Carl EsPen

President Donald Trump said on Wednesday that the government will purchase “a lot” of the drug esketamine, a derivative of ketamine.

Though ketamine is known as a recreational hallucinogen, Trump asserted that a new nasal-spray derivative would be of great benefit to veterans with depression. As he left the White House for a veterans’ conference in Kentucky, he told reporters that he had instructed the Department of Veterans Affairs to make a large purchase—overriding a recent decision by the doctors who manage the hospitals’ formulary of which drugs are to be prescribed.

“There’s a product that’s made right now that just came out by Johnson & Johnson which has a tremendously positive—pretty short-term, but nevertheless positive—effect,” Trump said. But that statement is contrary to the evidence. A review by the Food and Drug Administration of what limited studies have been done with esketamine found mixed results, leaving many scientists unsure if the drug is indeed effective and safe. Just last week, the agency published a report that said the drug was not reliably better than placebo.

Rates of suicide among veterans have perennially been about 50 percent higher than those among people who were never in the military. Then, last year, the VA reported that rates increased by 10 percent among younger veterans in particular. Despite pressure to better address and treat suicidal depression, the VA’s medical advisory board voted in June against including esketamine in the list of drugs that the hospital system offers in its formulary. The VA declined to comment on its decision, but current guidelines, a VA spokesperson told me by email, allow for esketamine’s occasional use in “veterans who have not previously responded to adequate trials of other available treatments for major depression.”

Esketamine recently underwent an expedited trial to see if it could be of benefit for people with depression. In March, the FDA granted a controversial fast-track approval to the drug (which is sold under the brand name Spravato) for use in severe depression. Only one of three clinical trials showed any benefit. The drug was not shown to decrease suicide: three patients who were taking the drug died by suicide during the clinical trials, compared with none who weren’t.

The FDA ultimately voted to approve the drug, but only for use in conjunction with an oral antidepressant medication, and only for the treatment of severe cases of depression where other approaches haven’t helped. Given the many potential adverse effects, the drug has to be administered by a physician. The patient then has to be overseen for two subsequent hours. Effectively, esketamine was deemed safe enough for doctors to consider prescribing when everything else has failed and a person is still suffering.

This is a far cry from the promises the president made to veterans. “Hopefully we are getting it at a very good cost,” Trump said. “I guess it’s a form of a stimulant where if somebody is really in trouble from the standpoint of suicide, it can do something.” The drug is, in fact, a sedative; ketamine has long been used as an anesthetic. And its daily cost is $737.50.

Speaking to veterans later that day in Kentucky, Trump reiterated the promise: “I’ve instructed the top officials to go out and get as much of it as you can from Johnson & Johnson.”

Despite Trump’s remarks, the VA spokesperson, Susan Carter, told me that the agency has no immediate plans to change its policy: “VA will closely monitor the use of esketamine in veterans to more fully understand its relative safety and effectiveness as compared to other available treatments. Based on this information, VA may revise its clinical guidance and formulary status if warranted.”

Even if the drug does prove safe and effective enough for the VA to adopt it widely, by no measure would it constitute a comprehensive approach to preventing suicide. Antidepressant medications of all sorts have only ever constituted part of an effective treatment plan.

Preventing the onset and escalation of depression in high-risk groups is more difficult still. It involves building community and connection—creating and maintaining healthy avenues for veterans to process trauma, reintegrate into the often directionless maw of civilian life, and recalibrate a sense of purpose and belonging. Putting great hope in a nasal spray—as anything more than an emergency last resort in extreme cases—is to overlook the fundamental complexity of depression, and to miss the root causes of the disease.

That is the subtitle title of a paper by Jansen, Incerti and Linthicum (2019) in Pharmacoeconomics.

The Innovation and Value Initiative started the Open-Source Value Project with the aim to improve the credibility and relevance of model-based value assessment in the context of the US healthcare environment. As a core activity of the Open-Source Value Project, the Innovation and Value Initiative develops and provides access to flexible open-source economic models that are developed iteratively based on public feedback and input. In this article, we describe our experience to date with the development of two currently released, Open-Source Value Project models, one in rheumatoid arthritis and one in epidermal growth factor receptor-positive non-small-cell lung cancer. We developed both Open-Source Value Project models using the statistical programming language R instead of spreadsheet software (i.e., Excel), which allows the models to capture multiple model structures, model sequential treatment with individual patient simulations, and improve integration with formal evidence synthesis…Development of the rheumatoid arthritis and non-small-cell lung cancer model platforms has presented multiple challenges. The development of multiple components of the model platform tailored to different audiences, including web interfaces, required more resources than a cost-effectiveness analysis for a publication would. Furthermore, we faced methodological hurdles, in particular related to the incorporation of multiple competing model structures and novel elements of value. The iterative development based on public feedback also posed some challenges during the review phase, where methodological experts did not always understand feedback from clinicians and vice versa. Response to the Open-Source Value Project by the modeling community and patient organizations has been positive, but feedback from US decision makers has been limited to date.

Interesting throughout.

Getting smaller is big business in America. Last year, the country’s market for weight-loss products and services reached an all-time high of $72 billion. Analysts predict it will only grow in the years ahead, in large part because of the potential for apps and tech products like FitBit and MyFitnessPal to capture the attention of young consumers, who tend to like data and hate the in-person meetings that many diet companies have required of past generations.

In this context, “young consumers” almost always refers to people over the age of 18. America’s childhood-obesity numbers have been climbing for decades, but children and adolescents also need to gain weight in their formative years to become healthy, strong adults. That can make creating healthy relationships between kids and food a delicate process, which is why it has historically been the province of doctors and nutritionists. Marketing weight-loss services directly to kids has been a public-relations third rail.

Nevertheless, last week, America’s biggest diet company went for it. WW, the company formerly known as Weight Watchers before it rebranded in 2018, launched Kurbo by WW, an app intended to track food consumption, physical activity, and weight loss in kids as young as 8. At Kurbo’s launch, WW’s president and CEO, Mindy Grossman, said the company sees an opportunity “to change the health trajectory of the world” with its products.

Exactly how a food-tracking app could accomplish that lofty goal is far from clear. Researchers have yet to find a reliable way for the majority of adults to lose weight and keep it off, let alone children who are still growing. WW’s new app takes those daunting odds and reduces the task down to the personal responsibility of children mostly too young to drive or have money of their own.

Downloading Kurbo and using its basic tools is free, and its approach to food centers on research from Stanford University and a long-standing concept often referred to as the traffic-light system. This system filters foods into three broad categories: “Green” foods like fresh vegetables and lean protein should be actively included in a person’s diet. “Yellow” foods like low-fat dairy products and bread should be eaten in moderation. “Red” foods like french fries, full-fat dairy products, and most sweets should be limited and planned for.

The Kurbo app pre-categorizes hundreds of common foods according to traffic-light color, so that kids can search for what they eat and add it to their daily tallies. When I set up a Kurbo test account, the app immediately advised me to limit my “red” foods to six per day or fewer.

“It’s common sense,” says Gary Foster, WW’s chief science officer. Red foods “aren’t foods that should be encouraged in kids’ diets, but they also shouldn’t be vilified or demonized, and there has to be a system that’s simple and science-based that highlights that so everyone in the family can understand.” An emphasis on family participation is central to Kurbo’s sales pitch, and they claim that the app will facilitate family-level changes in diet and activity.

In its design, though, the app only tracks the actions and food consumption of an individual. Research suggests that the parents of overweight kids are already keenly aware of which foods are considered healthy or unhealthy for their children, without the aid of structured programs or apps to guide them.  And Kurbo only requires children under the age of 13 to sign up for Kurbo with a parent, which leaves teens who have their own phones free to use the app’s food- and weight-tracking tools without parental consent or involvement, even if they are in what the app considers a normal weight range to begin with.

Foster confirmed to me that warnings about a child losing weight too quickly or eating too little—behaviors that may indicate the onset of an eating disorder—are only available to those who sign up for the app’s optional one-on-one coaching service, which starts at $70 for a one-month plan. When pressed, Foster held firm in his assessment that building in more safety features for kids who can’t use WW’s coaching services was unnecessary, characterizing such warnings as a “bad user experience” for people who might, for example, only log their breakfast foods.

Foster dismisses the possibility that Kurbo could trigger any dangerous behaviors. “People are not categorizing these foods as good or bad,” he says. “It’s not leading to any eating disorders or anything that approximates eating-disorder thinking.” As evidence, he cites an analysis published recently that found no increased prevalence of eating disorders among overweight and obese minors in monitored weight-loss programs.

It’s unclear how relevant that study is to Kurbo, however. The analysis specifically excludes existing internet-based weight-loss methods (such as apps) and programs that include minors who aren’t clinically overweight. Kurbo isn’t professionally monitored unless a parent pays for the coaching service, and its coaches are not required to have outside training in nutrition or dietetics.

When I later asked Foster about these discrepancies, he told me in an email that no studies that look specifically at apps exist, so WW is “leveraging data that analyzes the approach rather than the channel.” He added that WW will “continue to test the efficacy of Kurbo by WW to ensure we are making a positive impact on and [meeting] the needs of families.”

Natalie Muth, a pediatrician and a spokesperson for the American Academy of Pediatrics, is more wary of the potential for a tool like Kurbo to turn dangerous in the hands of kids. “Children are not ‘little adults’ and the approaches that may ‘work’ for adults, such as weight-loss goals, are not appropriate for children most of the time,” she says. “Interventions that focus on weight as the main target can trigger disordered eating patterns, low confidence and self-esteem when goals are not met, and an unhealthy preoccupation with looking a certain way.”

Kurbo lets kids choose goals like “boost my confidence” and “have more energy” instead of the explicit goal of weight loss at sign-up, but all of the goals require children to track their weight and food.

Overweight kids are more likely than their smaller peers to experience anxiety and depression, and there is significant evidence that these problems stem from how poorly fat people are treated in America. According to Andrew Subica, a professor of public health at UC Riverside, interventions that place an emphasis on individual weight loss rather than on broader policy initiatives around the availability of fresh food and safe opportunities for physical activity have the potential to exacerbate that stigma against those who don’t or can’t lose weight. “That’s really not a message we want to be sending to anyone, but especially vulnerable children who are still trying to learn how to make friends and how to avoid being ostracized and bullied,” he says.

Subica points out that although kids are now heavier on average than they were a generation ago, they haven’t gained weight evenly across demographics. Instead, black and Hispanic kids, kids who come from working-class and poor families, and kids who live in underserved neighborhoods are far more likely to gain weight. “My concern with anything like [Kurbo], but especially something that’s targeting young children, is that it puts the blame on the child when really it’s a lot of the cultural forces around the child that lead to obesity,” he says.

These forces include food deserts, the relatively high cost of healthy foods, and marketing campaigns behind unhealthier foods that disproportionately target poorer populations. An app can tell you to eat your vegetables, but it can’t make those foods affordable, and it can’t stabilize a parent’s work schedule so they can pack lunch and cook a fresh dinner.

Although diet plans, apps, and programs remain enormously profitable in America, they frequently provide the people who use them with little new information. Girls in the U.S. are commonly aware of restrictive dieting behaviors as young as age 5. The average American has likely heard the basic message that fruits and vegetables are good for you, and that soda and chips should be consumed in moderation, even if he or she lacks the ability or desire to eat according to those guidelines. Weight loss is hard and almost never effective in the long term, and the tools of a healthy lifestyle are frequently out of reach. That people are willing to try a new app, or that they want to spare their child the grief of losing weight as an adult, doesn’t exactly beggar belief.

It does, however, make the diet industry a lucrative business for companies like WW. “You train these kids at young ages to think in these terms around weight loss and diet, and then of course, from a business perspective, that would be something you’d anticipate they would continue to do in the future,” Subica notes. “Children dieting when they’re 8 or 9 are probably going to diet when they’re 15 and 25 and 35 and then make their kids diet.”

Muth, too, pointed out that parental food behaviors are often reflected in children. Those who believe in programs like WW are likely to create the next generation of diet-app users, not the next generation of people with healthy relationships to food and their bodies. The same analysts who forecast the weight-loss industry’s bright future caution that the proliferation of positive body image could dampen diet companies’ prosperity. Whether or not WW’s products are good for kids, they’re probably very good for the company.

In the rural parts of Uganda, lab technicians spend hours each day on thankless and seemingly unceasing work. The most common tests they run are for malaria. A technician smears a blood sample on a slide, treats it with dye, and then slowly scans it for cells that contain malaria parasites. She then uses a handheld clicker to record how many parasites she sees.

A typical test might take from 30 minutes to an hour. A health center might see dozens of patients in a day. When Manu Prakash visited on a recent trip, “There were places where the technicians couldn’t stop to talk to me, because they were busy working, which could last for eight to 10 hours per day,” he says.

An Indian-born biophysicist who works at Stanford University, Prakash is best known for creating the Foldscope—a $1 pocket microscope that magnifies objects by more than 2,000 times and can be folded from a single sheet of paper embedded with microoptics. But on this trip, while field-testing the Foldscope, Prakash realized that being cheap wasn’t enough. His devices also needed to be fast.

Rapid diagnostic tests can quickly check whether someone has malaria, but they don’t count the number of parasites. That figure is important: It reveals the severity of an infection and informs treatment choices. To count parasites, you need trained technicians and good microscopes. “There’s incredible talent, but it’s limited by their tools,” Prakash says. “I would meet health-care workers who would save their salary for a year to buy a fancier microscope.”

So Prakash and his colleague Hongquan Li built a fancier microscope—a high-speed, malaria-detecting device that they’ve called Octopi. It can automatically scan entire blood-smeared slides for malaria parasites, using a neural network trained on more than 20,000 existing images. Octopi works off a phone charger. It analyzes slides at speeds that are 120 times faster than traditional microscopy. Weighing fewer than seven pounds, it’s portable. And at a do-it-yourself cost of $250 to $500, it’s cheaper than many basic microscopes or other automated slide-analyzing devices.

Prakash has spent his career building extremely cheap medical devices that can be used in some of the poorest parts of the world. Besides the Foldscope, he developed a $10 skin patch that can detect parasitic worms. And he developed a 20-cent, hand-powered centrifuge that can spin medical samples at up to 125,000 revolutions per minute, achieving what costly, bulky, and expensive machines can do using little more than paper, string, and tape. But diagnostic speed was a new challenge.

At first, Li disassembled and reverse-engineered hundreds of DVD drives to try to build something that could scan slides quickly and efficiently. Eventually, he decided to fashion something from scratch. What he built was a fully modular microscope, with separate illuminating, scanning, and processing units that snap together magnetically. It looks quite unlike a standard microscope: There’s no eyepiece, for a start, nor a need for one. To use it, a technician prepares a slide in the usual way. “And then, you load the slide in the microscope and hit the scan button,” Li says.

The modular design makes the microscope very flexible. Technicians can switch between a low-magnification module that can efficiently find the parasites on a slide, and a high-magnification one that can more sensitively count them within those hot spots. They can also swap between different types of imaging, from the basic kind, in which white light shines through a slide from below, to more advanced techniques that look at the colors of samples treated with fluorescent dyes.

For malaria, the latter is crucial, because Li found that malaria parasites fluoresce in a slightly different color than surrounding blood cells. The distinction—roughly, teal versus blue—is hard to discern with the naked eye, but to Octopi, it’s clear. At first “we thought, That can’t be right,” Prakash says. “But the parasites do light up differently!”

The Octopi name has many origins. It’s a very loose acronym, which stands for “open configurable high-throughput platform for infectious diseases.” The microscope is very versatile, in the way that octopuses are. The “pi” ending, though the wrong plural form for octopus, is a nod to Raspberry Pi, a simple computer designed for use in developing countries. And, “my kids are of the age where they love octopuses,” Prakash says.

Prakash announced Octopi last month, to widespread acclaim online. His paper describing the project has been uploaded in advance of formal review and publication, and he is ushering the device into clinical trials in Peru, Uganda, and India. In the meantime, Elena Gómez-Díaz, a malaria researcher at IPBLN-CSIC in Spain, is impressed. “Malaria diagnosis is time-consuming,” she says. “This device automatizes the process at affordable cost. Whether it will replace the talent and hard work of so many skilled technicians working in malaria diagnosis in endemic countries, I can’t say. To me, they are heroes.”

Prakash feels the same. His goal isn’t to replace technicians but to make their lives easier—and not just when examining malaria. Octopi’s modularity means that it could be easily reconfigured to detect other diseases, too, by swapping in the right unit—an advantage it has over the many other technologies designed to spot malaria specifically. Prakash’s team has already used Octopi to look at the bacteria that cause tuberculosis and pneumonia and the parasites behind sleeping sickness and leishmaniasis. “It’s like a Swiss Army knife,” he says. “Anyone in the world can make a module.”

He hopes they do. Prakash has made Octopi’s assembly instructions and code freely available, and as he did with Foldscope, he is distributing 100 of the devices to researchers around the world, on the proviso that any data they collect are also openly available. The goal is the democratization of microscopy. Prakash envisions a future in which health workers worldwide diagnose infectious diseases with a network of cheap, automated microscopes, whose algorithms are constantly improved by the data collected by the entire community.

“If you like robotics, biology, and want to tackle these problems: join forces,” he said on Twitter. “Build DIY tools, apply them to problems you care about. Make new Octopi modules, teach someone, start [an] Octopi club. [The] microscopic world is for everyone.”

On July 31, North Korea tested a ballistic missile. Prisoners in Egypt refused food in protest of inhumane treatment. Residents of Baltimore rebuked the president of the United States for calling their district “a disgusting, rat and rodent infested mess.” Yet for much of the day, the No. 1 trending topic on Twitter was avocados.

People shared recipes and photos, trivia and tales about the fruit. Not because avocados were in the news—not at the center of some controversy or scandal or massacre. It was, simply, National Avocado Day (#NationalAvocadoDay).

This might have struck people in the U.S. as odd, since 80 percent of America’s avocados come from Mexico. But scrutiny for such days tends to be low, evidenced by the now almost daily phenomenon of a trending “national day” blanketing Facebook and Twitter, and even Instagram. As I write this, it’s National Relaxation Day. August also now includes National Dog Day, National Matchmaker Day, and National Sisters Day.

Many of these days are new in the past few years, and a small percentage are recognized by the government. Whimsical as these days seem, the creation and maintenance of national days are a phenomenon with massive financial implications. Many such days are used—or were even specifically invented—to coax people to talk about products and services. This happens on a scale that traditional advertising almost never achieves. Even spending millions on a Super Bowl commercial cannot command so much favorable attention to a product—given freely and enthusiastically by unassuming consumers who blast it into the timelines of everyone they know.

I was especially attentive to the avocado talk because just a few days before, I’d noticed the U.S. surgeon general, Jerome Adams, tweet, “This #NationalIceCreamDay, I’ll be treating myself to a scoop of [strawberry ice-cream emoji] after getting in a good workout. Like anything else, moderation is key!” I could see a surgeon general emphasizing moderation on Halloween or Thanksgiving. But when almost no one realized it was National Ice Cream Day, a tweet about it probably just made people want ice cream.

[Read: The rise of the micro-holiday]

In fact, that’s explicitly why the day was started. In 1984, President Ronald Reagan declared ice cream a “nutritious and wholesome food” to help the dairy industry, since he was already trying to find a way to get rid of a surplus of 500 million pounds of cheese. In the years since, sales of ice cream have spiked on this day. Dippin’ Dots, Cold Stone Creamery, and Baskin-Robbins ran promotions and in-store giveaways on National Ice Cream Day 2019, as did PetSmart and Williams Sonoma. Halo Top gave out vouchers in a promotional collaboration with Bumble. Yes, some Americans are likely now using a dating app because Ronald Reagan had too much cheese.

National Avocado Day has no such history. A meal-delivery business in California started it in 2017. The government doesn’t recognize the day, but it’s no less of an excuse to sell products. One publicist emailed me a few weeks ago to see whether I was “planning to cover National Avocado Day” and, if so, whether I would please mention an avocado lip gloss. This year, even Chipotle ran a campaign to “celebrate” National Avocado Day by making guacamole temporarily not extra.

Similar promotions happen on National Bowling Day, National Waffle Day, and National Shapewear Day—among many, many others. Though declaring new national days traditionally required an act of Congress, businesses such as Hallmark created days such as National Friendship Day as early as 1919, without declaration, to boost card sales. Still, this often took years and large franchises to sew the day into the national fabric. Now it seems to happen as soon as the day is trending on social media. Where do these new days come from? Can any industry declare a day? Am I the only one who finds it weird that you can just tell people “it’s National Milkshake Day” and they will say, “Oh, great, let’s get milkshakes!” (Try it. It works on literally any day.)

In some cases, industries are simply capitalizing on a national day that already existed—hiring publicists to “raise awareness,” buying promotion of hashtags on social media, and partnering with brands to launch celebratory ad campaigns. In other cases, the industries are now baldly creating the days. But they rarely do so on their own. Avocado Day was started in conjunction with a website called National Day Calendar. So, I find, were many other days, including National Bobblehead Day, National Brazilian Blowout Day, and National Water Balloon Day. Insofar as Google results indicate authority, National Day Calendar is the primary arbiter of national-day reality.

Despite what the name might imply, National Day Calendar—like the days it promotes (including National Avocado Day)—is not affiliated with any governmental agency. National Day Calendar is a privately held organization based in Mandan, the seventh-largest city in North Dakota. The company’s website keeps a page for each national day it recognizes, including origin stories and suggested ways to celebrate (most often by consuming something). The design could be charitably described as glitchy and premodern. It is, at least, not the sort of entity one might expect to be capable of overwhelming the zeitgeist with phenomena like National Siblings Day. This small company seems to have found a way, despite so much heated geopolitical discourse surrounding the global rise of ethnonationalism, to get everyone talking about avocados.

The process by which a new national day is recognized is not stated on the site. There is a mailing address and phone number, but no staff listing or email contact. The site invites anyone to pitch a new “national day.” So I do. An online application involves entering my name and email address, and then making a pitch. I do this earnestly, because I’m sure that some of these days mean things to people—even National Tapioca Pudding Day and National Delaware Day. I don’t want to be the one to turn this into a farce.

I submit an application for what I deemed National Microbiome Day. The microbes interact with our immune systems and our metabolic processes to keep us well nourished and attuned to our environment, I suggested, at some length. This is an important subject. At the very least, National Microbiome Day seems as important as National Sponge Cake Day.

The automated response I received was instant and jarring: “Thank you for submitting your idea for a National Observance. Our committee is hard at work reviewing the over 20,000 applications they receive every year. If you are one of the 25 or so applications approved each year, someone will reach out to you about the next steps.”

What? Only 25 out of 20,000 applications? I can see screening out pranks and redundancies, but that would still leave thousands of legitimate proposals rejected. National Day Calendar already recognizes “almost 1700” days, I would later learn. Is there a fear that this number could get out of hand? If the number of days has not already caused them to lose meaning, how many would that take?

I do some journalistic work and uncover a lead. At the bottom of the automated email, it is signed “Smiles, Marlo Anderson. Founder, National Day Calendar.” Anderson immediately agrees to talk. He describes himself as a serial entrepreneur. He started National Day Calendar almost seven years ago, as a blog about national days. By the time a day becomes woven into calendars and memories, he noticed, no one seems to care or remember whether it is “official” or not. Or people simply forget about a national day entirely, even if it exists in a record book somewhere.

Anderson dredged all of the days up and put them on one calendar that he could print and sell. For the digital version of the calendar, the website, he sold ads. Some of these ads, he says, go to relevant industries that want to sponsor a particular day’s page. But anyone can advertise.

Eventually Anderson reasoned, why not start making new days altogether? In the past few years, he estimates that the company has started 150 days. Some included in-person commemorations of the new day; others were done simply with a web page announcing the day. His favorites are National Astronaut Day and National Road Trip Day.

I was unable to independently verify all the information Anderson cited about the tremendous reach of National Day Calendar, including the 20,000 applications. He told me that National Day Calendar employs 15 people, while his colleague, Amy LaVallie, put the number at six. Anderson says the business is very busy selling and placing ads on the website, distributing a printed calendar, developing a clothing line, doing appearances at festivals, collecting licensing fees, creating a nationally syndicated radio segment, and developing an app, a TV show, and a “potential movie.”

Anderson says he’s not involved in the actual process of selecting and declaring new national days—that’s up to a committee of four or five people. LaVallie is one. Her favorite days are Book Lovers Day, Sangria Day, Unicorn Day, and “the chocolate days.” When I asked her cautiously about my application for National Microbiome Day, she, like Anderson, was deeply noncommittal. They are looking for days that are “fun, family-friendly, unique, relevant to the world,” she told me. She assured me that I am in the running.

Since I can’t wait four weeks to hear their verdict, I considered simply declaring the day myself. Other sites, National Today, also invite submissions for “national days.” These are unaffiliated with National Day Calendar, according to LaVallie and Anderson, who both express concern over “copycatting issues.” The notable difference is that the National Today calendar is overtly a marketing exercise, without any of Anderson’s pretense about the primacy of celebrating things that make us happy. National Today’s site reads, “Given the success of quirky holidays like Amazon Prime Day in the U.S. and Singles Day in China—which generated a whopping $17B in sales—increasing numbers of brands are looking for holidays that compel consumers to engage, share, and buy.”

Anderson maintains that industry profits are simply the serendipitous result of important national days. He is indignant at the suggestion that he might accept payments from various industries—the avocado growers, for example—to make sure their application for a new day makes it to the top of the pile. “You will not believe the money we’ve turned away because of that exact scenario,” Anderson said, chuckling, then getting serious. “We’re not a pay-for-play organization. We think having a national day is special. We have to be good stewards of the calendar.”

Having just one entity—federal or otherwise—oversee the calendar would at least ensure some quality control. The more national days, the less value each has. The value proposition is not enhanced by the existence of days such as National Grab Some Nuts Day, National Sneak Some Zucchini Into Your Neighbor’s Porch Day, etc. (All of these are real.) As days lose value, so do the printed calendars and advertising space on the website. I asked LaVallie whether National Day Calendar looks at other companies’ calendars when updating its own. “Actually, we don’t. They look at ours,” she said, dropping the proverbial mic. “All the copycat sites on the internet are trying to get traction, but we’re the source that everybody goes to.”

Whether or not that’s correct, it does seem that these are boom times for national days. As I finish writing this, National Tell a Joke Day is now trending above any other topic. LaVallie thinks this is because of—not despite—the intensity and stakes of the news. People want the opportunity to talk about fun and barely consequential things. As everything happening online collapses into a single social-media feed, people feel they need a reason to talk about something other than what’s clearly more important news. National days offer an excuse—an invitation, even—to transgress. “In this day and age, when everything is so serious, it’s nice to have a little fun,” LaVallie says, “even if it’s just celebrating a cookie day.” (There are many days for different types of cookies.)

Of course, it’s one thing to celebrate cookies of your own volition. It’s another to talk about cookies because a coalition of multinational corporations is, at any level, coaxing you into it, and using your love of cookies to get you to join a dating app. If national days are growing in number and popularity because people want a simple escape from consequential dialogue, there is sadness even in people earnestly celebrating National Ice Cream Day.

The strange little PowerPoint asks me to imagine being the new kid at school. I feel nervous and excluded, its instructions tell me. Kids pick on me. Sometimes I think I’ll never make friends. Then the voice of a young, male narrator cuts in. “By acting differently, you can actually build new connections between neurons in your brain,” the voice reassures me. “People aren’t stuck being shy, sad, or left out.”

The activity, called Project Personality, is a brief digital activity meant to build a feeling of control over anxiety in 12-to-15-year-olds. Consisting of a series of stories, writing exercises, and brief explainers about neuroscience, it was created by Jessica Schleider, an assistant professor at Stony Brook University, where she directs the Lab for Scalable Mental Health. She sent it to me so I could see how teens might use it to essentially perform psychotherapy on themselves, without the aid of a therapist.

In the middle of my new-kid scenario, the program tells me the story of Phineas Gage, the 19th-century railroad worker whose behavior changed radically after a metal spike was driven through his skull. With white backgrounds and rudimentary drawings, the program uses Gage’s experience to suggest that personality resides at least partly in the brain. If a metal spike can change your disposition, Project Personality reasons, so can something less violent—such as a shift in your mind-set. There are, perhaps, better ways to illustrate this than an extreme and hotly disputed historical event, but Project Personality finds a way to make it uplifting: “By learning new ways of thinking, each of us can grow into the type of person we want to be.”

Toward the end, the activity asks me to reassure a friend who was snubbed by another friend in high school. What would I tell the friend about how people can change? It encourages me to apply what I just learned about personality and the brain. The total program takes me less than an hour to complete.

Schleider admits that the production values are a little rudimentary; she’s currently working on a slicker version. Still, last year, she and her colleague John Weisz found that a single session with a very similar program helped reduce depression and anxiety among 96 young people ages 12 to 15. Beyond digital programs such as Project Personality, Schleider’s lab is about to test how well a single session of in-person psychotherapy can help teens and adults. The session will focus on “taking one step toward solving a problem that’s very troublesome,” she told me. “People will leave with a concrete plan for how to cope.”

If Schleider’s work is successful, it may help upend the traditional, pricey model of American psychotherapy. She wants to see whether people can get the same benefit from just an hour of digital or in-person therapy as they can from paying $200 an hour every week for months.

Granted, there are known risks to using well-meaning quick fixes as therapy. In one of her studies, Schleider points out that Scared Straight programs, in which teens visit with prisoners, are a type of single-session intervention, but they actually have been found to increase youth delinquency. There are also plenty of apps these days that allow people to access therapy-like programs without either an expensive psychologist or a primitive PowerPoint.

But Schleider argues that many wellness apps out there haven’t been proved to work. Her lab’s goal is to study the effectiveness of various programs, digital and in-person, to be sure that they’re doing what they’re supposed to. Effective solutions are crucial because Americans—stressed out, lonely, and ghosted by Tinder dates—are in desperate need of someone to talk to. The data suggest that most of the Americans who have a mental illness aren’t receiving treatment. About 30 percent of psychotherapists don’t take insurance. The wait list for the roster of therapists at Stony Brook’s community clinic, who take insurance and charge relatively lower fees, is three to six months. As Schleider put it to me, her quick interventions offer “something, when the alternative is nothing.”

Single-session interventions, like the kind Schleider studies, are typically five to 90 minutes long and, eventually, could be deployed in schools or pediatricians’ offices, rather than in traditional therapists’ offices. Schleider’s lab is especially interested in targeting adolescents, since about half of all mental illnesses set in by age 14. Unlike traditional therapy, Schleider’s program and others aim to get participants to become “helpers” for their peers after they’ve learned information about personality change for themselves. The point is to increase intrinsic motivation: Kids might be more likely to want to sort out other kids’ problems than to sit in their room and do therapy homework.

Perhaps to the chagrin of those of us who have sunk entire paychecks into traditional psychotherapy, there is some evidence that extremely brief therapy is indeed effective. Schleider published a meta-analysis of single-session interventions focused on children and teens (not including her own work, which was tested later) that found that a teen who received a single-session intervention had a 58 percent greater chance of having his or her symptoms improve than one who did not. The single sessions worked especially well for decreasing anxiety and behavioral problems. In fact, Schleider says, on these measures, one session of therapy turned out to be about as effective as 16 sessions. “I don’t know if that’s great or scary,” she says.

Other researchers have also discovered some surprising benefits to quick interventions. One study found that just four days of exposure therapy—in which patients confront whatever they are preoccupied with—helped two-thirds of teens with obsessive-compulsive disorder go into remission. A separate 90-minute intervention increased college students’ sense of “hope, life purpose, and vocational calling.” And a somewhat longer-term program of four to eight weeks was enough to change a person’s personality. That’s longer than 90 minutes, but it’s shorter than many traditional psychotherapy regimens, which can be open-ended and go on for years.

“Definitely, there are times when one session can be powerful,” says Michael Brustein, a clinical psychologist in Manhattan. One fast-acting technique he mentions is motivational interviewing, in which the therapist prods the patient to examine whether his actions are helping him achieve his goals. For example, a father who missed his son’s basketball game because of a drinking problem might be asked whether he’s living up to his sense of what it means to be a “good father.” Certain phobias can also be dealt with in a few short consultations: Brustein told me he once helped a yoga instructor manage an elevator phobia by applying mindfulness techniques from his yoga practice.

Shorter-term therapy is also more likely to work if your definition of “work” isn’t “become permanently and totally happy.” “For too long, our target has been total amelioration of symptoms,’” Jodi Polaha, a psychologist and East Tennessee State University professor, told me via email. (Polaha researches therapeutic interventions that are as short as 20 minutes and delivered in a doctor’s office; I profiled her clinic in 2017.) Rather than complex mental illnesses, simpler problems—such as smoking cessation, weight loss, and even medication adherence—might yield to the precision strike of a short intervention, Polaha said.

The big challenge to scaling up this kind of microtherapy, according to Polaha, is convincing both patients and doctors that there’s no special transformation that happens at 50 minutes. “When I start sessions with my patients, I always tell them we will talk for 30 minutes and then decide if follow-up is needed,” she said, “because change can happen at any time.”

Lynn Bufka, a psychologist with the American Psychological Association, says that these types of brief interventions could be just a first step toward the treatment of various mental-health woes. They might be enough for some people, while others go on to get more intensive therapy. But Brustein and Bufka both say that for more severe issues, such as bipolar disorder and major depression, a quick dose of therapy is unlikely to be enough. “These kinds of interventions are probably more likely to be beneficial before full-blown symptoms or disorders have developed,” Bufka told me.

If Schleider succeeds, and the air begins to leak out of the 50-minute, weekly therapy model, we may begin to wonder: What is the point of therapy? For decades, Americans have been told that the key to inner tranquility is to talk to someone. Have you tried cognitive-behavioral therapy? is the cop-out solution of stumped advice columnists everywhere. But how can talking to a stranger (or looking at a slide deck) for less than the length of a superhero movie be enough to fix your brain? What are we after when we go to therapy, anyway?

The fact that the short-term interventions span about the length of a movie is actually relevant, based on a metaphor Brustein used to describe the benefit of therapy. When you go to a movie, he noted, you can see the characters and understand their motivations. You can tell when they’re about to make a mistake: You wish you could scream at them to not go down to the basement, or back to that guy. But when it comes to our own lives, we have a harder time seeing those patterns. We’re too close to our own problems, so the basement seems like the perfect place to run to. One major goal of therapy, Brustein said, “is to observe ourselves from the outside.”

Therapists, like the anonymous narrator of Project Personality, aim to send a message: Your story isn’t over till it’s over. Your character’s plot is still unfolding; there’s still time to escape. Sometimes, it can take hours and hours on a therapist’s couch to understand that. Maybe, just maybe, it could start to take less.

The strange little PowerPoint asks me to imagine being the new kid at school. I feel nervous and excluded, its instructions tell me. Kids pick on me. Sometimes I think I’ll never make friends. Then the voice of a young, male narrator cuts in. “By acting differently, you can actually build new connections between neurons in your brain,” the voice reassures me. “People aren’t stuck being shy, sad, or left out.”

The activity, called “Project Personality,” is a brief digital activity meant to build a feeling of control over anxiety in 12-to-15 year olds. Consisting of a series of stories, writing exercises, and brief explainers about neuroscience, it was created by Jessica Schleider, an assistant professor at Stony Brook University, where she directs the Lab for Scalable Mental Health. She sent it to me so I could see how teens might use it to essentially perform psychotherapy on themselves, without the aid of a therapist.

In the middle of my new-kid scenario, the program tells me the story of Phineas Gage, the 19th-century railroad worker whose behavior changed radically after a metal spike was driven through his skull. With white backgrounds and rudimentary drawings, the program uses Gage’s experience to suggest that personality resides at least partly in the brain. If a metal spike can change your disposition, Project Personality reasons, so can something less violent—like a shift in your mindset. There are, perhaps, better ways to illustrate this than an extreme and hotly disputed historical event, but Project Personality finds a way to make it uplifting: “By learning new ways of thinking, each of us can grow into the type of person we want to be.”

Toward the end, the activity asks me to reassure a friend who was snubbed by another friend in high school. What would I tell the friend about how people can change? It encourages me to apply what I just learned about personality and the brain. The total program takes me less than an hour to complete.

Schleider admits the production values are a little rudimentary; she’s currently working on a slicker version. Still, last year, she and her colleague John Weisz found that a single session with a very similar program helped reduce depression and anxiety among 96 young people between the ages of 12 and 15. Beyond digital programs like Project Personality, Schleider’s lab is about to test how well a single session of in-person psychotherapy can help teens and adults. The session will focus on “taking one step toward solving a problem that’s very troublesome,” she told me. “People will leave with a concrete plan for how to cope.”

If Schleider’s work is successful, it may help upend the pricey, traditional model of American psychotherapy. She wants to see whether people can get the same benefit, or at least some benefit, from just an hour of digital or in-person therapy as they can from paying $200 per hour every week for months.

Granted, there are known risks to using well-meaning quick fixes as therapy. In one of her studies, Schleider points out that “Scared Straight” programs, where teens visit with prisoners, are a type of single-session intervention, but they actually have been found to increase youth delinquency. There are also plenty of apps these days that allow people to access therapy-like programs without either an expensive psychologist or a primitive PowerPoint.

But Schleider argues that many wellness apps out there haven’t been proven to work. Her lab’s goal is to study the effectiveness of the various programs, digital and in-person, to be sure they’re doing what they’re supposed to. Effective solutions are crucial because Americans—stressed-out, lonely, and ghosted by Tinder dates—are in desperate need of someone to talk to. The data suggest that most of the Americans who have a mental illness aren’t receiving treatment. About 30 percent of psychotherapists don’t take insurance. Even the waitlist for the roster of therapists at Stony Brook’s community clinic, who take insurance and charge relatively lower fees, is three to six months. As Schleider put it to me, her quick interventions offer “something, when the alternative is nothing.”

Single-session interventions, like the kind Schleider studies, are typically five to 90 minutes long and, eventually, could be deployed in schools or pediatricians’ offices, rather than in traditional therapists’ offices. Schleider’s lab is especially interested in targeting adolescents, since about half of all mental illnesses set in by age 14. Unlike traditional therapy, Schleider’s program and others aim to get participants to become a “helper” for their own peers after they’ve learned the information about personality change for themselves. The point is to increase intrinsic motivation: Kids might be more likely to want to sort out other kids’ problems than to sit in their rooms and do therapy homework.

Perhaps to the chagrin of those of us who have sunk entire paychecks into traditional psychotherapy, there is some evidence that extremely brief therapy is indeed effective. Schleider published one meta-analysis of these so-called “single-session interventions” that focused on children and teens. (It didn’t include her own work, which was tested later.) It found that a teen who received a single-session had a 58 percent greater chance of having his or her symptoms improve than one who did not. The single sessions worked especially well for decreasing anxiety and behavioral problems. In fact, Schleider says, on these measures, one session of therapy turned out to be about as effective as 16 sessions. “I don’t know if that’s great or scary,” she says.

Other researchers have also discovered some surprising benefits to quick interventions. One study found that just four days of exposure therapy—in which patients confront whatever they are preoccupied with—helped two-thirds of teens with obsessive-compulsive disorder go into remission. A separate 90-minute intervention increased college students’ sense of “hope, life purpose, and vocational calling.” And a somewhat longer-term program of four to eight weeks was enough to change a person’s personality. That’s longer than 90 minutes, but it’s shorter than many traditional psychotherapy regimens, which can be open-ended and go on for years.

“Definitely, there are times when one session can be powerful,” says Michael Brustein, a clinical psychologist in Manhattan. One fast-acting technique he mentions is motivational interviewing, in which the therapist prods the patient to examine whether his or her actions are helping them achieve their goals. For example, a father who missed his son’s basketball game because of a drinking problem might be asked if he’s living up to his sense of what it means to be a “good father.” Certain phobias can also be dealt with in a few short consultations: Brutstein says he once helped a yoga instructor manage an elevator phobia by applying mindfulness techniques from his yoga practice.

Shorter-term therapy is also more likely to work if your definition of “work” isn’t “become permanently and totally happy.” “For too long, our target has been total amelioration of symptoms,’” Jodi Polaha, a psychologist and East Tennessee State University professor, told me via email. (Polaha researches therapeutic interventions that are as short as 20 minutes long and delivered in a doctor’s office; I profiled her clinic in 2017.) Rather than complex mental illnesses, simpler problems—like smoking cessation, weight loss, or even medication adherence—might yield to the precision strike of a short intervention, Polaha says.

The big challenge to scaling up this kind of micro-therapy, according to Polah, is to convince both patients and doctors that there’s no special transformation that happens at 50 minutes. “When I start sessions with my patients, I always tell them we will talk for 30 minutes and then decide if follow up is needed,” she says, “because change can happen at any time.”

Lynn Bufka, a psychologist with the American Psychological Association, says that these types of brief interventions could be just a first step toward the treatment of various mental-health woes. They might be enough for some people, while others go on to get more intensive therapy. But Brustein and Bufka both say that for more severe issues, like bipolar disorder or major depression, a quick dose of therapy is unlikely to be enough. “These kinds of interventions are probably more likely to be beneficial before full-blown symptoms or disorders have developed,” Bufka told me.

If Schleider succeeds, and the air begins to leak out of the 50-minute, weekly therapy model, it  may raise the question: What is the point of therapy? For decades, Americans have been told that the key to inner tranquility is to talk to someone. Have you tried cognitive-behavioral therapy? is the cop-out answer for stumped advice columnists everywhere. But how can talking to a stranger (or looking at a slide deck) for less than the length of a superhero movie be enough to fix your brain? What are we after when we go to therapy, anyway?

The fact that the short-term interventions span about the length of a movie is actually apt, based on a metaphor Brustein gave me to describe the benefit of therapy. When you go to a movie, he noted, you can see the characters and understand their motivations. You can tell when they’re about to make a mistake: You wish you could scream at them not to go down to the basement, or back to that guy. But when it comes to our own lives, it’s harder to see those patterns. We’re too close to our own problems, so the basement seems like the perfect place to run to. One major goal of therapy, Brustein says, “is to observe ourselves from the outside.”

Therapists, like the anonymous narrator of Project Personality, aim to send the message: Your story isn’t over till it’s over. Your character’s plot is still unfolding; there’s still time to escape. Sometimes, it can take hours and hours on a therapist’s couch to understand that. Maybe, just maybe, it could start to take less.