Hiccups are a weirdly distressing physical experience. In their normal version, they are benign and, given enough time and patience on the part of the sufferer, end by themselves. Yet there is something oddly unbearable about that brief eternity when you’ve just hiccuped and are waiting, powerlessly, for the next one to strike.

The search for a cure has, naturally enough in the age of the internet, resulted in a multitude of Reddit threads. Many claim a 100 percent, never-fails guarantee: putting a cold knife on the back of your tongue, saying pineapple, closing your eyes and gently pressing on your eyeballs, drinking water while holding down an ear. Specifically, your left ear.

Spoiler: None of these is a 100 percent, never-fails, guaranteed cure. As common and discomforting as experiencing hiccups is, remarkably little medical research has been done into the phenomenon—and even less into how to end a bout.

We might not know why we hiccup, but we have a rough sense of how hiccups happen. They involve a quick spasm of the diaphragm. The spasm causes both a sudden inhalation of air and the sudden closing of the glottis, which is the space between your vocal cords, causing the trademark “hic.” An unfortunate loop between the diaphragm itself, the phrenic nerve that controls it, and the vagus nerve—a long, wandering nerve that connects the brain to the chest, diaphragm, and other parts of the body—cause the diaphragm spasms to repeat. And repeat. And repeat.

For a long time, that was approximately humanity’s collective knowledge on the subject. Until the arrival of Ali Seifi.

Seifi is a sprightly, smiling neurointensivist at the University of Texas at San Antonio. He is also an inventor, an entrepreneur, and probably the world’s most cited hiccup expert. He is a font of excellent hiccup facts: “They can have different frequencies, but 10 times per minute is most common.” And also: “I don’t know how God created that, but most of the time they’re equally spaced.”

[Read: When evidence says no, but doctors say yes]

As a specialist in brain injuries, Seifi had often encountered patients who were suffering from post-surgery hiccups, a common pathology. But he was inspired to investigate the condition more deeply at the prompting of a stroke patient, who exasperatedly asked him, “You do heart transplants, but nothing for hiccups?”

Doctors often describe pressure in terms of centimeters of water pressure, although water needn’t be involved. Seifi found the exact threshold of pressure in the diagram required to stop a hiccup fit, which helped him understand existing remedies and work to develop a new one.

“All of the current home remedies have science behind them,” Seifi says, though perhaps not the one that involves saying pineapple. “All of them are valid! They came to the community just by trial and error.”

Seifi believes that each of the remedies ultimately works by generating the required pressure in the diaphragm—at least, sometimes. “They just don’t reach the threshold where they can stop that cycle all the time, so it’s hit-and-miss.” In 2015, Seifi set to work designing a physical tool to help with hiccups more reliably than the home remedies. He wanted to make something that could consistently generate 100 centimeters of water pressure in the diaphragm, which he deemed the effective threshold to stop hiccups in adults.

His solution was based on what physicists call Bernoulli’s Principle. “Imagine you have a water hose and you open the faucet,” Seifi says. “If you put half your thumb in front of the hose, the flow stays the same, but by changing the diameter the speed of the fluid changes; it ejects more.”

Seifi designed a special kind of straw that uses this principle in reverse. The bottom of the straw has a very small pinhole, while the drinking end has a fairly large one. To get any water through the straw, the user has to exert an unusually large amount of suction, which means generating pressure in the diaphragm. Seifi was able to calculate the required dimensions for the pinhole at the bottom, the opening at the top, and the length of the straw, such that getting water into the mouth required exerting exactly 100 centimeters of water pressure.

Seifi named his creation the HiccAway, and sold his first unit in 2020, priced at  $13.42. He launched a Kickstarter campaign that raised $60,649, and co-authored a research letter published in June 2021 in JAMA Network Open.

Seifi didn’t stop there. In January 2022, he appeared on Shark Tank. The pitch was a success; Mark Cuban declared his unshaking belief that, in the future, everybody’s medicine cabinet would have one, and put $250,000 into the company. So far, that seems to be a sound investment. The HiccAway has now grossed more than $1 million.

Yet Seifi’s straw is not the only hiccup cure. There is another reliable method, also backed by sound science, but it does not cost $13.42. In fact, it is as free as the air you breathe.

Luc Morris is a surgeon at the Memorial Sloan Kettering Cancer Center, specializing in tumors of the head and neck. Almost 20 years ago, when he was a medical student at NYU, he wrote a letter to the editor of a specialist medical journal in which he laid out a potential treatment for “idiopathic persistent singultus,” a.k.a. the hiccups. The name he gave to the new technique was “supra-supramaximal inspiration.”

SSMI, as the medical profession’s predilection for abbreviations has it, boils down to a simple breathing exercise. First, exhale completely, then inhale a deep breath. Wait 10 seconds, then—without exhaling—inhale a little more. Wait another five seconds, then top up the breath again. Finally, exhale. Generally, you will find that your singultus is gone.

With collaborators, Morris went on to conduct a study of 19 patients, 12 male and seven female, from the ages of 10 to 51, who “presented with hiccups ranging in duration from 20 min to 8h.” As they reported, in a second letter to the editor, this time in the Journal of Emergency Medicine, thanks to the SSMI technique, “an immediate and permanent termination to hiccups was achieved in 16 of the 19 patients (84%). Three patients were unable to tolerate the inspired volumes or the duration of breath holding.”

In other words, all of the people who were able to perform SSMI found that it stopped their hiccups. To this day, those two letters represent more or less the sum of medical research on SSMI. Hardly an exhaustive survey.

“We have a biologically plausible explanation about what it does to the diaphragm,” Morris told me, “but that’s based on pure speculation.” And yet, the SSMI technique is just a more sophisticated take on the old folk remedy that poses that the cure for hiccups is simply to hold your breath.

I purchased a HiccAway. As medical equipment goes, it was very reasonably priced. I can certainly see the appeal of a device that “enforces” the right behavior from the patient, rather than requiring her to follow some steps. Seifi mentioned to me that many happy customers are parents of young children; babies and infants commonly suffer from hiccups.

[Derek Thompson: Why America has so few doctors]

So the HiccAway has attractions that SSMI lacks. At the same time, SSMI has one obvious advantage: When hiccups hit, you don’t need to find your straw; you just have to remember a breathing exercise. Yet Harvard Health’s hiccups page was the only major health organization I could discover that even mentioned SSMI as a possibility. Other sites generally considered good sources of consumer health information—such as NHS Digital, the Mayo Clinic, and the Cleveland Clinic—mention numerous home remedies, but not SSMI.

I asked Morris why he never took his hiccup research further. “Why did we never do a clinical trial? Well, you know, we got busy,” he said. “But also, how would we do a clinical trial? Who would pay for it? There’s no drug we can sell. Nobody will invest the money and hire all the people and do all the regulatory paperwork, because there’s no money to be made.”

Our health-care system is not designed to promote free cures. Patent laws allow innovators to profit from the discoveries they make or inventions they create, but only if those discoveries or inventions can be packaged as a product that enables some form of commercial gatekeeping. SSMI has no such market potential: It can be described in a couple of sentences, and copyright doesn’t cover it.

It’s hard to suppress the feeling that the crucial difference between SSMI and HiccAway is that only one of them can be monetized. I don’t at all think Seifi is motivated primarily by profit; he seems rightly proud to help people avoid a major minor nuisance. And he worked exceptionally hard for years to make the HiccAway straw a success.

But with that same motivation, could someone have done the same for the breathing technique? Maybe, for all the challenges of building a successful company, publicizing valuable but free information is even harder.

Life is unfair, as a Democratic president once put it. That was John F. Kennedy, at a press conference early in his term.

Jimmy Carter did not go through as extreme a range of the blessings and cruelties of fate as did Kennedy and his family. But I think Carter’s long years in the public eye highlighted a theme of most lives, public and private: the tension between what we plan and what happens. Between the luck that people can make for themselves and the blind chance they cannot foresee or control.

In the decades of weekly Bible classes he led in his hometown of Plains, Georgia, Jimmy Carter must have covered Proverbs 19:21. One contemporary translation of that verse renders it as: “Man proposes, God disposes.”

Not everything in his life happened the way Jimmy Carter proposed or preferred. But he made the very most of the years that God and the fates granted him.

Americans generally know Jimmy Carter as the gray-haired retiree who came into the news when building houses or fighting diseases or monitoring elections, and whose political past became shorthand for the threadbare America of the 1970s. Most of today’s Americans had not been born by the time Carter left office in 1981. Only about one-fifth are old enough to have voted when he won and then lost the presidency. It is hard for Americans to imagine Jimmy Carter as young—almost as hard as it is to imagine John F. Kennedy as old.

But there are consistent accounts of Carter’s personality throughout his long life: as a Depression-era child in rural Georgia, as a hotshot Naval Academy graduate working in Hyman Rickover’s then-futuristic-seeming nuclear-powered submarine force, as a small businessman who entered politics but eventually was forced out of it, as the inventor of the modern post-presidency.

What these accounts all stress is that, old or young, powerful or diminished, Jimmy Carter has always been the same person. That is the message that comes through from Carter’s own prepresidential campaign autobiography, Why Not the Best?, and his many postpresidential books, of which the most charming and revealing is An Hour Before Daylight: Memories of a Rural Boyhood. It is a theme of Jonathan Alter’s insightful biography, His Very Best. It is what I learned in two and a half years of working directly with Carter as a speechwriter during the 1976 campaign and on the White House staff, and in my connections with the Carter diaspora since then.

Whatever his role, whatever the outside assessment of him, whether luck was running with him or against, Carter was the same. He was self-controlled and disciplined. He liked mordant, edgy humor. He was enormously intelligent—and aware of it—politically crafty, and deeply spiritual. And he was intelligent, crafty, and spiritual enough to recognize inevitable trade-offs between his ambitions and his ideals. People who knew him at one stage of his life would recognize him at another.

Jimmy Carter didn’t change. Luck and circumstances did.

Jimmy Carter made his luck, and benefited from luck, when he ran for president. He couldn’t have done it without his own discipline and commitment, and his strategy. He seemed to shake every hand in Iowa—but his team was also the first to recognize that the new Iowa caucus system opened the chance for an outsider to leap into the presidency. At a time when his national name recognition was 1 percent, he spent all day walking up to strangers and saying, “My name is Jimmy Carter, and I’m running for president.” Stop and imagine doing that yourself, even once. Carter was easier to admire—when delivering his stump speech to a rapt crowd, when introducing himself at a PTA meeting or in a diner—than he was to work for. But that is probably true of most public figures with such a drive to succeed.

Because he was so engaging in person, and made such a connection in countless small-group meetings across Iowa, he won the caucuses and went on to win the nomination and the presidency. No other candidate has gone from near-invisibility to the White House in so short a time. (Barack Obama became a Democratic Party star with his famous convention speech in 2004, four years before he won the presidency. Donald Trump had been a celebrity for decades.)

This is how Carter and his team helped themselves. Other developments they hadn’t planned affected the race—mainly to their benefit.

By early 1976, Carter had become the new thing. He embraced rock music and quoted Bob Dylan. He was as powerful and exciting a fusion of cultures as any candidate who came after him. He was a Naval Academy graduate and an Allman Brothers fan. He was deeply of the South and of the Church. He also spoke about Vietnam as a racist war. He quoted poems by Dylan Thomas. He was, yes, cool. He appeared at a Law Day meeting at the University of Georgia’s law school and upbraided the audience about the injustice of America’s legal system. Here’s just one sample of the speech, which would now be considered part of the Sanders-Warren platform:

I grew up as a landowner’s son. But I don’t think I ever realized the proper interrelationship between the landowner and those who worked on a farm until I heard Dylan’s record … ”Maggie’s Farm.”

It’s worth reading the whole thing.

But what if Hunter S. Thompson had not noticed this speech and announced that he “liked Jimmy Carter” in an influential article in Rolling Stone? What if Time and Newsweek, also very influential then, had not certified him as a serious potential leader with their coverage? What if the civil-rights figures Martin Luther King Sr. and Andrew Young had not endorsed Carter to Black audiences around the country, and reassured white liberals that he was the southern voice an inclusive America needed? (As governor of Georgia, Carter had placed a portrait of MLK Jr. in the state capitol.) What if Jerry Brown had not waited so long to enter the primaries? What if Teddy Kennedy had dared to run? What if Mo Udall had figured out the Iowa-caucus angle before Carter did? What if Scoop Jackson had not been so dull? Or George Wallace so extreme?

And for the general election, what if Gerald Ford had not pardoned Richard Nixon, turning Watergate into Ford’s own problem? (The Carter team knew that this was a campaign plus. But in the first sentence of his inaugural address, Carter thanked Ford for all he had done “to heal our land.”) What if Saturday Night Live, then in its first season and itself hugely influential, had not made Ford the butt of ongoing jokes? What if Ford had not blundered in a crucial presidential debate? What if Carter’s trademark lines on the stump—I’ll never lie to you and We need a government as good as its people—had not been so tuned to the battered spirit of that moment, and had been received with sneers rather than support?

What if, what if. There are a thousand more possibilities. In the end the race was very close. Luck ran his way.

Then he was in office. Intelligent, disciplined, self-contained, spiritual. President Carter made some of his own luck, good and bad—as I described in this magazine 44 years ago. There is little I would change in that assessment, highly controversial at the time, except to say that in 1979 Carter still had nearly half of his time in office ahead of him, and most of his adult life. I argued then that his was a “passionless” presidency. He revealed his passions—his ideals, his commitments—in the long years to come.

In office he also had the challenge of trying to govern a nearly ungovernable America: less than two years after its humiliating withdrawal from Saigon, in its first years of energy crisis and energy shortage, on the cusp of the “stagflation” that has made his era a symbol of economic dysfunction. It seems hard to believe now, but it’s true: The prime interest rate in 1980, the year Carter ran for reelection, exceeded 20 percent. You never hear, “Let’s go back to the late ’70s.”

Probably only a country as near-impossible to lead as the United States of that time could have given someone like Jimmy Carter a chance to lead it.

Despite it all, Carter had broader support during his first year in office than almost any of his successors, except briefly the two Bushes in wartime emergencies. Despite it all, most reckonings have suggested that Carter might well have beaten Ronald Reagan, and held on for a second term, if one more helicopter had been sent on the “Desert One” rescue mission in Iran, or if fewer of the helicopters that were sent had failed. Or if, before that, Teddy Kennedy had not challenged Carter in the Democratic primary. Or if John Anderson had not run as an independent in the general election. What if the ayatollah’s Iranian government had not stonewalled on negotiations to free its U.S. hostages until after Carter had been defeated? What if, what if.

Carter claimed for years that he came within one broken helicopter of reelection. It’s plausible. We’ll never know.

Because we do know, in retrospect, that Reagan had two landslide victories, over Carter and then Walter Mondale, and that the 1980 election broke heavily in Reagan’s favor in its final weeks, it’s natural to believe that Carter never had a chance. But it looked so different at the time. History changed, through effort and luck, when Carter arrived on the national stage in 1976. And it changed, through effort and luck, when he departed four years later.

Effort and luck combined for Jimmy Carter’s first two acts: becoming president, and serving in office.

Luck played a profoundly important role in his third act, allowing him to live mostly vigorously until age 98, and to celebrate his 76th wedding anniversary with his beloved wife, Rosalyn. He had 42 full years in the postpresidential role—10 times longer than his term in office, by far the most of any former president.

This extended span mattered for reasons within Carter’s control, and beyond it. Good fortune, medical science, and a lifetime history as a trim, fit athlete (he was a good tennis player, a runner, and a skillful softball pitcher), helped Carter survive several bouts of cancer and other tolls of aging. But his faith, will, idealism, and purpose allowed him to invent and exemplify a new role for former presidents, and to see his own years in office reconsidered.

Suppose that, like Lyndon B. Johnson, he had died of a literal and figurative broken heart at age 64. His record and achievements would have concluded with Ronald Reagan still in office, and his story would have been summarized as ending on a loss. Carter could never have received the Nobel Peace Prize, which he won while nearing age 80, in 2002. (Nobel Prizes cannot be given posthumously.)

With health like Lyndon Johnson’s, Jimmy Carter would not have had a chance to establish his new identity—and to see prevailing assessments of his role as president change as profoundly as those of Harry Truman did. As with Truman, the passing years have made it easier to see what Carter achieved, and to recognize what he was trying to do even when unsuccessful. But Truman was no longer alive to see that happen. For Carter I think the process of reassessment will go on.

It is hard for most Americans to imagine the Jimmy Carter of those days. It is hard even for me to recognize how different the country is as a whole.

Just to talk about politics: The South was then the Democrats’ base, and the West Coast was hostile territory. Jimmy Carter swept all states of the old Confederacy except Virginia, and lost every state west of the Rockies except Hawaii. In Electoral College calculations, the GOP started by counting on California.

The Democrats held enormous majorities in both the Senate and the House. Carter griped about dealing with Congress, as all presidents do. But under Majority Leader Robert Byrd, the Democrats held 61 seats in the Senate through Carter’s time. In the House, under Speaker Tip O’Neill, they had a margin of nearly 150 seats (not a typo). The serious legislative dealmaking was among the Democrats.

In culture and economics—well, you just need to watch some movies from the 1970s, Rocky, Taxi Driver, The Conversation, Dog Day Afternoon (or, if you prefer, Saturday Night Fever and Star Wars). The United States was a country fraying on all its edges, just beginning to absorb the shock of the Vietnam years, in its first wave of grappling with globalization and environmental constraints.

Prevailing memories reached back far beyond Vietnam to the Korean War, World War II, and the Great Depression. In campaign speeches, Carter talked about the difference it made to him, as a boy, when Franklin Roosevelt’s Rural Electrification Administration brought electric power to small communities like his. We on the speechwriting staff could rely on the story for applause. Enough people remembered.

There were no cellphones then, nor even bulky “portable” phones. Computers meant behemoths at major data centers.

And in civic life, Richard Nixon’s downfall seemed to have reinforced the idea that there was such a thing as public shame. It was construed as embarrassing for Jimmy Carter that his hard-luck brother, Billy, was in a penny-ante way cashing on the family fame by promoting six packs of his own “Billy Beer.” Carter, from a small-town business-owning background, felt that he had to sell the family peanut mill to avoid even the appearance of impropriety. After Nixon’s scandals and Spiro Agnew’s resignation, “doing the right thing” mattered, and Carter did so.

Jimmy Carter took office in the “before” times. We live in an unrecognizable “after.” He did his best, in office and out, to promote the values he cared about through it all.

What did he do in office? He did a lot. He was visionary about climate and the environment. He changed the composition of the federal courts. For better and worse he deregulated countless industries, from craft brewing to the airlines. I direct you to Stuart Eizenstat’s detailed and authoritative President Carter: The White House Years for specifics. I’ll just add:

Jimmy Carter did more than anyone else, before or since, to bring peace to the Middle East, with his Camp David accords. The agreement between Menachem Begin and Anwar Sadat could not possibly have been reached without Carter’s all-in, round-the-clock involvement. I was there and saw it. Any other witness would agree. (This was also the theme of Lawrence Wright’s excellent Thirteen Days in September.) Jimmy Carter saved the United States decades of woe with his Panama Canal Treaty. Jimmy Carter bought the United States several generations’ worth of respect with his human-rights policy. Can such an approach be no-exceptions or absolute? Of course not. Carter recognized as clearly as anyone the tension between ideals and reality. But does even imperfect idealism make a difference? That is the case Carter made in a speech at Notre Dame in 1977. I think it stands up well. Its essence:

We have reaffirmed America's commitment to human rights as a fundamental tenet of our foreign policy …

This does not mean that we can conduct our foreign policy by rigid moral maxims. We live in a world that is imperfect and which will always be imperfect—a world that is complex and confused and which will always be complex and confused.

I understand fully the limits of moral suasion. We have no illusion that changes will come easily or soon. But I also believe that it is a mistake to undervalue the power of words and of the ideas that words embody. In our own history, that power has ranged from Thomas Paine's "Common Sense" to Martin Luther King, Jr.’s “I Have a Dream.”

In the life of the human spirit, words are action.

Jimmy Carter spoke to the “values” and “engagement” crises decades before demagogues like Trump or healers like Obama. In the summer of 1979, he gave an unusually sober and sermonlike address on the national “crisis of confidence.” This is generally known as the “malaise” speech, and is widely considered a downbeat marker of a down era. But as Kevin Mattson points out in his entertaining What the Heck Are You Up to, Mr. President?, the speech was well received at the time. Carter’s popularity rating went up nearly 10 points in its wake. (Also, the speech didn’t include the word malaise.) Things again started going wrong for Carter soon after that—he made mistakes, and was unlucky—but the speech deserves respect. It was a leader’s attempt to express the fears and hard truths many people felt, and to find a way forward.

Jimmy Carter survived to see many of his ambitions realized, including near eradication of the dreaded guinea worm, which, unglamorous as it sounds, represents an increase in human well-being greater than most leaders have achieved. He survived to see his character, vision, and sincerity recognized, and to know that other ex-presidents will be judged by the standard he has set.

He was an unlucky president, and a lucky man.

We are lucky to have had him. Blessed.