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Guilt-Tripping for the Public Good Often Achieves Its Intended Result

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Tuesday, April 16, 2024

In 2016 Merck launched an advertising campaign for its HPV vaccine that aroused a storm of protest and headlines. The Washington Post published an article entitled “Do the new Merck HPV ads guilt-trip parents or tell hard truths? Both.” One of Merck’s TV ads showed an adult woman diagnosed with cervical cancer and flashed back to her as a child, asking, “Did you know [there was a vaccine for HPV]—Mom, Dad?”“I thought, ‘This is the thing that's going to make parents say I would feel horrible if my kid got cervical cancer later, and I could have vaccinated them,’” says Monique Turner, a communication scientist at Michigan State University (MSU). ”So, from a research perspective, I was like, ‘Thumbs-up, Merck.’ But they took a lot of heat for it.”Guilt is a powerful tool. Research has shown that, wielded effectively, it can persuade people to do the right thing. In a recent analysis of 26 studies of guilt appeals, Washington State University communication scientist Wei Peng found that guilt works—if people hearing the pitch are not made to feel responsible for a bad situation. Picture asking them to help with an environmental catastrophe.On supporting science journalismIf you're enjoying this article, consider supporting our award-winning journalism by subscribing. By purchasing a subscription you are helping to ensure the future of impactful stories about the discoveries and ideas shaping our world today.The most straightforward pitches involve what researchers call “existential guilt,” Peng says. They rely on our internal moral code that, as a human being, we have an obligation to relieve the suffering of others if we can. “What I found is that people feel guilty about people’s suffering even if they don’t have a direct personal relationship,” Peng says, “even if they are on the other side of the world.”It’s hard for most people to see photographs of starving children. Doing so hurts. Taking action to help them offers some relief. That’s what advocates are counting on when they ask you for donations to feed orphans or build shelters for earthquake survivors. Knowing guilt’s potential for good, social scientists are seeking the optimal formula to craft pitches for everything from promoting health behaviors and road safety to safeguarding the planet.But getting the formula right is tricky. “We have a hardwired negativity bias to instantly pay attention to anything that arouses a negative emotion,” says Pennsylvania State University media psychologist Jessica Myrick. That’s why inflicting guilt often works. But the downside of arousing this intensely uncomfortable feeling is that people can employ a battery of defenses against it: getting angry, rationalizing or distancing from the issue.That is the important takeaway from Peng’s research: guilt works when it doesn’t trigger resistance. In other words, don’t make listeners feel they’ve done something bad. “If you say we need to do something different versus you,” says persuasion scholar Robin Nabi of the University of California, Santa Barbara, “now you’re not the bad guy. We all have responsibility.”There are many ways to get this wrong. For example, if messengers arouse shame rather than guilt, MSU’s Turner found, people resist more. In her research, participants were asked to read an ad urging testing for sexually transmitted diseases (STDs) that evoked either guilt or shame and then to give their reactions. A headline in the guilt and shame appeals respectively asked what or who would give one’s partner an STD,” followed by multiple-choice answers. In both, the correct answer—“all of the above”—was circled at the bottom. The second-to-last option seen by both groups was objective: it referred to a person who hadn’t been tested for an STD The other multiple-choice answers were designed to evoke either guilt or shame. Those in the guilt appeal group were presented with choices such as, “someone with uninformed behavior”and “someone with forgetful behavior.” The group reading the shame appeal saw choices such as, “a selfish person” and “an irresponsible person.” Subjects in the latter group were likelier to feel angry and manipulated.As Turner explains, pointing out problematic behavior induces guilt, but focusing on someone’s inherent character traits—selfishness, for example—can induce shame. In most contexts, making people feel ashamed is not a good persuader.The key to making a guilt pitch succeed is to offer people relief from the guilt they’re feeling. In humanitarian appeals, people are usually offered easy-to-accomplish solutions: save the puppies from being euthanized by donating or volunteering, for instance. For health or safety messages, taking action may be harder, making messaging more challenging.If you’re asking parents to shield their kids from asthma risk from secondhand smoke, for example, saying, “Just quit” may be too hard for them. It is more effective, Nabi says, if you give people options: “Just smoke outside or not around your kids” or “Cut down how much you smoke.” “The idea is that when you evoke this emotion and then you give people a sense of efficacy,” she says, “it’s actually hope evoking.”That’s what scientists are finding in the lab. Adding a feel-good emotion to a guilt appeal—hope or pride, for example—works better. For one thing, it reduces people’s defensiveness, and that’s the first step: make sure they don’t shut you out. One recent study tested the effect of building hope into guilt appeals in a campaign to reduce texting while driving, which is an urgent safety issue because laws and enforcement have done little to reduce crashes tied to texting.In the online experiment, about 400 people were randomly placed in four groups. The first two groups viewed identical posters except that one added a hopeful message. The headline in both read, “You are never alone on the road.”The posters acknowledged how tempting it was to answer a text but noted that texting while driving was a factor in 20 percent of crashes. The “hope” message added recommendations to “turn on drive mode or silence your phone” and noted that doing so “can save lives.” In two other groups, people read what were essentially the same guilt-invoking or hopeful messages except that the language was more intense. The top headline, for example, read, “What you don’t see is a long and lovely life.” Adding the hopeful message reduced targets’ defensive responses in both language intensity groups. It also increased their stated intentions to avoid texting while driving.One new preprint study on guilt messaging tested the effect of inducing empathy alongside guilt in a hypothetical public-service campaign to reduce plastic bag pollution in oceans. In this online experiment, 257 college students were randomly assigned to read one of four messages from a fictional Facebook page, “Save the Marine Animals Foundation,” asking them to reduce their plastic bag use. In half the groups the undergraduates were asked to take the perspective of an animal suffering from ingesting a plastic bag. Researchers found that adopting the animals’ viewpoint created empathy. More empathy was associated with more guilt, which was, in turn, correlated with an increase in participants’ intentions to cut down on plastic bag use.In some appeals to protect the environment, inducing pride along with guilt proves to be the winning recipe for persuading people to change their behavior. In a meta-analysis of 30 years of research, data scientist Nathan Shipley, then at the University of Illinois at Urbana-Champaign, zeroed in on campaigns that induce people to imagine they’ll feel guilty or proud of themselves depending on their future behavior. He found that both emotions correlated with subjects’ intended and reported pro-environmental behavior, but the pride relationship was stronger.The success of these efforts depends at least partly on how well a message is tailored to a specific audience. Undergraduates in these studies, for example, are typically more environmentally conscious than their parents. The results in a new study showed that for Generation Z restaurant diners, both anticipated guilt for eating less environmentally sustainable food and an anticipated pride for eating more environmentally friendly, plant-based foods influenced their intentions to eat at chain restaurants that offered nonmeat options.Another study tested whether mothers of young children were more susceptible than others to guilt appeals to switch to buying organic food. The researchers found that they were. That’s not surprising, says Myrick, who is a mother of three kids under the age of five. Myrick is bombarded with guilt appeals. She’s had to triage the things she feels guilty about, such as using disposable diapers and paper plates, because, she says, “I’d feel even more guilty if I didn’t feed my kids something even when I don’t have time to prepare food.”Another study measured neither pride nor guilt, but both may have been implicitly invoked, says Elizabeth Hewitt, a social scientist at Stony Brook University and lead author of the paper. Over 12 weeks in two next-door apartment buildings in New York City, experimenters posted signs in the trash rooms every week announcing how well each building had done in recycling efforts. The sign in one building compared the amount of much of plastic, metal and glass its residents had recycled during the previous week with how much they had recycled the week before. The sign in the other building compared the amount its residents recycled in the previous week with how much their neighbors recycled during the same period. Both buildings increased their recycling by bag weight, but the feedback that compared residents with their neighbors resulted in more recycled material. Although the mechanism operated through peer pressure, guilt can play a role if a person feels they are not doing as much as they should, Hewitt says. Surpassing your neighbors can trigger pride.This swell of research is both timely and necessary, scientists say. Left to our own devices, we are not always our best selves—or our own best friends. Persuasive public service messaging will need to be crafted for new generations. Take the campaigns for the HPV vaccine. Over 20 years, they were a factor in reducing HPV infections in teenage girls by 88 percent and in young adult women by 81 percent. Yet vaccination rates in the U.S. remain lower than in other countries, and rates are uneven across the U.S., leaving many vulnerable to preventable cancers. To address such problems, it remains urgent to find effective tools of persuasion. Guilt, massaged in the right ways, can be a powerful tool.

The emerging science of laying guilt through public messaging can help safeguard the planet and improve health behaviors

In 2016 Merck launched an advertising campaign for its HPV vaccine that aroused a storm of protest and headlines. The Washington Post published an article entitled “Do the new Merck HPV ads guilt-trip parents or tell hard truths? Both.” One of Merck’s TV ads showed an adult woman diagnosed with cervical cancer and flashed back to her as a child, asking, “Did you know [there was a vaccine for HPV]—Mom, Dad?”

“I thought, ‘This is the thing that's going to make parents say I would feel horrible if my kid got cervical cancer later, and I could have vaccinated them,’” says Monique Turner, a communication scientist at Michigan State University (MSU). ”So, from a research perspective, I was like, ‘Thumbs-up, Merck.’ But they took a lot of heat for it.”

Guilt is a powerful tool. Research has shown that, wielded effectively, it can persuade people to do the right thing. In a recent analysis of 26 studies of guilt appeals, Washington State University communication scientist Wei Peng found that guilt works—if people hearing the pitch are not made to feel responsible for a bad situation. Picture asking them to help with an environmental catastrophe.


On supporting science journalism

If you're enjoying this article, consider supporting our award-winning journalism by subscribing. By purchasing a subscription you are helping to ensure the future of impactful stories about the discoveries and ideas shaping our world today.


The most straightforward pitches involve what researchers call “existential guilt,” Peng says. They rely on our internal moral code that, as a human being, we have an obligation to relieve the suffering of others if we can. “What I found is that people feel guilty about people’s suffering even if they don’t have a direct personal relationship,” Peng says, “even if they are on the other side of the world.”

It’s hard for most people to see photographs of starving children. Doing so hurts. Taking action to help them offers some relief. That’s what advocates are counting on when they ask you for donations to feed orphans or build shelters for earthquake survivors. Knowing guilt’s potential for good, social scientists are seeking the optimal formula to craft pitches for everything from promoting health behaviors and road safety to safeguarding the planet.

But getting the formula right is tricky. “We have a hardwired negativity bias to instantly pay attention to anything that arouses a negative emotion,” says Pennsylvania State University media psychologist Jessica Myrick. That’s why inflicting guilt often works. But the downside of arousing this intensely uncomfortable feeling is that people can employ a battery of defenses against it: getting angry, rationalizing or distancing from the issue.

That is the important takeaway from Peng’s research: guilt works when it doesn’t trigger resistance. In other words, don’t make listeners feel they’ve done something bad. “If you say we need to do something different versus you,” says persuasion scholar Robin Nabi of the University of California, Santa Barbara, “now you’re not the bad guy. We all have responsibility.”

There are many ways to get this wrong. For example, if messengers arouse shame rather than guilt, MSU’s Turner found, people resist more. In her research, participants were asked to read an ad urging testing for sexually transmitted diseases (STDs) that evoked either guilt or shame and then to give their reactions. A headline in the guilt and shame appeals respectively asked what or who would give one’s partner an STD,” followed by multiple-choice answers. In both, the correct answer—“all of the above”—was circled at the bottom. The second-to-last option seen by both groups was objective: it referred to a person who hadn’t been tested for an STD The other multiple-choice answers were designed to evoke either guilt or shame. Those in the guilt appeal group were presented with choices such as, “someone with uninformed behavior”and “someone with forgetful behavior.” The group reading the shame appeal saw choices such as, “a selfish person” and “an irresponsible person.” Subjects in the latter group were likelier to feel angry and manipulated.

As Turner explains, pointing out problematic behavior induces guilt, but focusing on someone’s inherent character traits—selfishness, for example—can induce shame. In most contexts, making people feel ashamed is not a good persuader.

The key to making a guilt pitch succeed is to offer people relief from the guilt they’re feeling. In humanitarian appeals, people are usually offered easy-to-accomplish solutions: save the puppies from being euthanized by donating or volunteering, for instance. For health or safety messages, taking action may be harder, making messaging more challenging.

If you’re asking parents to shield their kids from asthma risk from secondhand smoke, for example, saying, “Just quit” may be too hard for them. It is more effective, Nabi says, if you give people options: “Just smoke outside or not around your kids” or “Cut down how much you smoke.” “The idea is that when you evoke this emotion and then you give people a sense of efficacy,” she says, “it’s actually hope evoking.”

That’s what scientists are finding in the lab. Adding a feel-good emotion to a guilt appeal—hope or pride, for example—works better. For one thing, it reduces people’s defensiveness, and that’s the first step: make sure they don’t shut you out. One recent study tested the effect of building hope into guilt appeals in a campaign to reduce texting while driving, which is an urgent safety issue because laws and enforcement have done little to reduce crashes tied to texting.

In the online experiment, about 400 people were randomly placed in four groups. The first two groups viewed identical posters except that one added a hopeful message. The headline in both read, “You are never alone on the road.”The posters acknowledged how tempting it was to answer a text but noted that texting while driving was a factor in 20 percent of crashes. The “hope” message added recommendations to “turn on drive mode or silence your phone” and noted that doing so “can save lives.” In two other groups, people read what were essentially the same guilt-invoking or hopeful messages except that the language was more intense. The top headline, for example, read, “What you don’t see is a long and lovely life.” Adding the hopeful message reduced targets’ defensive responses in both language intensity groups. It also increased their stated intentions to avoid texting while driving.

One new preprint study on guilt messaging tested the effect of inducing empathy alongside guilt in a hypothetical public-service campaign to reduce plastic bag pollution in oceans. In this online experiment, 257 college students were randomly assigned to read one of four messages from a fictional Facebook page, “Save the Marine Animals Foundation,” asking them to reduce their plastic bag use. In half the groups the undergraduates were asked to take the perspective of an animal suffering from ingesting a plastic bag. Researchers found that adopting the animals’ viewpoint created empathy. More empathy was associated with more guilt, which was, in turn, correlated with an increase in participants’ intentions to cut down on plastic bag use.

In some appeals to protect the environment, inducing pride along with guilt proves to be the winning recipe for persuading people to change their behavior. In a meta-analysis of 30 years of research, data scientist Nathan Shipley, then at the University of Illinois at Urbana-Champaign, zeroed in on campaigns that induce people to imagine they’ll feel guilty or proud of themselves depending on their future behavior. He found that both emotions correlated with subjects’ intended and reported pro-environmental behavior, but the pride relationship was stronger.

The success of these efforts depends at least partly on how well a message is tailored to a specific audience. Undergraduates in these studies, for example, are typically more environmentally conscious than their parents. The results in a new study showed that for Generation Z restaurant diners, both anticipated guilt for eating less environmentally sustainable food and an anticipated pride for eating more environmentally friendly, plant-based foods influenced their intentions to eat at chain restaurants that offered nonmeat options.

Another study tested whether mothers of young children were more susceptible than others to guilt appeals to switch to buying organic food. The researchers found that they were. That’s not surprising, says Myrick, who is a mother of three kids under the age of five. Myrick is bombarded with guilt appeals. She’s had to triage the things she feels guilty about, such as using disposable diapers and paper plates, because, she says, “I’d feel even more guilty if I didn’t feed my kids something even when I don’t have time to prepare food.”

Another study measured neither pride nor guilt, but both may have been implicitly invoked, says Elizabeth Hewitt, a social scientist at Stony Brook University and lead author of the paper. Over 12 weeks in two next-door apartment buildings in New York City, experimenters posted signs in the trash rooms every week announcing how well each building had done in recycling efforts. The sign in one building compared the amount of much of plastic, metal and glass its residents had recycled during the previous week with how much they had recycled the week before. The sign in the other building compared the amount its residents recycled in the previous week with how much their neighbors recycled during the same period. Both buildings increased their recycling by bag weight, but the feedback that compared residents with their neighbors resulted in more recycled material. Although the mechanism operated through peer pressure, guilt can play a role if a person feels they are not doing as much as they should, Hewitt says. Surpassing your neighbors can trigger pride.

This swell of research is both timely and necessary, scientists say. Left to our own devices, we are not always our best selves—or our own best friends. Persuasive public service messaging will need to be crafted for new generations. Take the campaigns for the HPV vaccine. Over 20 years, they were a factor in reducing HPV infections in teenage girls by 88 percent and in young adult women by 81 percent. Yet vaccination rates in the U.S. remain lower than in other countries, and rates are uneven across the U.S., leaving many vulnerable to preventable cancers. To address such problems, it remains urgent to find effective tools of persuasion. Guilt, massaged in the right ways, can be a powerful tool.

Read the full story here.
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New Flu Variant Could Bring Another Severe U.S. Season

By I. Edwards HealthDay ReporterTHURSDAY, Nov. 20, 2025 (HealthDay News) — A new flu variant spreading overseas may set the stage for another tough...

THURSDAY, Nov. 20, 2025 (HealthDay News) — A new flu variant spreading overseas may set the stage for another tough winter in the United States, experts warn.The strain, called subclade K, has caused a rise in flu cases in the United Kingdom, Canada and Japan. And now signs suggest it is beginning to take hold across the United States as flu activity rises.According to the latest U.S. Centers for Disease Control and Prevention (CDC) FluView report, reported flu activity in the United States remains low but is climbing quickly.Last year’s flu season was the worst the United States had seen in nearly 15 years and led to at least 280 child deaths, according to the CDC.Most cases this year are from the H3N2 virus and about half of those belong to the subclade K variant, the same strain that fueled a difficult flu season in the Southern Hemisphere.Because it wasn’t circulating widely when strains were selected for the vaccine update, this year’s flu shot targets close strains of the virus."It’s not like we’re expecting to get complete loss of protection for the vaccine, but perhaps we might expect a little bit of a drop-off if this is the virus that sort of dominates the season, and early indications are that’s probably going to be the case," Richard Webby, a researcher at St. Jude Children’s Research Hospital in Memphis, Tennessee, told CNN.Early findings from the UK Health Security Agency suggest the variant carries seven genetic changes on a major part of the virus, making it a bit harder for the body's immune system to recognize.Even so, they found that the flu shot has reduced the risk of hospitalization or emergency care by about 75% in children and 30% to 40% in adults so far this season.What worries experts even more is that fewer Americans appear to be getting the flu shot.Data from IQVIA shows that pharmacies gave 26.5 million flu vaccinations from August through October, down from 28.7 million during the same period last year."I’m not surprised," Jennifer Nuzzo, professor of epidemiology and director of the Pandemic Center at Brown University in Providence, Rhode Island, said.She said recent debates about vaccine safety have "left people confused but possibly at the worst have left people worried about getting vaccinated."Australia’s flu shot rates also fell this year and the country went on to record more than 443,000 cases."What they saw in Australia is that they had a bad season. And so it’s concerning for you and us, what’s coming," Dr. Earl Rubin, division director of infectious disease at Montreal Children’s Hospital, told CNN.Several early indicators already show flu levels rising in the U.S.The WastewaterSCAN network found type A flu in 40% of samples in November, up from 18% in October, according to Marlene Wolfe, an assistant professor in the department of environmental health at Emory University in Atlanta.Only four U.S. monitoring sites in Maine, Vermont, Iowa and Hawaii have officially crossed the threshold for declaring flu activity high, but experts say the trend is clear.While it’s not yet clear whether subclade K could cause more severe illness, a rise in infections alone could cause hospitalizations to skyrocket, Rubin noted."It’s not too late. Go and get your flu shot," Dr. Adam Lauring, chief of the division of infectious diseases at the University of Michigan Medical School, in Ann Arbor, said.These results are preliminary and have not yet been peer-reviewed.The Texas Department of State Health Services (DSHS) has more on the flu vaccine.SOURCE: CNN, Nov. 18, 2025Copyright © 2025 HealthDay. All rights reserved.

Thousands of US Hazardous Sites Are at Risk of Flooding Because of Sea Level Rise, Study Finds

A new study finds that thousands of hazardous sites across the U.S. are at risk of flooding due to sea level rise that could pose public health threats to neighboring communities

If heat-trapping pollution from burning coal, oil and gas continues unchecked, thousands of hazardous sites across the United States risk being flooded from sea level rise by the turn of the century, posing serious health risks to nearby communities, according to a new study.Researchers identified 5,500 sites that store, emit or handle sewage, trash, oil, gas and other hazards that could face coastal flooding by 2100, with much of the risk already locked in due to past emissions. But more than half the sites are projected to face flood risk much sooner — as soon as 2050. Low-income, communities of color and other marginalized groups are the most at risk.With even moderate reductions to planet-warming emissions, researchers also determined that roughly 300 fewer sites would be at risk by the end of the century. “Our goal with this analysis was to try to get ahead of the problem by looking far out into the future," said Lara J. Cushing, associate professor in the Department of Environmental Health Sciences at the University of California, Los Angeles who co-authored the paper published in the science journal Nature Communications.“We do have time to respond and try to mitigate the risks and also increase resilience," she added, speaking at a media briefing Wednesday ahead of the study's release. The study was funded by the Environmental Protection Agency and builds on previous research from California. Climate change is driving and accelerating sea level rise. Glaciers and ice sheets are melting, and the sea's waters are expanding as they warm. In many places along the coastal U.S., sea level rise is accelerating faster than the global average because of things like erosion and land sinking from groundwater pumping, according to the National Oceanic and Atmospheric Administration. Thomas Chandler, managing director at the National Center for Disaster Preparedness at Columbia University who was not involved in the research, said it’s “a really important study” that the public, policy makers and government agencies “need to make note of.” Derek Van Berkel, an associate professor in the school for environment and sustainability at University of Michigan who was also not involved in the study, wasn't surprised to learn about the disproportionate risks. What was “alarming” was considering the magnitude of “feedback effects” from flooding, he said. How researchers approached the data The study's researchers started by identifying and classifying tens of thousands of hazardous sites near the coasts of Puerto Rico and the 23 states with coastline. Next, they wanted to know each site's projected future flood risk. They did this by calculating how likely each year coastal flooding could inundate a site using historical sea level measurements and projected sea level rise in 2050 and 2100 under low and high emissions scenarios. Lastly, they identified and classified communities as being at-risk if homes are located within 1 kilometer (0.62 miles) of a hazardous site with a high threat of future flooding, and compared those communities' characteristics with other coastal neighborhoods with no at-risk sites nearby. But researchers did not include all types of hazardous facilities, such as oil and gas pipelines, nor did they account for groundwater upwelling or more intense and frequent storms in the future, which could lead to underestimates. On the other end, the flood-risk model they used could have overestimated the number of threatened sites. “It is important to note that previous disasters, such as hurricanes Katrina, Rita and Harvey, did result in a lot of toxic contamination from oil and gas pipelines,” Chandler said. The 5,500 at-risk sites includes 44% that are fossil fuel ports and terminals, 30% power plants, 24% refineries and 22% coastal sewage treatment facilities. Most of the sites — nearly 80% — are in Louisiana, Florida, New Jersey, Texas, California, New York and Massachusetts. Potential health impacts from exposure to hazards People exposed to flood waters near industrial animal farms or sewage treatment plants could be exposed to bacteria like E. coli, said Sacoby Wilson, professor of global, environmental and occupational health at the University of Maryland during the briefing. Symptoms can include bloody or watery diarrhea, severe stomach cramps or vomiting and fever. Those living near industrial sites like refineries could be exposed to heavy metals and chemicals that can cause rashes, burning of the eyes, nose and throat, headaches or fatigue, added Wilson, who was not involved in the study. “For folks who are vulnerable, maybe have an underlying health condition, those health conditions could be exacerbated during those flood events.” Longer term, some of these exposures could contribute to cancer, liver, kidney or other organ damage, or have reproductive effects, he said. For Chandler, the Columbia University director, the study highlights the need to heavily invest in hazard mitigation. “It's really important for federal, state and local governments in the United States to address these factors through multi-stakeholder resilience planning and encouraging local governments to integrate climate risk assessments into their mitigation strategies.”The Associated Press receives support from the Walton Family Foundation for coverage of water and environmental policy. The AP is solely responsible for all content. For all of AP’s environmental coverage, visit https://apnews.com/hub/climate-and-environment.Copyright 2025 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.Photos You Should See – Nov. 2025

RFK Jr.’s Miasma Theory of Health Is Spreading

The agency is picking up Robert F. Kennedy Jr.’s argument that a healthy immune system can keep even pandemic germs at bay.

Last week, the two top officials at the National Institutes of Health—the world’s largest public funder of biomedical research—debuted a new plan to help Americans weather the next pandemic: getting everyone to eat better and exercise.The standard pandemic-preparedness playbook “has failed catastrophically,” NIH Director Jay Bhattacharya and NIH Principal Deputy Director Matthew J. Memoli wrote in City Journal, a magazine and website published by the Manhattan Institute for Policy Research, a conservative think tank. The pair argue that finding and studying pathogens that could cause outbreaks, then stockpiling vaccines against them, is a waste of money. Instead, they say, the United States should encourage people to improve their baseline health—“whether simply by stopping smoking, controlling hypertension or diabetes, or getting up and walking more.”On its own, Bhattacharya and Memoli’s apparently serious suggestion that just being in better shape will carry the U.S. through an infectious crisis is reckless, experts told me—especially if it’s executed at the expense of other public-health responses. In an email, Andrew Nixon, the director of communications at the Department of Health and Human Services—which oversees the NIH—wrote that the agency “supports a comprehensive approach to pandemic preparedness that recognizes the importance of both biomedical tools and the factors individuals can control.” But more broadly, Bhattacharya and Memoli’s proposal reflects the spread of a dangerous philosophy that Robert F. Kennedy Jr., the secretary of HHS, has been pushing for years: a dismissal of germ theory, or the notion that infectious microbes are responsible for many of the diseases that plague humankind.In his 2021 book, The Real Anthony Fauci: Bill Gates, Big Pharma, and the Global War on Democracy and Public Health, Kennedy, a longtime anti-vaccine activist, argues that modern scientists have blamed too much of infectious disease on pathogens, which he suggests are rarely problematic, unless the immune system has been compromised by poor nutrition, toxins, and other environmental stressors. He credits sanitation and nutrition for driving declines in infectious-disease deaths during the 20th century; vaccination, he has baselessly claimed, was largely ineffective and unnecessary. In his view, germs don’t pose a substantial threat to people who have done the work of “fortifying the immune system”—essentially, those who have taken their health into their own hands.In terms of general health, most Americans would benefit from improvements in diet and exercise. A strong emphasis on both has been core to the Make America Healthy Again movement, and in one important aspect, Kennedy and his allies are correct: The immune system, like other bodily systems, is sensitive to nutritional status, and when people are dealing with chronic health issues, they often fare less well against infectious threats, Melinda Beck, a nutrition and infectious-disease researcher who recently retired from the University of North Carolina, told me. Conditions such as obesity and diabetes, for instance, raise the risk of severe COVID and flu; malnutrition exacerbates the course of diseases such as tuberculosis and measles.But applied to widespread infectious outbreaks, the MAHA prescription is still deeply flawed. Being generally healthy doesn’t guarantee survival, or even better outcomes against infectious diseases—especially when an entire population encounters a pathogen against which it has no immunity. Although some evidence suggests that the 1918 flu pandemic strongly affected certain groups of people who were less healthy at baseline—including undernourished World War I soldiers—“relatively healthy people, as far as we could understand, were the main victims,” Naomi Rogers, a historian of medicine at Yale, told me. Smallpox, too, infected and killed indiscriminately. HIV has devastated many communities of young, healthy people.In his book, Kennedy relies heavily on the term miasma theory as a shorthand for preventing disease “through nutrition and by reducing exposures to environmental toxins and stresses.” He’s employing that phrase incorrectly: Historically, at least, miasma theory referred to the notion that epidemics are caused by bad air—such as toxic emanations from corpses and trash—and was the predominant way of describing disease transmission until scientists found definitive proof of infectious microbes in the late 19th century. But his choice of words is also revealing. In pitting his ideas against germ theory, he plays on a centuries-old tension between lifestyle and microbes as roots of illness.In its early days, germ theory struggled to gain traction even among physicians, many of whom dismissed the idea as simplistic, Nancy Tomes, a historian at Stony Brook University, told me. After the idea became foundational to medicine, scientists still had to work to convince some members of the public that microbes could fell healthy people, too. In the early days of polio vaccination, when the virus still ran rampant in the U.S., some vaccine-skeptical Americans insisted that children were falling seriously ill primarily because their parents weren’t managing their kids’ nutrition well and “had disrupted the child’s internal health,” Rogers told me.Over time, as pharmaceutical companies made global businesses out of selling antibiotics, vaccines, and antivirals, the products became a symbol, for some people, of how germ theory had taken over medicine. Accepting vaccines came to represent trust in scientific expertise, Rogers said; misgivings about the industry, in contrast, might translate into rejecting those offerings. In that skeptical slice of the American public and amid the rise of alternative-wellness practitioners, Kennedy has found purchase for his ideas about nutrition as a cure-all.Since taking over as health secretary, he has on occasion made that distrust in germ theory national policy. In his book, he wrote that “when a starving African child succumbs to measles, the miasmist attributes the death to malnutrition; germ theory proponents (a.k.a. virologists) blame the virus.” Earlier this year, when measles raged through undervaccinated regions of West Texas, the secretary acted out his own miasmist theory of the outbreak, urging Americans to rely on vitamin-A supplementation as a first-line defense, even though deficiency of that vitamin is rare here.But germ theory is key to understanding why outbreaks become pandemics—not because people’s general health is wanting, but because a pathogen is so unfamiliar to so many people’s immune systems at once that it is able to spread unchecked. Pandemics then end because enough people acquire sufficient immunity to that pathogen. Vaccination, when available, remains the safest way to gain that immunity—and, unlike lifestyle choices, it can represent a near-universal strategy to shore up defenses against disease. Not all of the risk factors that worsen disease severity are tunable by simply eating better or working out more. For COVID and many other respiratory diseases, for instance, old age and pregnancy remain some of the biggest risk factors. Genetic predispositions to certain medical conditions, or structural barriers to changing health habits—not just lack of willpower—can make people vulnerable to disease, too.In their article, Bhattacharya and Memoli purport to be arguing against specific strategies of pandemic preparedness, most prominently the controversial type of gain-of-function research that can involve altering the disease-causing traits of pathogens, and has been restricted by the Trump administration. But the pair also mischaracterize the country’s current approach to pandemics, which, in addition to calling for virus research and vaccine development, prioritizes measures such as surveillance, international partnerships, and improved health-care capacity, Nahid Bhadelia, the director of the Center on Emerging Infectious Diseases at Boston University, told me. And Bhattacharya and Memoli’s alternative approach cuts against the most basic logic of public health—that the clearest way to help keep a whole population healthy is to offer protections that work on a societal level and that will reach as many people as possible. Fixating on personal nutrition and exercise regimens as pandemic preparedness would leave many people entirely unprotected. At the same time, “we’re basically setting up society to blame someone” in the event that they fall ill, Jennifer Nuzzo, the director of the pandemic center at the Brown University School of Public Health, told me.Kennedy’s book bemoans that the “warring philosophies” of miasma and germ theory have become a zero-sum game. And yet, at HHS, he and his officials are presenting outbreak preparedness—and the rest of public health—as exactly that: The country should worry about environment or pathogens; it should be either pushing people to eat better or stockpiling vaccines. Over email, Nixon told me that “encouraging healthier habits is one way to strengthen resilience alongside vaccines, treatments, and diagnostics developed through NIH-funded research.” But this year, under pressure from the Trump administration, the NIH has cut funding to hundreds of vaccine- and infectious-disease focused research projects; elsewhere at HHS, officials canceled nearly half a billion dollars’ worth of contracts geared toward developing mRNA vaccines.The reality is that both environment and pathogens often influence the outcome of disease, and both should be addressed. Today’s public-health establishment might not subscribe to the 19th-century version of miasma theory, but the idea that environmental and social factors shape people’s health is still core to the field. “They’re saying you can only do one thing at a time,” Bhadelia told me. “I don’t think we have to.”

Clinicians can help address environmental toxics in reproductive health, international experts say

In a recent opinion paper published in the International Journal of Gynecology & Obstetrics, the International Federation of Obstetrics and Gynecology (FIGO) addresses how exposures to environmental toxics — including endocrine disrupting chemicals — have a wide range of impacts on reproductive health, and how clinicians can play a role in addressing this issue.In short: Extensive research has linked exposure to environmental toxics with an increased risk of polycystic ovary syndrome (PCOS), endometriosis, uterine fibroids, hormonally mediated cancers, menopause, and both female and male infertility. The key mechanisms behind these impacts include hormone disruption, oxidative stress, inflammation, and epigenetic changes that can affect multiple generations.FIGO emphasizes that harm from environmental toxics can be addressed, and that clinicians play a crucial role in ensuring environmental factors are meaningfully considered as a part of patient care. Key quote: “As trusted health advisors, obstetricians and gynecologists (OBGYNs) have an essential role in integrating environmental health into routine gynecologic and fertility care.” Why this matters: In this opinion paper, FIGO argues that clinicians should incorporate environmental health into routine care, and provides practical strategies to do so. Some of these strategies include taking environmental histories, counseling patients on risk reduction and healthy lifestyles, recognizing high-risk settings (e.g., occupational exposures), and advising patients on simple steps to reduce exposure — particularly during sensitive windows like preconception, pregnancy, puberty, and menopause. Clinicians should be aware of regional environmental health alerts, such as air quality advisories or contamination events. In addition, clinicians can advocate for policy change.Related EHN coverage: Chemical mixtures may impact fertility and IVF success, new study findsUnderstanding how the environment affects pregnant people’s healthMore resources: Additional International Federation of Obstetrics and Gynecology (FIGO) statements and opinions relating to the environment:FIGO opinion on reproductive health impacts of exposure to toxic environmental chemicalsFIGO calls for removal of PFAS from global useRemoval of glyphosate from global usageClimate Crisis and HealthStatement on Draft Strategy on health, environment and climate changeToxic chemicals and environmental contaminants in prenatal vitaminsDeNicola, Nathaniel et al. for International Journal of Gynecology & Obstetrics. Sept. 26, 2025

In a recent opinion paper published in the International Journal of Gynecology & Obstetrics, the International Federation of Obstetrics and Gynecology (FIGO) addresses how exposures to environmental toxics — including endocrine disrupting chemicals — have a wide range of impacts on reproductive health, and how clinicians can play a role in addressing this issue.In short: Extensive research has linked exposure to environmental toxics with an increased risk of polycystic ovary syndrome (PCOS), endometriosis, uterine fibroids, hormonally mediated cancers, menopause, and both female and male infertility. The key mechanisms behind these impacts include hormone disruption, oxidative stress, inflammation, and epigenetic changes that can affect multiple generations.FIGO emphasizes that harm from environmental toxics can be addressed, and that clinicians play a crucial role in ensuring environmental factors are meaningfully considered as a part of patient care. Key quote: “As trusted health advisors, obstetricians and gynecologists (OBGYNs) have an essential role in integrating environmental health into routine gynecologic and fertility care.” Why this matters: In this opinion paper, FIGO argues that clinicians should incorporate environmental health into routine care, and provides practical strategies to do so. Some of these strategies include taking environmental histories, counseling patients on risk reduction and healthy lifestyles, recognizing high-risk settings (e.g., occupational exposures), and advising patients on simple steps to reduce exposure — particularly during sensitive windows like preconception, pregnancy, puberty, and menopause. Clinicians should be aware of regional environmental health alerts, such as air quality advisories or contamination events. In addition, clinicians can advocate for policy change.Related EHN coverage: Chemical mixtures may impact fertility and IVF success, new study findsUnderstanding how the environment affects pregnant people’s healthMore resources: Additional International Federation of Obstetrics and Gynecology (FIGO) statements and opinions relating to the environment:FIGO opinion on reproductive health impacts of exposure to toxic environmental chemicalsFIGO calls for removal of PFAS from global useRemoval of glyphosate from global usageClimate Crisis and HealthStatement on Draft Strategy on health, environment and climate changeToxic chemicals and environmental contaminants in prenatal vitaminsDeNicola, Nathaniel et al. for International Journal of Gynecology & Obstetrics. Sept. 26, 2025

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