The clichéd stereotype of a meditator is probably someone with a tranquil and peaceful demeanor, dressed in a flowing robe. It’s definitely not Jerry Seinfeld: an energetic, sneaker-loving stand-up comedian known for his obsessive, granular observations. Nonetheless, he’s probably the world’s most famous practitioner of Transcendental Meditation, a practice developed and taught by Maharishi Mahesh Yogi in 1950s India before spreading around the world, most famously via the influence of celebrities like The Beatles. (According to its official website, TM is “a simple mental technique practiced silently with the eyes closed, sitting in any comfortable position.”)
An inquisitive Seinfeld first learned about TM around age 18 while attending State University of New York at Oswego. “I don’t remember exactly how I started,” he said during a 2013 speech for the David Lynch Foundation, which was founded by the titular filmmaker and TM practitioner in 2005. “It was some kid I knew. I had just gone to college, and we were still kind of in the flush of the feeling of the ’60s, and I just wanted to try any new thing that I heard about. So I went and learned TM. I do remember the first time I did it, and I remember I was up the entire night because I’d never felt that good before. I had terrible acne…and it all just went away, and I became a world-famous comedian. That’s the story. That’s the entire story of my life.”
On a more serious note, Seinfeld talked about how TM became an essential part of his life, helping him process the strain and workload of his mega-hit sitcom, Seinfeld, which ran from 1989 to 1998. “I was doing [a] TV series in which I was the star of the show, the executive producer, the head writer, casting, and editing for 22 to 24 episodes on network television—not cable, network—for nine years, OK? That’s a lot of work,” he said. “I’m a regular guy, pretty much. I’m not one of these crazy people who has endless, boundless energy. I’m just a normal guy, but that was not a normal situation to be in. So what I would do is, every day when everybody would have lunch, I would do TM. And then while we’d go back to work, I would eat while I was working because I’d missed lunch. But that is how I survived the nine years—that 20 minutes in the middle of the day would save me.”
The stress of producing Seinfeld increased in tandem with its ratings, and being the public focal point didn’t help. “I know everybody’s life is hard and every job is hard, but when it’s your name on the goddamn show, the pressure is intense,” he said. “Then the show got successful and everybody expected each week to be even better than the last…I loved every second of it, but it was a lot of pressure and a lot of work. It was all great, but I never could have accomplished it without TM.”
David Lynch, who died in January 2025, practiced TM for over 50 years—and he was beautifully devoted to that ritual, often describing how it unlocks deeper parts of self and helps expand creativity. “If you have a golf ball-sized consciousness, when you read a book, you’ll have a golf ball-sized understanding; when you a look out, a golf ball-sized awareness; and when you wake up in the morning, a golf ball-sized wakefulness,” he said in a 2009 speech. “But if you could expand that consciousness—then you read that book, more understanding; you look out, more awareness; and when you wake up, more wakefulness. It’s consciousness. And there’s an ocean of pure, vibrant consciousness inside each one of us.”
As health care costs rise, patients aren’t just shouldering higher bills. They’re bearing more and more responsibility for getting information.
Americans are facing a health care affordability crunch on multiple fronts. In 2025, the Republican-controlled Congress approved a sweeping tax law that scaled back premium subsidies for Americans accessing care through the Affordable Care Act starting in 2026. As a result, millions on ACA plans now face much higher premiums, with many dropping out or expecting to drop out and risk going uninsured as premiums surge. By March 2026, about 1 in 10 people on ACA plans had dropped out, and that share is expected to rise.
Nearly half of U.S. adults now report difficulty affording health care. Together, these shifts are accelerating the “consumerization” of health care. Patients now have the ability to comparison shop, evaluate options and manage costs – but often without clear pricing. In this environment, knowing how to ask the right questions may be one of the most important tools patients have.
We are professors who study how perceptions of health care costs shape patients’ decisions about their care. Our research examines how factors such as price-transparency regulations influence patient choices. Across our work, we consistently hear from patients about rising costs and how conversations about price with their providers too often never happen.
Why speaking up about cost matters
When one of us took our child to the doctor for pink eye, the pediatrician quickly sent a prescription for antibiotic drops to the pharmacy. At the pickup, the pharmacist dropped the news that the drops would cost more than US$300. A follow-up phone call to the doctor’s office, however, yielded important information: A generic version of the same medication offered the same treatment and the same results, but at a fraction of the price.
That quick phone call saved her a lot of money. It also raised a broader question: Why don’t more people have these conversations about cost? In fact, one study shows that cost conversations occur in only about 30% of medical visits.
These discussions aren’t just for medications. They can be crucial when a recommended procedure has multiple alternatives; when out-of-pocket costs might affect whether you follow through on care; or when a sudden medical bill could create financial strain. Speaking up about price can help patients stay healthier and avoid the all-too-common trade-off between medical care and household expenses.
The study mentioned above also found that doctors and patients identified ways to reduce out-of-pocket costs – such as switching to a generic drug or adjusting the timing of care – in nearly half of those cases. Importantly, these conversations were typically brief and did not compromise the quality of care, the researchers found.
Patients actually prefer doctors who bring up costs, other research has found. Still, most patients remain hesitant. While a majority say they want to discuss cost, only a minority actually do, often waiting until a bill arrives – often when it’s too late to consider alternatives. That’s why it’s important that consumers feel empowered to ask the right questions. Here are three that can help make care more affordable.
One of the simplest ways to reduce drug costs is to ask whether a less expensive option is available. Brand-name medications can cost significantly more than generics, even when they are equally effective. One industry survey estimated that 90% of all prescriptions filled in 2024 were generic or biosimilar, but these accounted for only 12% of drug spending.
In many cases, physicians can substitute a generic drug or recommend a similar treatment that achieves the same outcome at a lower price. And when no direct generic exists, there may be therapeutic alternatives worth considering. For example, if a brand-name eye drop or inhaler isn’t available in generic form, doctors can often prescribe a different medication in the same class that works just as well but costs far less. Research on physician–patient cost conversations shows that switching to lower-cost, clinically similar alternatives within the same drug class is a common strategy for reducing out-of-pocket spending without compromising care.
Is there any financial assistance available?
Some hospitals and large health systems have specific programs aimed at making care more affordable for lower-income patients. In many states, government programs address this same goal. These programs often offer discounts on care, but they can be complex to navigate and require significant paperwork. Many health care offices have staff who are knowledgeable about these programs and can help patients determine eligibility and sometimes even assist with applications, although the Trump administration has cut funding.
Patients can often find these programs through hospital or health system websites, which typically include financial assistance or “charity care” pages outlining eligibility and how to apply. State Medicaid offices and insurance marketplaces are also key entry points for coverage and subsidy programs. Nonprofit organizations and patient advocacy groups may also offer or list assistance tailored to specific conditions or medications.
It’s also important to remember that for prescription medications, what you’re quoted isn’t always the final price. Many medications come with options to reduce costs, including manufacturer coupons, copay assistance programs and patient assistance programs. Doctors’ offices and pharmacists may also know practical ways to save money, such as using a different pharmacy, switching to mail order or adjusting how a prescription is written. Asking about these options can uncover savings that aren’t immediately obvious.
What will this cost me, and are there other options?
Health care pricing is often opaque, and costs can vary widely depending on where and how care is delivered. Asking up front about your expected out-of-pocket cost can help you avoid surprises later.
This question also opens the door to alternatives. For example, patients may be able to choose a lower-cost imaging center, opt for outpatient rather than hospital-based care, or delay nonurgent services until insurance coverage improves.
Speaking up is part of taking care of your health
Health care decisions shouldn’t feel like a choice between your well-being and your wallet. A brief, honest conversation about cost can lead to more affordable and more sustainable care.
Physicians can’t address financial concerns they don’t hear about, and most want to help their patients access care they can realistically follow through on. As costs continue to shift toward the patient’s burden, asking these questions isn’t just helpful – it’s essential.
The next time you’re handed a prescription or a referral, remember: One simple question about price could make all the difference.
Most people know only two things about the appendix: You don’t need it – and if it bursts, you need surgery fast.
That basic story traces back at least to Charles Darwin, the English naturalist who developed the theory of natural selection. In “The Descent of Man,” he described the appendix as a vestige: a leftover from plant-eating ancestors with larger digestive organs. For more than a century, that interpretation shaped both textbook and casual medical wisdom.
But the evolutionary story of the appendix turns out to be much more complicated.
Along with our colleague Helene M. Hartman, a student preparing for a career in health care, we combined our expertise in behavioral ecology, biology and history to review the scientific literature on the appendix, expecting a simple answer.
Instead, we found an organ that evolution kept reinventing, more interesting than most people imagine.
How did the appendix evolve?
The appendix is a small pouch branching off the first section of the large intestine. Its shape and structure vary widely across species – a clue that evolution may have tinkered with it more than once.
Some species, including certain primates such as humans and great apes, have a long, cylindrical appendix. In others, including several marsupials such as wombats and koalas, the appendix appears shorter or more funnel-shaped. Still others, including some rodents and rabbits, have differently proportioned or branching structures. This structural diversity suggests that evolution has modified the organ under different ecological conditions.
That suspicion is supported by evolutionary analyses. Comparative studies show that an appendix-like structure evolved independently in at least three distinct lineages of mammals – marsupials, primates and glires, a group that includes rodents and rabbits. A broader evolutionary survey found that the appendix evolved separately at least 32 times across 361 mammalian species.
When a trait evolves repeatedly and independently, biologists call this convergent evolution. Convergence does not mean a structure is indispensable. But it does suggest that, under certain environmental conditions, having that structure provided a consistent enough advantage for evolution to favor it again and again.
In other words, the appendix is unlikely to be a useless evolutionary accident.
What does the appendix do?
The appendix supports the immune system. It contains gut-associated lymphoid tissue – immune cells embedded in the intestinal wall that help monitor microbial activity in the gut. In early life, this tissue exposes developing immune cells to intestinal microbes, helping the body learn to distinguish between harmless symbionts and harmful pathogens.
The appendix is particularly rich in structures called lymphoid follicles during childhood and adolescence, when the immune system is still maturing. These immune components participate in mucosal immunity, which helps regulate microbial populations along the intestinal lining and other mucosal surfaces. Lymphoid follicles produce antibodies, such as immunoglobulin A, to neutralize pathogens.
These hypotheses motivated a question our team explored: If the appendix helps preserve microbial stability, could removing it subtly affect reproductive fitness?
Older clinical concerns suggested that appendicitis or appendectomy might impair fertility by causing inflammation and scarring – known as tubal adhesions – in the fallopian tubes. Such scarring could physically obstruct the egg’s passage to the uterus. But several large studies have since found no decrease in fertility after appendectomy – in some cases, researchers found a small increase in pregnancy rates.
The appendix appears to have multiple functions, including immune and microbial ones. Affecting fertility, however, does not seem to be one of them.
Evolutionary importance and modern life
While the appendix has an interesting past, with evolution continually reinventing it, its modern importance is modest at best. Darwin underestimated the organ’s history, but his instinct wasn’t far off in the medical present: Some parts of human biology mattered more in the environments people evolved in than in the lives they lead today.
Early humans lived in environments with little sanitation and strong social contact – perfect conditions for outbreaks of pathogens that cause diarrhea. An appendix that quickly restored the microbiome after infection could significantly improve survival. But over the past century, clean water, improved sanitation and antibiotics have sharply reduced deaths from diarrheal diseases in high-income countries.
As a result, the evolutionary pressures that once favored the appendix have largely disappeared. Meanwhile, the medical risks of keeping the appendix – most notably appendicitis – remain. Modern surgery typically treats an infected appendix by removing it. A structure that was once a global evolutionary advantage is now more of a medical liability.
This mismatch between past adaptations and present environments illustrates a core principle in evolutionary medicine: Evolution optimizes for survival and reproduction in ancestral environments, not for health, comfort or longevity in modern ones.
Evolution operates at the level of populations over generations, favoring traits that increase average reproductive success, even if those traits sometimes harm individuals. Medicine works the other way around – helping individuals thrive in the present world rather than survive the past one.
The appendix is not an IKEA spare part included “just in case,” but neither is it essential today. Human biology has many traits that were once beneficial, now marginal – and understanding them allows medicine to make better modern decisions.
Some doctors now believe you should be spending even LESS time in the shower than previously thought. Admittedly, I was already shocked when I found out a while back that the average shower should take only eight minutes. But upon reflection, it made sense. While hot showers can feel relaxing, we obviously need to be conscious of our resources, no matter where we live in the world.
But a recent piece by Pang-Chieh Ho called “You Could Be Showering Too Long,” published in Consumer Reports, claims that showers should really only be around five minutes, seven at the most. Just shaving off a couple of minutes can help tremendously with conservation. “For people in the U.S., the average shower lasts about 8 minutes, according to the Environmental Protection Agency. That’s 20 gallons for every average shower, given that the standard showerhead uses around 2.5 gallons of water per minute.”
Experts say your shower might be too long
A woman washing her hair in the shower. Photo credit: Canva
And it’s not just because of the environment. Our skin can dry out more quickly than some might think. Dermatologist Lisa Akintilo, MD, is cited as saying, “It’s true that long, hot showers may feel restorative, but they can dry and irritate the skin.”
An article in Time magazine, “How Much Do You Actually Need to Shower?” by Angela Haupt, reveals that some doctors say you can skip even the five-minute daily shower, though they admit, “there’s no one-size-fits-all equation.” Dermatologist at NYU Langone Health, Dr. Mary Stevenson, suggested, “Ideally, I think people should shower at least every other day. Most people, by day two or day three, are not clean. But it’s a little bit personal.” She later added, “In general, you really only need soap in your armpits, your groin, and your feet.”
“You probably don’t need to be in the shower as long as you are. You’re no cleaner—it’s just for your psychological health or for your routine.”
– Philadelphia dermatologist Dr. Jules Lipoff
Some people on Reddit disagree. In a thread called “On average, how long do you take to shower?” many admitted that long showers are a guilty pleasure. A few people answered 45 minutes to an hour. One even claimed they showered for “light years,” though someone quickly pointed out that “light year” was a measurement of distance, not time.
One noted that there are variables in play. “Depends on how many shower beers.”
Another measures the length of time in music. “Two Spotify songs,” they insisted.
People online still love their long showers
A bearded man singing in his shower with a microphone. Photo credit: Canva
One Reddit user got vulnerable about the mental benefits of a hot shower. “The mean and the median probably differ quite a lot for me. The vast majority of my showers do not exceed 20 minutes, but I’ve had some depression showers or anxiety showers or whatever you wanna call them where I stayed in for over an hour.” Another commenter put it less delicately: “Until I can no longer feel the pain of life.”
And lastly, this person didn’t mince words but mentioned the temperature variable. “If it’s a hot shower, no less than 30 minutes. If it’s a cold shower, I scrubba dubba the F out of there in less than three.”
This article originally appeared two years ago. It has been updated.
