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Iran is Trump's Katrina

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Photo by Jocelyn Augustino via Wikimedia Commons

Young people won’t remember this, but there was a distinct point at which George W. Bush started to lose the country. In August 2005, a giant hurricane swamped New Orleans, killing over a thousand people and washing away whole parts of the city. Bush displayed startling incompetence and tone-deafness during the cleanup, which began a process of general disillusionment with his presidency that intensified with the financial crisis of 2008 and the long slog in Iraq.

I don’t know whether Trump’s debacle in Iran will be a similar moment for his presidency. For one thing, unlike Bush, Trump’s approval ratings were already very low before Iran:

Source: Nate Silver

Compared to the other stuff people hate about Trump — the blasé attitude towards inflation, the tariffs, the unprecedented corruption, the ICE raids, the various abuses of power — the Iran War may end up being a minor footnote. But there is one similarity with Katrina: This is the point at which even many of Trump’s defenders will be forced to admit, in private if not in public, that the man and his administration are grossly, pathetically incompetent.

The details of the deal that Trump is trying to make in order to withdraw from the war he started are still murky and unclear — probably because as soon as those details are released, people will realize that the U.S. has effectively been defeated by Iran. Here’s what the deal is rumored to contain:

(Update: Bloomberg has the confirmed details of the draft memorandum, and and the initial reports look to have been completely accurate.)

Plenty of people, looking at these details and observing the conduct of the war, are ready to speak the plain truth that the U.S. lost the war to Iran. Tom Nichols, a former professor at the U.S. Naval War College, had this to say:

Trump and his team, in record time, just lost a war to a militarily mediocre—but nonetheless extremely dangerous—adversary…[E]ven before we have the details, it is clear that Trump has failed to achieve every one of the goals he put forward for this war of choice, and now he is determined to sign, seal, and deliver America’s capitulation as quickly as possible.

The New York Times editorial board concurs, with the headline: “Trump Lost the War He Started in Iran”. The WSJ Editorial Board is slightly nicer, writing “Trump Stages an Iran Retreat”.

As regular readers of this blog know, I’m very skeptical of claims that America has “lost” this or that war:

For example, we clearly won the Iraq War, despite a generation of pundits who got used to repeating that we “lost”. We defeated all enemies — Saddam, various militias, and ISIS — and established a friendly, pliant government that allows U.S. oil companies unfettered access to the country. Bush’s war was a strategic mistake — in my opinion, the geopolitical benefits weren’t worth the costs — but by any reasonable historical standard, it was a victory.

The same is not true, however, of Trump’s war in Iran. This one really is a clear defeat for the U.S. The reason is not just that the U.S. failed to achieve its strategic goals. It’s how Iran forced the U.S. to give up those goals.

How Iran won the war

Iran used military force to defeat the U.S. First, it successfully dispersed and hardened its key forces — missiles and drones. This is from the Washington Post on May 7th:

A confidential CIA analysis delivered to administration policymakers this week…found that Tehran retains significant ballistic missile capabilities despite weeks of intense U.S. and Israeli bombardment…Iran retains about 75 percent of its prewar inventories of mobile launchers and about 70 percent of its prewar stockpiles of missiles, a U.S. official said. The official said there is evidence that the regime has been able to recover and reopen almost all of its underground storage facilities, repair some damaged missiles and even assemble some new missiles that were nearly complete when the war began.

And this is from CNN on May 21st:

Iran has already restarted some of its drone production during the six-week ceasefire that began in early April, one sign it is rapidly rebuilding certain military capabilities degraded by US-Israeli strikes, according to two sources familiar with US intelligence assessments…Iran’s military is reconstituting much faster than initially estimated…[S]ome US intelligence estimates indicate Iran could fully reconstitute its drone attack capability in as soon as six months…Iran has been able to rebuild much faster than expected due to a combination of factors, ranging from support it is receiving from Russia and China to the fact that the US and Israel did not inflict as much damage as the two countries had hoped, one of the sources told CNN…

Thousands of Iranian drones still exist — roughly 50% of the country’s drone capabilities[.]

Iran dispersed and buried both its weaponry and its defense industrial base, and the U.S. was unable to destroy it.

Next, Iran used its surviving weapons to execute an effective naval blockade of the U.S., and its key allies.

The naval blockade was Iran’s closure of the Strait of Hormuz. This vital waterway, which delivers much of the world’s oil, is right next to Iran, so Iran had the geographic advantage. It used drone boats, naval mines, aerial drones, and missiles to prevent ships from transiting the strait. This did two things. First, it raised the global price of oil, which raised gasoline prices in America:

It also sent U.S. inflation back to around 4%, which caused Americans’ real wages to start falling:

Meanwhile, the U.S.’ allies — the Gulf states and Saudi Arabia — were severely impacted by Iran’s blockade of Hormuz, since much of their oil couldn’t be sold. These allies put pressure on Trump to end the war.

The U.S. tried many things to open the Strait of Hormuz, but nothing worked. American strikes were incapable of destroying Iran’s weaponry or forcing Iran’s regime to submit. So in the end, it had to submit. The deal Trump is reportedly cutting makes huge concessions to Iran, leaving Iran in a much stronger position both economically and militarily than it was before the war:

  • The U.S. will withdraw its forces from the conflict zone within 30 days.

  • All U.S. sanctions on Iran are reportedly being lifted. Before the war, sanctions had crippled Iran’s economy since 2012, leaving it stagnant and sclerotic. With those sanctions gone, Iran will be able to sell oil and grow much more prosperous.

  • Iran will reportedly start charging fees on transit through the Strait of Hormuz. This is a toll on international shipping — something forbidden by the UN Convention on the Law of the Sea. This will be a huge source of income for Iran — something that didn’t exist before the war.

  • The U.S. and/or its Middle Eastern allies will reportedly pay Iran a $300 billion reconstruction fund, as well as unfreezing Iranian assets. This is equal to one entire year of Iran’s GDP, and would effectively constitute war reparations. JD Vance has said that the reconstruction fund is not yet confirmed.

Iran thus compelled the U.S. to withdraw its military, end the sanctions that were in place before the war, and potentially pay Iran reparations. In exchange, Iran will allow the Strait of Hormuz to open (with tolls) and will publicly declare that it’s not pursuing nuclear weapons (which it has always publicly declared in the past).

In addition, Iran will gain an important new source of geopolitical power and economic revenue: control of the Strait of Hormuz.

Before the war, Iran didn’t control the strait, simply because it didn’t realize it could. Drone technology had advanced to the point where Iran was able to shut down Hormuz, but Iran didn’t know that until the U.S. attack forced it to try the risky and desperate move of actually shutting down the strait. The gambit paid off spectacularly, and now Iran knows that modern drone weaponry gives it an advantage it didn’t have in previous decades. So it controls Hormuz.

It’s kind of wild to step back and consider how good of a position Iran’s leaders are in now, compared to the situation before the war. Iran had lost most of its proxy armies in the Middle East — Hezbollah, Assad, most of Hamas. The regime had been rocked by massive nationwide protests, which it only managed to quell by murdering tens of thousands of innocent Iranian citizens. The country’s economy was slowly dying. Now the leaders are firmly entrenched in power, their economy will be revived, and they find themselves the masters of Hormuz for the first time.

Anyway, I don’t see any sense in which this is not a classic military defeat for Donald Trump and the United States. Consider the contrast with Iraq. None of America’s opponents in the war were in power after the war; in Iran, despite the assassination of a few leaders, the regime is even more firmly in power now than before the war. In Iraq, the U.S. suffered some economic damage, but was willing to see the conflict through until all opposition was defeated and all U.S. war aims were achieved (except for the destruction of WMDs, which never existed in the first place and so could not be destroyed). In Iran, economic pressure forced America to make major concessions relative to the pre-war status quo.

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Dementia is rising, but your personal risk is falling | Vox

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I turned 48 this week, which meant it was time for my annual physical. After the usual battery of questions from my doctor — How much did I drink? Was I exercising? How was I sleeping? — it was my turn to ask a question. I had one prepared: Should I get the shingles vaccine?

  • Dementia cases will keep climbing as the population ages — a projected million new US cases annually by 2060 — but your odds of getting it at any given age have been falling for decades. An 80-year-old today is meaningfully less likely to have dementia than one a generation ago.
  • Across wealthy countries, age-specific dementia rates have dropped roughly 13 percent per decade since the late 1980s, and most of that decline tracks with things we can influence: better-controlled blood pressure and cholesterol, less smoking, more years of school. The brain lives downstream of the heart.
  • A 2024 Lancet commission estimated that up to 45 percent of dementia could be prevented or delayed by addressing 14 risk factors — and the highest-leverage window is midlife, not old age.
  • The anti-dementia to-do list: treat your blood pressure and LDL cholesterol, don’t smoke, stay physically active, get your hearing and vision checked, keep learning, and go easy on alcohol. Unglamorous, but it buys time for your brain.
  • A growing run of studies links the shingles vaccine to lower dementia risk. The evidence isn’t conclusive and the shot is only recommended at 50, but it’s worth a conversation with your doctor.
  • There is no drug that reverses dementia today. That’s not the same as being helpless.

According to standard medical guidance, the answer would be no. The shingles vaccine is only recommended by the government for people 50 years or older; the only exceptions are adults whose immune systems are weakened by disease or treatment. And despite the way my back feels when I get out of bed each morning, I wasn’t there quite yet. Our immune systems weaken as we age, but at 48, I was probably still capable of beating back the varicella-zoster virus that causes shingles (and chickenpox).

And yet my doctor was open to the idea for the same reason that I was asking about it: because there is early but growing evidence that the shingles vaccine may be protective against neurodegenerative diseases like dementia. For someone my age, with more time behind me than in front of me, the possibility of developing those diseases — and the desire to do anything to prevent them — is suddenly looming large.

I’m far from alone. Dementia already afflicts more than 6 million Americans today, and a 2025 study in Nature Medicine estimated that the lifetime risk of developing dementia after age 55 is 42 percent, with higher figures for women, Black adults, and those who carry the APOE ε4 allele genetic variant, which is known to increase the risk for Alzheimer’s. That same study projected new US cases of dementia would double by 2060, from 514,000 a year in 2020 to more than 1 million annually, due largely to population aging.

Behind those figures is a universe of suffering. Nearly everyone reading this has watched, or will watch, someone they love succumb to dementia. And once you get to my side of your 40s, that risk starts to feel less abstract and a lot more personal.

Yet the frightening story of the rise in dementia cases as the US population ages obscures real progress that is already being made to prevent it — and the even greater progress that could follow. Dementia may feel inevitable, a cruel side effect of longer life. But it doesn’t have to be.

The Nature study is about incidence — new cases, not the total number of people living with dementia. Separate CDC estimates project nearly 14 million older Americans living with Alzheimer’s disease, the most common form of dementia, by 2060.

But the rate hasn’t been holding steady — it’s been dropping. A 2020 study that drew on data from six countries across Europe and North America found that age-specific dementia incidence for people of European ancestry had fallen about 13 percent per decade since the late 1980s, and around 16 percent per decade for clinical Alzheimer’s. A 2016 study tracked five-year dementia rates across four periods between the late 1970s and the early 2000s and found them steadily falling, ultimately dropping 44 percent by the most recent period. The authors of the 2020 study project that if the decline in incidence remains steady in the future, 15 million fewer people might develop dementia by 2040 across high-income countries than if the incidence of the disease remained unchanged.

That good news may not be shared by everyone. The 2016 study found that the decline only showed up among people with at least a high school diploma — more on that below — and even then, it wasn’t evenly shared. And the sheer increase in older people means that a continually dropping incidence only blunts the coming dementia wave, rather than blocking it. One study of older adults in England actually found dementia incidence falling through 2008 and then creeping back up; the researchers also found that when you account for the fact that people headed toward dementia tend to die earlier, the drop gets much harder to see. What’s fallen before can rise again.

But what this likely means in practice is that a person turning 80 today is meaningfully less likely to have dementia than a person who turned 80 a generation ago. And it’s reasonable to hope the same will hold for whoever turns 80 next — like, say, me.

The question, though, is why.

Here’s a veteran health journalist tip: if anyone ever asks you why something is improving in public health, just attribute it to the decline in smoking. There’s a decent chance you’ll be right.

While Alzheimer’s is a brain disease, and dementia is the umbrella term for several kinds of cognitive decline, there is a growing consensus that they are deeply driven by vascular health — meaning what damages your heart and blood vessels is ultimately what damages your mind. Thanks to the development of blood pressure and cholesterol-lowering medicines, better heart disease and stroke management, and perhaps most of all, drastic reductions in smoking, cardiovascular health has been improving. Even with the rise of obesity and diabetes, most vascular risk factors have decreased over the same time that dementia and Alzheimer’s prevalence fell.

The rise in education over the same time period may play a role as well. Americans turning 80 today went to school during a great mid-century expansion in education, while their parents were schooled — or rather, not schooled — in the 1920s and ’30s. In 1940, only 24.5 percent of Americans 25 and older had a high school diploma, and just 4.6 percent had completed a bachelor’s degree or more. By 2017, high school completion had reached 90 percent, and the share of people with a bachelor’s or more had hit 34 percent. And researchers have correlated higher education attainment with lower dementia and Alzheimer’s rates.

Now repeat after me: correlation is not causation. Researchers don’t really know why more years of schooling seem to be associated with a lower risk of dementia, though there are theories that education might boost the brain’s “cognitive reserve.” But the hopeful take is that the decline in incidence is largely driven by behaviors and life conditions we can change. And one of the most unexpected and promising acts is something as simple as routine vaccination.

Last April, I wrote about what I called “one of the brightest spots in an otherwise dark field”: a study in Wales that found that older adults who received a vaccine against shingles were 20 percent less likely to develop dementia in the seven years following vaccination than those who did not receive it. It wasn’t a randomized trial, but it was stronger than the usual observational association: the study harnessed a natural experiment in Wales, where vaccine eligibility turned on a birthday cutoff, meaning it was less likely that the results were because vaccinated people were simply healthier.

Earlier this year, a study in Canada looked at hundreds of thousands of people over the age of 70 and, like the Welsh study, found that those who had taken the shingles vaccine were less likely to develop dementia. And a new analysis from late 2025 of the data in the Welsh study found that the vaccine was associated with benefits that went beyond prevention — it also seemed to slow the disease for those with dementia and reduced deaths attributable to it.

The shingles vaccine in the Welsh study was an older, live-virus version; the current vaccine is a newer recombinant form that can’t accidentally cause shingles, and another study found it was associated with even greater protection from dementia.

These findings are promising but still leave plenty of questions. The Welsh live-vaccine study found a larger apparent benefit in women, who also suffer higher rates of dementia. But the pattern is not settled: the newer recombinant-vaccine study found an association in both men and women, though stronger in women. Shingles may be connected to dementia, though the evidence is still messy: A large 2025 health-records study found recurrent shingles was associated with a modestly higher dementia risk than a single episode, while earlier evidence has been more mixed.

Shingles occurs when the dormant varicella zoster virus — the same virus that causes chickenpox — reactivates. It’s possible that the resulting neural inflammation may feed dementia. A randomized controlled trial published in December tested a related herpes-virus idea, treating 120 adults with early Alzheimer’s or mild cognitive impairment — all with evidence of prior herpes simplex infection — with a medication called valacyclovir. After 18 months, researchers found no significant advantage over a placebo, dampening hopes that herpes antivirals could be an effective Alzheimer’s treatment.

That’s a real strike against the simplest version of the theory that the virus itself is rotting the brain. But it could mean that the shingles vaccine’s possible protective effects don’t come from shingles at all. A 2025 study found that the newer shingles vaccine and an RSV vaccine that share the same AS01 immune-boosting adjuvant were each associated with lower 18-month dementia risk compared with flu vaccination, and researchers did not find a statistically significant difference between the two AS01 vaccines. The implication is that the benefit might come from giving an aging immune system a jolt, rather than from any one bug it’s aimed at.

But as the vaccine science sorts itself out, there are lifestyle changes you can make to help protect yourself without getting a shot. A 2024 Lancet commission found that, in principle, up to 45 percent of dementia cases could be prevented or delayed by addressing 14 risk factors, including not smoking; lowering high LDL cholesterol in midlife; treating hearing loss, especially from midlife on; and limiting obesity. The key period here is midlife, which the commission defined (rather widely in my opinion) as 18-65. Which, for someone my age, means there’s no better time to focus on prevention.

I don’t know whether I’ll go ahead and try to get the shingles vaccine early, and to be clear, I’m not telling anyone they should. The science is still uncertain, and I am, obviously, not a medical doctor. But the lifestyle factors that have been shown to protect against dementia — which are largely the same ones that help cardiovascular health — can be adopted by everyone, for their health now and in the future.

No one knows for sure what the future holds, for me or for you. What’s certain is that, barring a medical miracle, the sheer number of dementia cases will continue to rise as our population ages, and that some of us will be in that number. But that doesn’t mean we’re helpless.

A version of this story originally appeared in the Good News newsletter. Sign up here!

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acdha
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Close to home age-wise 💉
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A slavery exhibit becomes a flashpoint in Philadelphia ahead of America's 250th

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Activists in Philadelphia are fighting to restore an exhibit about enslaved people who lived and worked in George Washington's presidential household.

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Researchers are uncovering ADHD’s links to these other health conditions

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Attention-deficit/hyperactivity disorder, or ADHD, is one of the most common neurodevelopmental conditions in the United States, affecting an estimated 15.5 million adults and roughly 7 million children.

A growing body of evidence suggests that people with ADHD may be at risk for other health conditions, including anxiety, disordered eating, autoimmune disease, migraines, long covid and chronic pelvic pain.

For example, in a study published this spring in Scientific Reports, researchers looked at 958 adults with treatment-resistant chronic pain. They found that those with “extremely severe” pain — consistently rated 9 or 10 on a 10-point scale — were more likely to have ADHD symptoms than those with less severe pain. Overall, ADHD symptoms were about twice as common in the study group as in the general population.

What’s not clear, however, is whether there is a direct biological link between ADHD and pain (or any other condition), or whether years of stress, overwhelm, poor sleep patterns, social difficulties, untreated ADHD symptoms and side effects of ADHD medications are the real culprits.

We spoke with experts and dug into the research to understand more about the complex connections.

ADHD and pain

As the new study and other research suggest, adults with ADHD are more likely to report chronic pain and may experience greater pain severity in conditions such as migraine, fibromyalgia and chronic low-back pain.

Karen Stewart, a clinical psychologist based in Huntsville, Alabama, who specializes in ADHD, said impulsivity and cognitive rigidity (difficulty adapting to new thoughts or behaviors), both of which are common ADHD traits, may help explain this connection.

“Our beliefs about our pain and our reactions can amplify or ameliorate our physical suffering,” Stewart said. For example, catastrophizing or quickly jumping to worst-case scenarios, which can be an aspect of impulsivity, and not being able to shake those thoughts, which can be part of cognitive rigidity, can ultimately increase your perception of pain, she said.

People with ADHD who are experiencing pain, in particular, can sometimes become consumed by fears that their symptoms will never improve, said Margo Pumar, a psychiatrist who specializes in ADHD and reproductive psychiatry in San Francisco. This can lead to a looping internal dialogue along the lines of: “I can’t have this keep happening. I can’t live this way. What if I always have to live this way?”

Imagining the worst-case scenario may also amplify nerve sensitivity, a phenomenon called central sensitization, which research suggests is more common in people with ADHD. This describes when your nervous system becomes hypersensitive to sensory signals, which can magnify your perception of discomfort and pain.

Neuroinflammation — which is when the tissues in the brain or spinal cord become inflamed and is one of the factors that play a role in ADHD — may additionally increase your risk of experiencing central sensitization. (ADHD is generally thought to be caused by a complex mix of genetic and environmental factors.)

Eugene Merzon, an ADHD researcher and Israeli Health Ministry-certified ADHD diagnostician, explained that neuroinflammation may disrupt how neurons in the brain communicate and function, resulting in ADHD’s signature symptoms, such as inattention and executive dysfunction.

What causes neuroinflammation is unclear, but in addition to potentially influencing brain development and increasing the risk of disorders such as ADHD, research has suggested that “ongoing inflammation may overstimulate the nervous system, making symptoms like pain, fatigue and memory problems worse over time,” said Valentin Dragoi, a professor of neuroscience at Houston Methodist Academic Institute.

ADHD is linked to chronic pain and other health conditions. (iStock)

ADHD and the immune system

ADHD also seems to co-occur with disorders of immune function, such as asthma, allergies, eczema, rheumatoid arthritis, Type 1 diabetes and hypothyroidism, said Jeffrey Newcorn, director of the division of ADHD and learning disorders within the department of psychiatry at Mount Sinai in New York.

In one of Merzon’s studies, he and his team of researchers found that having a diagnosis of ADHD was associated with a higher risk of covid infection early in the pandemic, more severe illness and a greater likelihood of long covid, raising questions about how neuroinflammation affects the immune system.

Another study that he co-authored found that children diagnosed with ADHD had elevated inflammatory markers, including higher eosinophil (immune cells involved in allergic and inflammatory responses) counts, as early 1 year old.

Brain scans reveal 3 ADHD subtypes, including a more extreme form

ADHD drugs work, but not the way experts thought

Researchers have also explored these connections in autoimmune conditions such as lupus. Neuropsychiatric lupus, an umbrella term describing the neurological and psychiatric symptoms that can occur in people with systemic lupus erythematosus (SLE), can lead to symptoms that mirror ADHD-related brain fog.

For years, many lupus patients were told these symptoms — such as difficulty concentrating, short-term memory loss, mixing up words and difficulty completing thoughts — were simply emotional reactions to chronic illness, said Meggan Mackay, a Lupus Research Alliance-funded researcher, rheumatologist and professor at the Feinstein Institutes for Medical Research. But growing evidence suggests neuroinflammation could be at the root of these symptoms.

Navigating ADHD and other conditions

People with ADHD may also have a more difficult time navigating complex health conditions, Newcorn said, which could result in worse symptoms or more severe outcomes.

That’s because managing chronic illness — remembering medications, monitoring symptoms, attending appointments and maintaining consistent sleep schedules — requires high levels of executive function, or the collection of mental skills that help people plan, prioritize, manage time and follow through on tasks. Executive dysfunction is a classic manifestation of ADHD.

Research suggests that stimulant medications used to treat ADHD and multiple types of antidepressants also could help improve chronic pain and mood disorders that can occur alongside ADHD.

Ultimately, the science surrounding ADHD and chronic illness is still evolving. “The human brain is infinitely complex and difficult to understand and study,” Dragoi said. But the thing that experts did stress is that we need to stop looking at ADHD as just a condition that affects the brain.

“It’s one body,” Pumar said. “There are no secrets. Your brain knows exactly what’s happening in all the parts of your body.”

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“In times of great uncertainty, people-at-large will act cautiously and avoid committing themselves…

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“In times of great uncertainty, people-at-large will act cautiously and avoid committing themselves to major resource outlays, or else make desperate flailing gambles when they feel really backed into a corner. This isn’t because anyone is being evil or stupid. It’s necessary, predictable, and wise on a micro-level.”

“The nature of technological development is such that, for the foreseeable future, literally all times will be times of great uncertainty.”

Someone oughta, y'know, look into that.

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mareino
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