shrimp, for example — and, at times, riveting. I’ll never forget watching Colton leap that fence. It was raw and captivating, everything we ask reality TV to be for our entertainment.

But as the controversies have piled up, and now a lead contestant’s alleged domestic violence caught on camera, it’s become impossible to simply enjoy the mess and ignore the real-life trauma behind it. Maybe the world doesn’t need The Bachelor anymore.

Maybe this has happened to you: Your doctor is talking to you about your health, saying you need a test or a medication, and suddenly your brain leaps to a question that has nothing to do with your medical needs:

How much is this going to cost?

Health care in America is too expensive. According to a Gallup poll released this month, about one-third of Americans, equivalent to more than 82 million people, said that they had cut back on other expenses — groceries, gas, even utilities — in order to afford medical services. According to KFF, 36 percent of Americans say they have put off medical care in the past 12 months due to the costs.

So of course many of us think about money in those moments. It would be nice if your provider, the person tasked with looking out for your well-being, could be an ally in navigating the complex web of insurance benefits, prior authorization, and prescription drug formularies that ultimately determine how much you pay for medical care. 

But unfortunately, while Americans wish they were having these conversations with their physician, many of them aren’t. A 2024 survey of 1,500 people who have cancer or autoimmune conditions found that 62 percent said they wanted to have a cost discussion — but only 32 percent of them had. In a 2023 survey of 1,000 US adults, 41 percent said their doctor never brought up the financial side of their care.

The unavoidable reality is, we each have to act as our own advocate when it comes to our health. If our provider isn’t bringing it up, we need to. But that can be intimidating: Many of us already fear being judged by a physician. I’ve certainly felt that way. Here’s a secret: Even doctors feel that way sometimes when they are the patient.

“I have found health care billing in my own experience to be inconsistent and to be surprising and to be shrouded in a lot of mysteries,” Dr. Cailly Howell-McLean, a Toledo, Ohio pediatrician and member of the American Academy of Pediatrics, told me. “So I can’t imagine for someone who is not in that kind of role that I am.”

To help people with how they can approach those tough talks, I spoke to two doctors — Howell-McLean and Dr. Sarah Nosal, president of the American Academy of Family Physicians — to get their advice.

Here’s what I learned.

When in doubt, ask

Here’s one assumption I had: There might be some times when it doesn’t make sense to ask your doctor about finances. But that’s really the wrong way to think about it. As both Howell-McLean and Nosal put it to me, the doctor can’t help you if they don’t know there’s a problem.

“At the end of the day, as providers, we can’t assist with concerns we aren’t aware of,” Howell-McLean said. “So err on the side of bringing it up. And if it’s not something your doctor can help you with, they’ll tell you that. But better to ask.”

Many clinics have staff dedicated to handling billing or financing questions. If nothing else, your doctor will be able to connect you with those people — but, again, you have to ask.

“None of us are perfect as humans or doctors. I have definitely had patients where I only found out that they didn’t get a medication because of cost when their, for instance, diabetes was out of control,” Nosal said. “And I feel so bad that I didn’t explain to them that they can get in touch with us.”

Ask your doctor direct questions when you’re in the room with them

Some of the questions you’ll need to ask will partly depend on your own circumstances: your insurance coverage, your medical needs, your overall financial situation. One question to ask before you ever step foot inside the doctor’s office: Are you in my health insurance plan’s provider network? What about the blood or imaging labs you work with?

Then when you’re seeing a doctor and they are proposing new treatment — a scan, a specialist visit, a new medication — there are some stock questions that are usually worth asking:

• Is this likely to be expensive?
• What are the risks of not doing this?
• If this is not covered by my insurance, what do next steps look like? Are there lower-cost options?
• Could we wait and follow up soon to see if treatment is really needed?

If your prescriptions are surprisingly expensive, don’t just let it go

Every time you get a new prescription, Nosal said you should ask about a generic version of the drug. Doctors may write you a prescription for the brand-name version without thinking about it, while there is a cheaper generic available that can save you a chunk of money.

If you get to the pharmacy and discover a prescription is more expensive than you expected, don’t just let it go. Call your doctor. 

You can also ask your provider to try to make your life easier in other ways. Howell-McLean singled out albuterol, the asthma inhaler medication, as one drug that she tries to assist patients with. Insurers limit the prescription to one per month, but it can be helpful to have multiple inhalers (one at school, one at home; one at mom’s house, one at dad’s house). 

To make things simpler for her patients, she will simultaneously write one prescription for the current month and another for the following month during one visit. That way, her patients can get what they need without the hassle of having to get back in touch with their physician.  

There’s a good chance your provider will have ideas like this that will make your life easier and save you money, and the best way to know for certain is to ask them.

If you’re not sure how to start, focus on how the costs affect your health 

In an ideal world, your doctor would proactively bring up the cost of your care or, at the least, take an active interest if you bring it up. But we do not live in an ideal world and sometimes, even if you try to initiate a cost conversation with your doctor, they might seem uninterested or reluctant to engage. What do you do then?

First, you might have better luck getting your doctor’s help if you frame the question around your medical care, Nosal told me, rather than strictly finances. So instead of saying you don’t think you can afford your new prescription, say you don’t think you’ll be able to take it. It’s a subtle difference, but it’s more likely to send up a red flag to your provider.

“The doctor is most worried about getting you the right clinical care,” Nosal told me. “Where those two things meet might be an easier way to open that conversation and [get] the doctor to realize, ‘Oh, I need to think about that.’”

And at the end of the day, everyone should be able to be honest with their health care provider; that’s the foundation of a healthy and trusting doctor-patient relationship. If you don’t feel comfortable talking to the  provider you’re currently seeing about your financial concerns, you might want to consider finding a new one.

Plan ahead as much as you can for emergency care

This is the other nightmare scenario that I brought up to Nosal and Howell-McLean: You or your loved one needs treatment right now. The financial stakes are high, too: While there have been efforts to make sure people don’t get surprise bills from the hospital, it still happens, and those bills can be tens of thousands of dollars. 

The tension between wanting the best emergency care and not wanting to go bankrupt is acute. But don’t panic.

One thing to do right now, before you’re in an emergency situation, is research the hospitals in your area. What’s in your insurance network and what isn’t? If you’re in a bad car crash, you may not have a say about where you get treated, but if it’s a situation when you’re taking yourself or a family member, checking around ahead of time could save you a lot of stress in a high-pressure moment.

If you have a medical situation that demands attention but you have a little wiggle room in terms of time, you might want to call a nursing referral service before getting into your car or calling the taxi. Some health plans have started denying coverage for ER visits they deem to be unnecessary. A quick call to have a clinician confirm that you actually need to go to the hospital could save you some headaches with your insurer later. However, Nosal noted, if you’re having signs of a serious imminent medical event — like chest pains that suggest a heart attack — you should head straight to the ER and worry about the costs later. 

And once you’re at the hospital, many facilities actually have billing support staff who might be able to answer your questions or address your concerns. Ask to talk to one of them as soon as possible.

That’s the overarching advice here: Even if you’re intimidated or embarrassed or think there’s nothing they can do, ask. In most cases, your providers really are on your side.

“We want to help,” Howell-McLean said. “We want our treatment plans to be successful. We want our patients and families to be as healthy as they can be.”