Month: November 2020
The company is now seeking Food and Drug Administration approval.
With the already staggering coronavirus case and death toll expected to climb further in the US following Thanksgiving, there’s at least more good news on the vaccine front. The biotech firm Moderna released the final results of its 30,000-person vaccine trial in a press release Monday, reporting a 94.1 percent rate of efficacy. The finding squares with the 94.5 percent efficacy rate the company reported two weeks ago, based on its first interim analysis of trial data.
Of the 196 Covid-19 cases in the trial, 185 were in the placebo group and only 11 in the vaccine group, Moderna reported.
Even more important, the vaccine — called mRNA-1273 — appears to protect against severe disease, not just asymptomatic or mild cases. Of the 30 severe Covid-19 cases among trial participants, all occurred in the placebo group. If the finding is real, it would likely mean averted deaths and hospitalizations when millions of people are immunized.
“You’ve got 100 percent protection against severe disease,” Paul Offit, an infectious disease and vaccine researcher at Children’s Hospital of Philadelphia, told Vox. “That’s remarkable.”
Back in September, we wrote about the need to show severe #COVID19 cases were prevented by a vaccinehttps://t.co/f5jvcdTCx2
Today we know that. Of @moderna_tx final efficacy all 30 severe cases were in the placebo group. pic.twitter.com/Pl1910I5nT
— Eric Topol (@EricTopol) November 30, 2020
“If these numbers are right, it’s more than we’d need for the vaccine to be a major control measure for this outbreak,” said Eric Rubin, an infectious disease specialist and the editor-in-chief of the New England Journal of Medicine.
Moderna’s CEO, Stéphane Bancel, said in the press release that the company plans to request an Emergency Use Authorization from the Food and Drug Administration, which would allow the vaccine to be used in limited cases for people facing some of the highest risk of exposure to Covid-19, like health care workers. “We believe that our vaccine will provide a new and powerful tool that may change the course of this pandemic and help prevent severe disease, hospitalizations and death,” he added.
Trial has accrued 196 events
185 in placebo, 11 in vaccine = 94.1% efficacy
30 severe cases in placebo, 0 in vaccine =
No severe adverse events
Application for EUA today, FDA advisory group meets 12/17
Expect authorization after
— Ashish K. Jha, MD, MPH (@ashishkjha) November 30, 2020
Given that the Pfizer/BioNTech and AstraZeneca/Oxford coronavirus vaccine research groups have also put out promising findings recently, this latest announcement of final data from the Moderna trial reaffirms that the world will likely have several highly effective vaccines for Covid-19 — and the end of the pandemic may be on the horizon. High efficacy also means that fewer people would need to be vaccinated in order to achieve herd immunity, the threshold at which the virus can no longer spread easily from person to person.
But, as always, there are caveats. In this case, the vaccine requires two doses, there are some side effects, and we don’t yet have details about how the vaccine worked in high-risk groups. And while demonstrating efficacy is important, the road to getting millions of people vaccinated will be fraught with logistical challenges. A lot of difficult work on a Covid-19 vaccine still lies ahead.
How Moderna showed that its Covid-19 vaccine works
Moderna’s announcement of 94.1 percent efficacy is based on a phase 3 clinical trial. In particular, the results are from the COVE study, conducted in collaboration with the US government’s National Institute of Allergy and Infectious Diseases (NIAID) and the Biomedical Advanced Research and Development Authority (BARDA).
Phase 3 is where the vaccine is tested against the virus spreading in the real world. Since experimenters can’t deliberately infect people, they have to wait and see who gets sick with Covid-19 in their volunteer pool, comparing the group that received the actual vaccine to the group that received the placebo. Moderna’s vaccine is administered as two doses.
To speed up the process, researchers recruit thousands of volunteers so that the rate of accumulating infections goes up. But it only takes a handful of infections to demonstrate that the vaccine works.
If a vaccine doesn’t work, and half the people in the trial get the vaccine and the other half get the placebo, we’d expect coronavirus cases to be evenly split in the two groups, Natalie Dean, an assistant professor of biostatistics at the University of Florida, told Vox. But when a vaccine is effective, we get results like the ones Moderna is reporting.
According to the biotech firm, experimenters detected 11 cases in people who received two doses of the vaccine compared to 185 in the placebo group. This shows that the virus was spreading among volunteers in the clinical trial but was drastically lower among those who received Moderna’s vaccine. “When we think about the level of evidence, this is a strong result,” Dean said.
There are some caveats to Moderna’s Covid-19 vaccine results
Moderna’s latest results were announced in a press release, and came directly from the company. While there have been several peer-reviewed interim studies about its vaccine, Monday’s announcement of final results didn’t arrive with any published data — just like the November 16 announcement of interim results.
Caution: this is a press release not a scientific paper. Looking forward to more detailed efficacy and safety data e.g. https://t.co/DQctLPM0li
— Saad B. Omer (@SaadOmer3) November 16, 2020
That doesn’t mean the findings are wrong, but they lack critical details and nuances we need to interpret them — like how well the vaccine works if people get only one dose (not an unlikely scenario in the real world) and how effective it is in high-risk groups.
We don’t know anything on the former, and on the latter, Moderna has only reported that “efficacy was consistent across age, race and ethnicity, and gender demographics.” While the company provided numbers for how many trial participants were over 65 and from various ethnic communities, the company didn’t say how the vaccine performed in each of these subgroups. That information is critical, since these are the people who’ve been hardest hit by the virus.
We also don’t yet know how long people who got the vaccine remain protected from the virus, Dean pointed out. There are also the side effects to consider. Moderna has reported no serious safety issues to date and said that most problems tended to be mild to moderate — but up to 10 percent of participants experienced severe side effects, according to an earlier press release. These included fatigue (9.7 percent), muscle pain (8.9 percent), joint pain (5.2 percent), headache (4.5 percent), other pain (4.1 percent), and redness at the injection site (2 percent).
Since the vaccines will ultimately have to be distributed to millions, if not billions, of people, it’s important to pay attention to side effects. Rare complications will be more likely to show up once lots of people get the shot. And clinical trials of other Covid-19 vaccine candidates — like the Johnson & Johnson vaccine or the University of Oxford and AstraZeneca vaccine — have already been paused due to complications among recipients.
What happens next for a Covid-19 vaccine
If the Moderna vaccine receives emergency approval in the US, distribution could begin in December. Bancel, the Moderna CEO, told Science that the company plans to charge $32 to $37 per dose of the vaccine in developed countries. But while the company says it will have 20 million doses ready by the end of 2020 for the US market, distributing the vaccine will be challenging.
Moderna’s vaccine requires long-term storage at minus 20 degrees Celsius (minus 4 degrees Fahrenheit) and is stable for 30 days between 2 and 8 degrees Celsius (36 degrees to 46 degrees Fahrenheit). That’s well within the temperature range of conventional refrigerators and warmer than the temperature requirements of the Pfizer/BioNTech shot, but it may still pose a logistical hurdle in some lower-resource settings, like rural hospitals, that lack certain kinds of cold storage facilities.
Moderna’s is also a two-dose vaccine, which means every recipient needs to come back for a second injection to get that high rate of efficacy. We know from other multi-dose vaccines that not everybody will return for that second shot — and the efficacy profile may look different. “When you do an experiment, it’s done under best conditions,” Offit said. “When things roll out in the real world, in real-world conditions, there’s a fraying.”
It’s also important to remember that an effective vaccine is not enough to end the pandemic quickly. Measures like social distancing, practicing good hygiene, and wearing face masks will remain essential to control the spread of Covid-19 until a vaccine is widely available. Public acceptance may also be an issue, and health officials will have to overcome a rising wave of vaccine hesitancy.
Vaccine research also doesn’t end once a vaccine is rolled out. Public health officials, doctors, and the biotech companies will still have to track complications across millions of people and pay attention to how quickly immunity wanes.
So far, we have two months of safety data after the second dose, and while that’s not long-term, it should build confidence, Offit said. “Serious side effects usually shot up within six weeks of the second dose. 260,000 people have died this year in the US [of Covid-19]. It would be great if we could do a three- to four-year study and look at length of efficacy and the duration of efficacy. But the question isn’t when do you know everything here — it’s when do you know enough.”
If I could get policymakers, and citizens, everywhere to read just one book this year, it would be Kim Stanley Robinson’s The Ministry for the Future.
Best known for the Mars trilogy, Robinson is one of the greatest living science fiction writers. And in recent years, he’s become the greatest writer of what people now call cli-fi — climate fiction. The name is a bit of a misnomer: Climate fiction is less fictitious speculation than an attempt to envision a near future that we are likely to inhabit. It’s an attempt to take our present — and thus the future we’re ensuring — more seriously than we do. Robinson’s new book does exactly that.
In The Ministry for the Future, Robinson imagines a world wracked by climate catastrophe. Some nations begin unilateral geoengineering. Eco-violence arises as people begin to experience unchecked climate change as an act of war against them, and they respond in kind, using new technologies to hunt those they blame. Capitalism ruptures, changes, and is remade. Nations, and the relations between them, transform. Ultimately, humanity is successful, but it is a terrifying success — a success that involves making the kinds of choices that none of us want to even think about making.
This conversation with Robinson was fantastic. We discuss why the end of the world is easier to imagine than the end of capitalism; how changes to the biosphere will force humanity to rethink capitalism, borders, terrorism, and currency; the influence of eco-Marxism on Robinson’s thinking; how existing power relationships define the boundaries of what is considered violence; why science fiction as a discipline is particularly suited to grapple with climate change; what a complete rethinking of the global economic system could look like; why Robinson thinks geoengineering needs to be on the table; the vastly underrated importance of the Paris climate agreement, and much more.
Alice Is Missing takes the tabletop RPG to new, incredibly moving places.
One Good Thing is Vox’s recommendations series. In each edition, we’ll tell you about something from the world of culture that we think you should check out.
The world of tabletop role-playing games is traditionally dominated by in-person experiences. A group of players, often a group of friends, gathers around a table to tell a story together by following very loose rules and rolling dice to determine the outcomes of important events. During each turn, players build off ideas introduced by other players, and the whole experience ends up being a weird combination of game and improvised storytelling. At its best, it’s sublime.
RPGs can be played over digital platforms, too. And in an era of pandemic-driven quarantines, digital platforms are the only way for many people to play these games (unless you live with your entire gaming group). But something is lost in the transition to playing an RPG over Zoom or Roll20, an online platform that facilitates groups playing together via a virtual tabletop and dice rolls. There’s a physicality to RPGs, an electric sense in the air as everyone watches the dice roll and hopes for the best.
Alice Is Missing, one of the best and most unique RPGs I’ve ever tried out, overcomes that digital divide by leaning into it. It’s a game played entirely via text message, which means it can literally be played with a group scattered all over the world with the help of your trusty phone. Three to five players take on the roles of characters who are looking into the disappearance of Alice, a girl from their small town; over roughly two hours of gameplay (about 15 minutes for setup, exactly 90 minutes for the game itself, and about 15 minutes for post-game discussion), they text the clues that they’ve found back and forth in the hope of solving the mystery.
Alice Is Missing is so immersive, it actually asks you to change the contact names in your phone from those of your real friends to the characters they’re playing for the duration of the play session. It even has a 90-minute playlist — full of officially licensed music! — that provides you with an appropriately haunting, angsty soundtrack.
If the story of a missing girl in a tiny town sounds a little like Twin Peaks, that’s not an accident. Alice Is Missing is heavily situated in the “mysteries in a small town” genre. And if you really want to push the game into the supernatural somehow, you probably can. But Alice Is Missing is best, I’ve found, when you keep it rooted in the everyday sorrows of the lives of its teenage characters, who are stuck in a dead-end town and have now lost one of their friends.
Alice Is Missing has a number of elements that would suggest it lacks the free-form quality that makes other RPGs so infinitely replayable, where the specifics of the story being told change based on the players gathered around the table. There is always a set group of characters, and there are always highly specific motives sketched out on cards you draw at the game’s start.
But characters and motives are separate cards. And most importantly, while you choose your character, your motive is randomly dealt to you. So your character — Alice’s older brother or secret girlfriend, for example — doesn’t always have the same motive. In one game, the girlfriend’s motive might be to ask as many questions as possible; in another it might be to defend Alice unconditionally from any untoward suggestions made about her. At the start of play, each player also records the last voicemail they left for Alice, in secret; those voicemails are all played back at the end of the game, after Alice’s fate has been revealed.
The identity and characteristics of Alice herself change based on a series of “missing person posters” (printed out ahead of time) showing different versions of a girl named Alice Briarwood, as well as questions the characters answer throughout the game. These questions are all open-ended enough to allow for a variety of interpretations.
I don’t know that Alice Is Missing is infinitely replayable, but I’ve played three times now, and each time the handful of discrete elements have combined in new ways to create very different games. And because all of the details are established via drawing either physical or virtual cards (including cards that introduce new suspects and locations), players don’t need any special RPG knowledge to play.
Alice Is Missing will likely be the most fun if you play with someone who is either familiar with it or with RPGs more generally, as they can explain everything to newer players. But the instructions are straightforward, and even if you’ve never played an RPG before, a few minutes with the extremely well-written instruction booklet should make everything clear.
The single biggest reason to recommend Alice Is Missing is the text-message element. Even in person, it is a completely silent game by design. It’s meant to create the feeling of a tight-knit group of friends hoping to help each other through a crisis by doing something (anything!) to gain some control over tragedy, and at that, it succeeds. I am loath to spoil the events of this game, even in the abstract, but I have been deeply moved by the time I have spent playing it.
Alice Is Missing is the work of Spenser Starke, one of the most innovative RPG designers working right now. His earlier game Icarus — which simulates the fall of a great civilization via building a tall tower of bricks stacked higher and higher until they all collapse — is a similarly brazen reworking of RPG assumptions (though it really has to be played in person). Starke’s games focus less on rules and more on creating experiences during which powerful stories can be told. Alice Is Missing touches on any number of dark or complicated themes across the course of play, but unlike some other games, it never feels exploitative, thanks to Starke’s thoughtful and sensitive design.
It is all too often very, very hard for role-playing games to capture the feeling of life as it’s really lived, rather than as some fantasy adventure. But Alice Is Missing manages this feat with aplomb. It’s about the feeling of being a teenager longing for something more, while fearing something more will never come. And it’s about the unique grief of (and for) the young, who will never know everything they missed.
Rural America on film, from Appalachia to the Ozarks, coal miners to sharecroppers.
Let’s not mince words: Netflix’s new Oscar-bait Hillbilly Elegy is not the ode to vanishing rural American life it seems to want to be. In the name of presenting an empathetic view of the Appalachian community where it’s set, Ron Howard’s film, based on the bestselling memoir by lawyer J.D. Vance, dredges up a litany of cringe-y tropes and stereotypes about poverty, drug use, classism, and fading small-town America. Outside of a few pointed shots of bricked-up buildings and storefronts with peeling paint, the film has remarkably little to say about either the hillbilly life of its title or hillbillies themselves and their struggle to survive.
What’s odd is that it’s not like there’s a shortage of films that Howard and his production team could have cribbed. There are so many better films that tackle the subject matter of rural American identity that we felt compelled to round them up for anyone who wants cinematic insight into hillbillies, rednecks, and rural life generally. (And no, Deliverance is not one of them.)
Below we present 11 films, a mix of dramas and documentaries, that are far better elegies for the rural Americans they depict than the one currently getting all the buzz.
First Language: The Race to Save Cherokee (2014)
This short documentary film tells the story of a dwindling community of Native Americans in mountainous North Carolina as they fight to keep knowledge of the Cherokee language alive and thriving. Featuring both Cherokee and English subtitles, the film uses the fight to teach the Cherokee language as a gateway to discussing the many larger challenges and grim realities of indigenous life in the US.
Most stories about Native Americans inevitably focus on reservation life in the West. It’s rare to get such a frank look at the communities who remain in the South, especially Appalachia. With its lovely lingering shots of the Carolina blue hills juxtaposed against glimpses of contemporary modern Cherokee life, First Language is not only a revealing portrait of Smoky Mountain culture, but it’s also a reminder that forced assimilation always comes at a cost — in this case, one still being felt centuries later.
Where to watch: YouTube
RaMell Ross’s tremendous, Oscar-nominated film Hale County might best be thought of as a tone poem rather than a traditional documentary. Through assembled footage of a rural Alabama county and stunning cinematography, Ross provides a close read of everyday Black life powerful enough to rival anything since Charles Burnett’s Killer of Sheep. The result: a film that transforms the mundanity of normal American life into a beautiful, Tarkovsky-esque epic.
It’s incredibly rare to find any film about Black communities in rural America that’s not using racism as the central conflict. (Consider: Mississippi Burning, Beloved, The Color Purple, and a film chosen for this list, Mudbound.) The weight of racial injustice does loom large over Hale County, but its primary work is to poeticize its subjects rather than frame them as victims. Through Ross’s delicate, soft lens, it’s kept at bay, at least for a while — much like the oncoming thunderstorm that serves as the film’s evening backdrop.
Harlan County, USA (1976)
The 1976 Oscar winner for Best Documentary, Harlan County, USA, documents the tense strike of unionized Eastern Kentucky miners to win higher wages in the face of institutional corruption, violent intimidation, and even murder.
Documentarian Barbara Kopple became far more than an observant bystander on the production, often using her camera crew’s presence to quell intimidation tactics against the striking miners. Even so, the reality of life in the mining community and anti-union violence as she captures it on film is eye-opening and utterly engrossing. In the middle of a heated union meeting, one woman pulls a gun out of her cleavage and gleefully waves it around. “I ain’t here for a man, I’m here for a contract!” another union woman declares. She’s later voted president of the association. Rock on.
Where to watch: YouTube
Hell or High Water (2016)
Gritty and infused with desperation, Hell or High Water is a modern heist Western that churns around a broader, relatable economic anxiety. It’s a post-recession No Country For Young Men, fueled by the housing crisis, fading towns, and the internal conflict between a Texan’s DIY wherewithal and an economic system that’s failed to protect him.
It’s kind of astonishing that Scottish filmmaker David McKenzie hopped across the pond to deliver this sensitive, sumptuous look at two brothers whose determination to save the family from destitution drives them to embark on a modern-day bank-robbing spree. Hell or High Water could have easily been cliched and over the top, but its solid cast, deep reliance on setting, and well-worn sense of place save it, muting its melodramatics and turning it instead into a meditation on the thwarted hopes and dreams of the American heartland.
The Last Picture Show (1971)
Peter Bogdanovich’s 1971 film about a dying southwestern town is a beautiful, devastating masterpiece — a film ostensibly about slow rural decay and the boredom of small-town life that seethes with tension and repressed emotion. Set in a fading Texas hamlet just before the Korean War, the film follows a group of high schoolers — including real-life siblings Timothy and Sam Bottoms — as they teeter between adolescence and adulthood, each getting a taste of sex, love, and disappointment as the war looms over them all.
The Last Picture Show is probably most famous for Bogdanovich’s decision to film in black and white in order to capture the feeling of a bygone era. But also memorable is its all-star ensemble cast, which includes a young Jeff Bridges, unforgettable turns from Ellen Burstyn and Eileen Brennan, Oscar-winning performances from Ben Johnson and Cloris Leachman, and a head-turning screen debut from a teenage Cybill Shepard. Its characters feel like transplants from a Tennessee Williams play that have grown too worn out from dust and despair to perform their typical dramatic Tennessee Williams bullshit. Instead, the film suggests that its epic conflicts have all been forgotten, repressed, and laid aside as its community focuses on just getting by. Never you mind, never you mind.
Mudbound, Dee Rees’s stunning look at the legacy of sharecropping and racial tensions in 1940s Mississippi, garnered Netflix four Oscar nominations, including a groundbreaking nod for cinematographer Rachel Morrison. Though it’s packed with historic detail, its story of neighboring families struggling to make peace and survive off the land could almost take place at any time during the last 200 years: Neither the land nor the turbulent racial tensions that divide Mudbound’s poor farmers are any easier to master today than they were in the post-war-era South.
Mudbound eschews the lush hills of the Ozarks or Appalachia for the flat, fertile, but unforgiving Mississippi Delta. Part of what makes this film so good is how tactile it is: The emphasis on all that mud doubles as an obvious metaphor for the drudgery and impossible cycle of poverty that besieges rural America, but it’s also an equally trenchant metaphor for plain old world-weary exhaustion; this is a film that looks and feels heavy. That Mudbound somehow manages to turn that feeling into something kinetic rather than boring is a testament to Rees’s astonishing direction, its superb ensemble cast, and a fantastic screenplay from Rees and Virgil Williams.
Where to watch: Netflix
O Brother, Where Art Thou? (2000)
The Coens’ marvelous tribute to the Depression-era South and old-timey folk culture is one movie I can’t be objective about. I grew up as a rural Southerner in a community still steeped in the legacy of the ’30 and ’40s, and no other film has ever captured that sensibility for me as vividly as this retelling of Homer’s The Odyssey. We follow escaped convict George Clooney and his two sidekicks (John Turturro and Tim Blake-Nelson, both sublime) across a daguerreotype-toned landscape of folk symbols. His goal? Make his way back to his wife and kids before she remarries — and, incidentally, before one of the historic floodings overseen by the Tennessee Valley Authority.
This film was completely overshadowed by its tremendously successful, critically acclaimed soundtrack, which was ubiquitous in my bluegrass town (and everywhere else) for about a year after its release. Easily one of the best compilation soundtracks ever assembled, it’s a must-hear, and a cultural journey in its own right — but don’t sleep on the movie itself. What a delight.
October Sky (1999)
Another film based on the true memoir of a small-town Appalachian boy who made good, October Sky adapts NASA engineer Homer Hickam’s life, with wide-eyed Jake Gyllenhaal playing the rocket-obsessed son of a coal miner. Like other biopics in its vein — Coal Miner’s Daughter comes to mind — October Sky runs on optimism in the face of hardship. But it also counters its up-by-your-bootstraps mantra with the reminder that life in the coal mines is often hopeless, with regional poverty leading to a generational cycle that forces many people to follow in their parents’ footsteps and become miners themselves.
In the face of that bleak reality, Hickam’s unrelenting positivity is almost daffy. But Gyllenhaal, for whom this was a breakout role, sells this unlikely success story by lacing his performance with sheer desperation — a grim determination to escape being trapped between a mountain and a hard place.
Yet another historical Appalachian folk tale, Songcatcher is loosely based on the real-life work of folklorists and linguists — not something you hear every day as the basis for a plot. Janet McTeer’s fictional linguistic anthropologist, a proper Edwardian Englishwoman, arrives in the backwoods of North Carolina to study the unique regional folk dialects, only to find herself a stranger in a strange land, far out of her depth.
Though the storyline is sometimes cheesy, Songcatcher benefits from having a singular and compelling subject, as well as from a unique and often thrilling soundtrack. The ensemble cast features performances from actual folk singers, like Iris Dement, whose hypnotic twang must be heard to be believed. Songcatcher is worth watching just to hear Dement’s rich voice encapsulate a nation‘s worth of hope and despair.
Where the Red Fern Grows (1974)
This film about a boy and his two prized coon hounds growing up in the Ozarks will never be on any best-of lists unless they involve movies about dogs. But you’d be hard-pressed to find a more influential film for a certain subset of conservative, rural America.
For a good period of my life growing up, I was subjected to Where The Red Fern Grows multiple times a week: at pre-school, at church, at grade school. Something about its mix of folksy Americana and nostalgia for a bygone vision of wilderness conquest, its overtly Christian themes, and cute dogs made this 1974 film (not to be confused with its 2003 remake or its odd 1992 sequel) a go-to form of indoctrination for countless ’80s and ’90s children across the region.
The fact that it’s also a notoriously sad film may have even made it more bitterly endearing. This is, perhaps, a film that embodied a familiar cycle: one of rural American dreams set alight, then smothered, only to smolder again thanks to a heady cocktail of faith, resilience, and ideology.
Where to watch: YouTube
Winter’s Bone (2008)
Before Ozark put the idea of “Ozark noir” into our heads, Debra Granik’s 2008 film Winter’s Bone did it first. It’s still the best version of it, too. It’s a bleak, beautiful, terrifying film that drew a Best Picture Oscar nod and launched its star Jennifer Lawrence’s entire career.
Winter’s Bone tells the story of a determined 17-year-old named Ree who embarks on the darkest hero’s quest: She has to find her missing father in order to keep her family’s house and keep her family together. To do that, she must navigate a world of drug lords and secrets and somehow uncover the truth without winding up dead herself. And she has to manage it almost entirely alone.
The general public mainly knows Lawrence through her goofy celeb persona and later career choices, but in Winter’s Bone, she turns in a performance that’s just about perfect. Co-star John Hawkes also got an Oscar nomination for playing her decrepit but well-meaning uncle, the only adult who has Ree’s back, to whatever degree he can. Filmed in the poverty-ridden Ozark community where it’s set, the landscape we see in Winter’s Bone is squalid but refreshingly authentic. Granik’s camera frames it unrelentingly and without judgment, allowing us to confront Ree’s everyday reality, and inevitably to see the humanity of everyone who endures it. As a statement on rural American life, it’s unique, unforgettable, and deeply empathetic.