Hi everyone,
There is a strange exhaustion in the modern wellness world that people rarely name out loud. Not the exhaustion of being sick, although that is everywhere. A different kind. The exhaustion of doing everything.
People are wearing devices, tracking metrics, stacking supplements, chasing protocols, rotating red light, cold, breathwork, peptides, adaptogens, nootropics. They have routines that look disciplined from the outside. Yet many feel the same underlying instability they started with. Sleep still fractures. Energy still collapses at the wrong time. Focus comes and goes like a weather pattern. The body feels “on edge” even when life is not. And the most haunting part is this: after a while, you stop believing your effort is connected to an outcome.
That disconnect is not a motivation problem. It is not a willpower problem. It is a visibility problem. And it sits on top of a deeper betrayal.
We already solved the core riddle of stress physiology in the twentieth century. We validated it, published it, quantified it, even reversed disease in ways that should have reorganized medicine. Then we quietly domesticated it into something safe. We turned a primary operating principle into an optional lifestyle accessory.
To see how that happened, you have to look at what was discovered, what it threatened, and what never crossed the legitimacy threshold.
The story you were told about stress is too small
Most people still hear “stress” and picture a feeling. Anxiety. Pressure. A mental state. A personality trait. Something soft.
But the scientific lineage that matters never treated stress as soft. It treated stress as physiology. As the continuous regulatory posture of the autonomic nervous system, the endocrine system, and the immune system in real time. Not a mood, but a control system. Not a symptom, but a master pattern.
When Herbert Benson described the relaxation response, he was not selling calm. He was describing a reproducible shift in autonomic function, a coordinated state change that could be trained and evoked, with measurable effects on heart rate, breathing, metabolism, and blood pressure.
When Bruce McEwen and Eliot Stellar framed allostatic load, they were not writing poetry. They were describing the biological wear and tear that accumulates when the body repeatedly activates stress response systems and cannot shut them off cleanly. That concept explicitly links chronic stress physiology to multi system disease patterns.
When Jon Kabat Zinn created mindfulness based stress reduction in 1979, he did something deceptively radical. He operationalized attention as a trainable intervention inside a medical center, not a monastery, and built a standardized program around it. The evidence base that followed was large enough that by the early 2000s meta analyses were already showing meaningful effects across a range of outcomes, even if the literature had limitations.
When Dean Ornish demonstrated regression of coronary atherosclerosis with intensive lifestyle change, he crossed a line modern medicine pretends does not exist. He showed reversal without lipid lowering drugs in that study design, and he sustained outcomes in long term follow up.
And when Kevin Tracey articulated the inflammatory reflex, he formalized something that should have ended the debate about whether regulation is “real medicine.” He showed the nervous system can reflexively regulate immune inflammation, and that this circuit can be targeted.
This was not fringe. This was a coherent upstream model forming in public.
So why did it not become the organizing layer?
Because truth does not win. Infrastructure wins.
A health system does not adopt what is true. It adopts what it can encode.
To become infrastructure, an idea has to do three things at once.
It needs measurement that is continuous enough to create accountability, not just inspiration.
It needs agency that is feasible for real people, not just ideal patients.
And it needs translation into power structures, meaning coding, reimbursement, credentialing, institutional legitimacy, and standard pathways.
This lineage never solved those three simultaneously.
Instead, it got trapped in a cultural holding pen.
The relaxation response became stress management.
Mindfulness became self care.
Ornish became a program.
Heart coherence became a wellness feature.
Vagal tone became a social media phrase.
None of that is inherently wrong. But it is structurally neutering.
Because once something is framed as optional, it stops being medicine. It becomes a suggestion.
Ornish proves the point by being the exception that stayed contained
There is a detail most people miss, and it matters.
Ornish did achieve a form of institutional translation. Medicare created a distinct benefit for intensive cardiac rehabilitation starting in 2010. CMS approved Dr. Ornish’s Program for Reversing Heart Disease as an intensive cardiac rehabilitation program effective August 12, 2010.
Read that again. A lifestyle based program crossed into reimbursement.
And yet, the world did not reorganize around autonomic regulation.
Why? Because it was allowed in one narrow lane that did not threaten the rest of the structure. Cardiac rehab is downstream. It is a defined episode. A bounded pathway. A place where lifestyle can be tolerated because it is framed as recovery after the real medicine has already happened.
Even the same CMS intensive cardiac rehabilitation list shows how rare this is: a small set of approved programs, including Pritikin and a Benson Henry Institute cardiac wellness program.
The system did not reject the model. It contained it.
That containment is the pattern.
Mindfulness did not fail scientifically. It failed politically.
If you want to understand why autonomic regulation never became an organizing principle, look at how mindfulness has struggled to become reimbursable as itself.
Even when an intervention has decades of research, payers still ask: what is it, exactly, in medical terms? Who delivers it? Under what license? What code? What outcomes? And perhaps most importantly, how do we ensure compliance?
A 2024 consensus oriented study on barriers to insurance coverage for MBSR identified a blunt obstacle: it is often perceived as not being a medical treatment, and the time burden on participants is considered high.
That sentence contains the whole story.
When an intervention requires participation, the system does not know how to own it.
And when the system cannot own it, it cannot scale it.
Biofeedback is the quiet proof that “the mirror” was always the missing piece
This is where the tragedy becomes obvious.
We have had the idea of a mirror for decades. Biofeedback is literally the concept of giving people real time physiological signals so they can learn regulation.
Biofeedback has CPT codes. Medicare recognizes outpatient therapy biofeedback training and specifies how it should be billed.
So why did biofeedback not become a foundational layer of care?
Because even when a code exists, it does not automatically become culture. Reimbursement can be narrow. Training can be inconsistent. Delivery can be inconvenient. And without a larger narrative and system that makes the feedback personally meaningful, it becomes a niche modality instead of a universal mirror.
Biofeedback is like a telescope invented in a world that refuses to look at the sky.
Tracey is important because the system finally recognized regulation when it became a device
Now we reach the part that exposes everything.
Kevin Tracey’s work on the inflammatory reflex helped open the door for bioelectronic medicine, the idea that neural circuits can be targeted to modulate immune function.
But the real watershed is not the concept. It is what happened next.
In July 2025, the FDA approved the SetPoint System, an implantable neuroimmune modulation device, for adults with moderately to severely active rheumatoid arthritis who had an inadequate response, loss of response, or intolerance to certain advanced therapies. This is documented in the FDA PMA database.
The significance is not just medical. It is sociological.
Because the moment regulation is packaged as hardware, the system can see it.
A device has ownership. A procedure has billing. A label has authority. A controlled intervention has compliance built in.
So the system grants legitimacy to autonomic regulation, but in a form that is structurally aligned with how medicine already works.
This is the paradox: the mechanism is validated, but agency is still excluded.
And that is why the deeper autonomic model keeps resurfacing without landing.
The supplement industry did not escape reductionism. It perfected it.
At this point, it becomes impossible not to talk about supplements, because supplements are the purest expression of modern reductionism.
A supplement is a lever. A molecule. A pathway nudge. Sometimes useful, sometimes powerful, often overpromised, frequently taken without a feedback loop.
And the public has responded exactly as you would predict in a system without a mirror.
People build routines.
Not strategies. Routines.
The routine becomes identity. The stack becomes ideology. The act of doing becomes the substitute for seeing.
This is not a moral failure. It is an adaptation to an environment that offers endless choices but very little clarity.
More than half of US adults report using dietary supplements, and use increases with age. In 2017 to 2018, 57.6 percent of adults reported using any dietary supplement in the past 30 days, with nearly one quarter of adults 60 and over reporting taking four or more supplements.
Read that as a cultural signal: the population is already medicating itself with nutrition like inputs.
But without a mirror, the body becomes a black box. People cannot tell what is working. They can only tell what they are doing.
So the supplement world stalls into repetition.
New products. Same paradigm. Same before and after photos. Same vague promises. Same language. Same funnel.
And meanwhile, the actual upstream state that determines whether any intervention works, the autonomic posture, remains largely unmeasured, untrained, and unseen.
Wearables promised the mirror, then delivered a scoreboard
Wearables made a promise that felt like salvation: finally, data.
Heart rate, sleep stages, recovery scores, HRV, readiness. A dashboard for the body.
But most wearables did not deliver a true mirror. They delivered a scoreboard.
A mirror shows you your state in a way that changes behavior naturally, because it is obvious. A scoreboard gives you numbers without context, and invites obsession, comparison, and interpretive chaos.
HRV is a perfect example. HRV is widely used as a marker related to autonomic function, and the consumer market has embraced it. But the measurement and validity can vary across devices and contexts. Reviews of wearable HRV measurement emphasize variability in accuracy, especially depending on conditions and sensing technology.
This matters because people are trying to build their lives on signals that may not be stable enough to serve as a compass.
So instead of deepening agency, wearables often produce a new kind of helplessness: numbers you cannot change, or do not understand, or cannot trust.
And when people cannot trust the mirror, they abandon it or use it as entertainment.
The real reason stress never landed is that it demands systems level understanding, and understanding threatens the existing economy
Now we can say the quiet part cleanly.
A true autonomic model would collapse the silos that keep medicine profitable and legible.
It would blur the boundary between mental and physical, because the nervous system does not respect that boundary.
It would reduce drug primacy, because state change can alter physiology upstream of many symptoms.
It would weaken procedure dominance, because many procedures are downstream responses to chronic dysregulation.
It would expose iatrogenesis, because a lot of modern care stabilizes numbers while leaving regulation untouched.
Most destabilizing of all, it would shift the patient from consumer to participant.
That is not a small adjustment. That is a paradigm threat.
So the system allows autonomic language as long as it stays decorative.
Meditation can be allowed if it is self care. Breathwork can be allowed if it is wellness. Coherence can be allowed if it is performance optimization. Vagal tone can be allowed as a conversation.
But not as the organizing principle.
Because if regulation becomes the organizing principle, the system has to admit that the patient is not broken. The patient is dysregulated.
And dysregulation is not something you fix once. It is something you learn to see, train, and maintain.
That is not a pharmaceutical business model. It is an educational model.
What would have changed everything is simple, and it is still missing
Here is the line you cannot unsee once you see it.
Those early pioneers asked people to practice.
They did not give people a mirror.
Without a mirror, effort remains abstract. A person can meditate for three weeks and still feel uncertain whether anything has changed. They can take supplements for six months and have no idea if they are supporting resilience or simply feeding a routine. They can do breathwork and still crash at 3 pm and wonder if it matters.
A mirror would make the nervous system unavoidable.
Not by moralizing, but by making state visible.
It would show trajectory, not just snapshots.
It would show recovery capacity, not just symptom suppression.
It would reveal patterns the way a continuous glucose monitor reveals patterns. Not as advice, but as undeniable feedback.
And the moment you have that, the entire health economy changes.
Because people do not need motivation when they have visibility.
They need coherence between action and outcome.
Why this moment is different, and why this time it might finally land
The reason you are seeing a new wave of autonomic adjacent products is not because the concept is new. It is because the prerequisites are finally in place.
Sensors are cheap. Signal processing is real. AI can model patterns across time. People are more afraid of their own bodies than they were ten years ago. The social fabric is more frayed. Sleep is more broken. Attention is more fragmented. The demand for regulation is now existential, not aspirational.
And that is why the next step is not another supplement, another app, another red light panel, another generic HRV score.
The next step is to build a mirror that restores agency.
Not agency as a slogan, but agency as a lived experience. The experience of being able to see state, intervene, and watch trajectory shift.
When people can do that, they stop being consumers of wellness. They become operators of their own physiology.
And once someone becomes an operator, they cannot unsee the difference between reductionism and systems level reality.
That is the line we have been circling for forty years.
The science has been waiting.
The only question is whether we finally build the mirror that makes regulation impossible to ignore.
To your best health,