I am a mostly visual thinker, and thoughts pose as scenes in the theater of my mind. When my many supportive family members, friends, and colleagues asked how I was doing, I’d see myself on a cliff, transfixed by an omniscient fog just past its edge. I’m there on the brink, with my parents and sisters, searching for a way down. In the scene, there is no sound or urgency and I am waiting for it to swallow me. I’m searching for shapes and navigational clues, but it’s so huge and gray and boundless.
I wanted to take that fog and put it under a microscope. I started Googling the stages of grief, and books and academic research about loss, from the app on my iPhone, perusing personal disaster while I waited for coffee or watched Netflix. How will it feel? How will I manage it?
I started, intentionally and unintentionally, consuming people’s experiences of grief and tragedy through Instagram videos, various newsfeeds, and Twitter testimonials.It was as if the internet secretly teamed up with my compulsions and started indulging my own worst fantasies; the algorithms were a sort of priest, offering confession and communion.
Yet with every search and click, I inadvertently created a sticky web of digital grief. Ultimately, it would prove nearly impossible to untangle myself. My mournful digital life was preserved in amber by the pernicious personalized algorithms that had deftly observed my mental preoccupations and offered me ever more cancer and loss.
I got out—eventually. But why is it so hard to unsubscribe from and opt out of content that we don’t want, even when it’s harmful to us?
I’m well aware of the power of algorithms—I’ve written about the mental-health impact of Instagram filters, the polarizing effect of Big Tech’s infatuation with engagement, and the strange ways that advertisers target specific audiences. But in my haze of panic and searching, I initially felt that my algorithms were a force for good. (Yes, I’m calling them “my” algorithms, because while I realize the code is uniform, the output is so intensely personal that they feel like mine.) They seemed to be working with me, helping me find stories of people managing tragedy, making me feel less alone and more capable.
In my haze of panic and searching, I initially felt that my algorithms were a force for good. They seemed to be working with me, making me feel less alone and more capable.
In reality, I was intimately and intensely experiencing the effects of an advertising-driven internet, which Ethan Zuckerman, the renowned internet ethicist and professor of public policy, information, and communication at the University of Massachusetts at Amherst, famously called “the Internet’s Original Sin” in a 2014 Atlantic piece. In the story, he explained the advertising model that brings revenue to content sites that are most equipped to target the right audience at the right time and at scale. This, of course, requires “moving deeper into the world of surveillance,” he wrote. This incentive structure is now known as “surveillance capitalism.”
Understanding how exactly to maximize the engagement of each user on a platform is the formula for revenue, and it’s the foundation for the current economic model of the web.
Over the course of the last year, so-called “miracle” weight-loss drugs have blown up across the internet. Although celebrity users have boosted their standing, they owe much of their fame to social media and discussion boards, where they are promoted by influencers and everyday people alike.
Yet not everyone who wants them goes to a doctor. Throughout 2022, rising demand for weight-loss injections caused global shortages. As a result, some people began seeking these drugs illegally, crossing borders or buying them under the counter without a prescription.
Do the hype and the hashtags tell the full story? What are the physical, social, and psychological side effects of a miracle? And can all the publicity lead people to do things they definitely shouldn’t? Read the full story.
—Amelia Tait
Texas is trying out new tactics to restrict access to abortion pills online
There’s been a quiet shift in the abortion fight in the US. Since the reversal of Roe v. Wade last June, laws that make most abortions illegal have passed in 13 states. Efforts to restrict abortion care have, so far, focused mostly on criminalizing medical providers. But increasingly, the battleground is moving online.
Texas is currently in the process of trying to limit access to abortion pills by cracking down on internet service providers and credit card processing companies. Earlier this month, Republicans in the state legislature introduced two bills to that effect.
Texas is trying to limit access to abortion pills by cracking down on internet service providers and credit card processing companies. These tactics reflect the reality that, post-Roe, the internet is a critical channel for people seeking information about abortion or trying to buy pills to terminate a pregnancy—especially in states where they can no longer access these things in physical pharmacies or medical centers.
Texas has long been a laboratory for anti-abortion political tactics, and on March 15, a US District Judge heard arguments in a case that’s seeking to reverse the FDA approval of mifepristone, a drug that can be used to terminate an early pregnancy. The case would limit online-facilitated abortions and would have far-reaching consequences even in states that are not trying to restrict abortion.
Earlier this month, Republicans in the Texas state legislature introduced two bills to restrict access to abortion pills. The first bill, HB 2690, would require internet service providers (ISPs) to ban sites that provide access to the pills or information about obtaining them. Companies like AT&T and Spectrum would have to “make every reasonable and technologically feasible effort to block Internet access to information or material intended to assist or facilitate efforts to obtain an elective abortion or an abortion-inducing drug.” The bill would also forbid both publishers and ordinary people from providing information about access to abortion-inducing drugs.
The second bill, SB 1440, would make it a felony for credit card companies to process transactions for abortion pills, and would also make them liable to lawsuits from the public.
Blair Wallace, a policy and advocacy strategist at the ACLU of Texas, a nonprofit that advocates for civil liberties and reproductive choice, said the recent developments mark “a new frontier for the ways in which they’re coming for [abortion access],” adding: “It is really terrifying.”
Wallace sees it as a continuation of a strategy that seeks to criminalize whole abortion care networks with the aim of isolating people seeking abortions. More broadly, this strategy of censoring information and language has become a popular tactic in US culture wars in the last several years, and the proposed bill could incentivize platforms to aggressively remove information about abortion access out of concern for legal risk. Some sites, like Meta’s Instagram and Facebook, have reportedly removed information about abortion pills in the past.
So what might the outcome of all the Texas action be? Both the bill that targets ISPs and the misteprone case this week are unprecedented, which means neither is likely to be successful. That said, the tactics are likely to stay. “Will we see it again next session? Will we see parts of this bill stripped down and put into amendments? There’s like a million ways that this can play out,” says Wallace. Anti-abortion political strategy is coordinated nationally even though the fights are playing out at a state level, and it’s likely that other states will target online spaces going forward.
Online abortion resources can pose risks to privacy. But there are lots of ways to access them more safely. Here are some resources I recommend.
In the beginning, weight loss was just a side effect. GLP-1 RAs were first developed to treat type 2 diabetes; their hormone-mimicking action provokes insulin production. In 2005, the US Food and Drug Administration approved the first drug of this kind, Exenatide, for diabetics. Throughout the 2000s, more and more GLP-1 RAs came onto the market. Right away, patients noticed that these drugs didn’t just treat their diabetes—they also helped them lose weight.
Ozempic and Wegovy, the brand names of a GLP-1 RA known as semaglutide, are both made by Novo Nordisk, a Danish pharmaceutical company. Though they both contain the same active ingredient, the drugs have different indications, dosages, prescribing information, titration schedules, and delivery devices. In 2017, Ozempic was first approved as a diabetes treatment, and doctors soon began to prescribe it off-label to overweight patients. Subsequently, Novo Nordisk developed Wegovy specifically for weight loss. In June 2021, it became the first new treatment for chronic obesity approved by the FDA since 2014.
Then, in May 2022, the FDA approved Mounjaro as a diabetes treatment; now the agency is officially “fast-tracking” the investigation of its active ingredient, tirzepatide, for obesity. A spokesperson for the drug’s manufacturer, Eli Lilly, said it is presently only approved for glycemic control in adults with type 2 diabetes and the company “does not promote or encourage use of Mounjaro outside of its FDA-approved indication.” Nonetheless, since the drug came to market, doctors have been prescribing it off-label for weight loss—there are almost 100,000 members in a Facebook group called “Mounjaro Weight Loss Success.”
Clinical trials have shown that tirzepatide patients lose at least 20% of their weight in 72 weeks, while overweight adults on Wegovy lose an average of 15% of their body weight in 68 weeks.
Edenfield is one such success story. Unable to work at the height of the pandemic, he had stayed at home “eating a lot and eating very unhealthy.” He compares his diet to a teenager’s: regular consumption of fast food sandwiches, cheese steaks, and burgers accompanied a “crippling addiction” to Coca-Cola. When his weight crept up to 357 pounds (he is 6 feet 3 inches tall), he sought gastric sleeve surgery because his employer would cover the cost. Yet the doctor he met with suggested Ozempic instead. He lost 15 pounds in his first month on the drug and switched to Wegovy in February 2022. He now weighs 228.
COURTESY OF MICHAEL EDENFIELD
“It’s changed every aspect of my life,” Edenfield says—he no longer feels “hijacked” by hunger and doesn’t get out of breath walking to work. “I feel like I’m in my 20s again,” he says.
The results may be enviable, but the day-to-day reality of weight-loss injections is not always pleasant. The most common side effects are gastrointestinal, including nausea, diarrhea, and constipation. Edenfield consulted Reddit for tips on alleviating “brutal” nausea. A number of subreddits dedicated to semaglutide have sprung up or grown in popularity over the last year—the one Edenfield posted on was created in 2021 and has almost 22,000 members today. Meanwhile, countless Facebook groups have also been created during the weight-loss injection boom. Here, people report experiencing vomiting, headaches, fatigue, “sulfur burps,” and hair loss—though the vast majority seem to feel it’s a small price to pay for losing weight.
During the 68-week Wegovy trial, 4.5% of participants discontinued treatment because of gastrointestinal events. Peter Kurtzhals, Novo Nordisk’s chief scientific advisor, says that such side effects normally decline gradually as patients build up a tolerance to the drug. A company spokesperson adds that patients experiencing nausea on Wegovy “should contact their health-care provider, who can offer guidance on ways to manage it.”
