GLP-1s are breaking life insurance(glp1digest.com) |
GLP-1s are breaking life insurance(glp1digest.com) |
I saw this:
https://media.nmfn.com/tnetwork/lifespan/index.html#0
is there anything better?
Or any slippage?
It caught my eye this explosion in slippage happened years before GLP-1s, and exactly in the year of a global pandemic that had sky-high mortality rates for older people.
humanity
Imagine that, people make up bullshit that isn't grounded in reality. Who would have thought!
Likely protective of a wide array of internal organs, likely life extending.
That same year, it paid out roughly $800B in claims.
TL;DR: there's no violin tiny enough for me to play for the life insurance industry's 'woes'.
From a quick search, Jarrah et al. (2023) "Medication Adherence and Its Influencing Factors among Patients with Heart Failure: A Cross Sectional Study" [0] discusses some of the relevant details.
The idea that a few pharmas artificially juicing a desperate population [who just want to feel good about themselves and live longer, happier lives for more than many can comfortably afford] is interfering with insurance adjustors ability to maximize profits doesn't leave me heartbroken.
It's precisely this shit that leads to people celebrating when pharma CEOs get tapped.
Huh? How would one get these electronic health records? I thought each provider keeps these and there's no public database except for vaccines? And it doesn't exist because HIPAA would make it hard?
Source? I agree that some people will regain the weight, but "usually" is an unfounded (without some data) generalization.
I understand where you're coming from, though, I used to think the same - I remember a specific situation where an obese person next to me was breathing heavily from doing something easy and me thinking "how do you hear yourself breathing audibly from doing almost nothing and not decide and just change it". Unfortunately, I got into a situation where I now understand the issue and am struggling to lose weight, despite hearing myself breathing audibly after picking up something from the floor and all the rational understanding and knowledge of what I need to do.
IMO, in a lot of cases, the first step should be going to a therapist.
With AI glasses doing this automatically for you upon seeing what your eating without u having to do anything some people may be shocked to learn how many calories they consume daily.
Currently, it's too time consuming now for the majority to do (i use GPT via texting it or talking to it to keep track as I eat out daily at healthy chains) but if it was done automagically I believe it definitely would be a substitute to Ozempic. I bet some or more would use that easily captured data that's shown to them (in the glasses or on their mobile device) to strive, make and possibly compete with their friends/family to eat less calories and carry less weight on them (be healthier). You can train your body to eat less to a lot less and for some that would definitely help them shed weight. The glasses could as well deduct calories burned from your daily walk, jog, etc.
*Being downvoted hmmm do you think AI by seeing it can't via an image calculate the calories of a burrito bought from Chipolte and other chains? All chains have nutrition information on their websites now that GPT goes and fetches. As for home cooked prepared meals I have taken pics of my food via GPT and it seemed to come close.
Yet majority of all people have no idea the amount of calories they eat daily. Im sure being shown this automagically will be valuable data to all people just how they choose to use this optional feature to make changes or not.
Obesity is not (in general) a result of addiction.
1. Expected high stress work day -> Coffee w/ food item in the morning
2. Stress during the day -> No exercise + large lunch.
3. Post-day -> door dash due to not feeling up for cooking.
4. Sleep -> Get 6 hours of sleep due to not having the energy to maintain bedtime discipline, getting paged, or late night meetings + childcare obligations.
5. Repeat.
This cycle continues for a few months leading to 10-20 pounds of weight gain, followed by a year long push to rebalance life and lose the weight. There is nothing that a magic calorie counter could do for this cycle other than guilt me over my door dash order at the end of the night.
For the aware user, combined with a scale, it helps normalize estimations of calories which can be incredibly deceptive. For example, try getting a group of people to estimate how many calories are in a store-bought muffin or donut, a bowl of nuts, a sweetened coffee drink from a drive-thru, or their typical bowl of a favorite cereal. I'm used to the casual observer's guess being about 1/3 of the true total if you weigh the item and read the label.
So in your scenario, the calorie counter would be a signal that you need to cut portions or cal density if your weight is going in the wrong direction, not unlike how a compass is just a tool if you're lost - you still need to know how to use it.
Why should that be? Is it not possible to order healthy food in? If not this would surprise me as it seems a number of people would be seeking this.
I'm asking as I don't have personal experience.
If what you're suggesting worked, then the horrible cancer pics on cig packs would have long eliminated smoking.
For those who don't have the will power there's the Ozempics to utilize at their discretion. For those who do have some or a lot of will power to change their lifestyle forever then this is going to be extremely helpful and those types wont be using Ozempics as Im sure such types are using it now.
I already do this with chatGPT but i have to do something vs. just living and glasses doing it automatically.
1. Exactly the type of "side effect" that people will report because they lost hair (because lots of people experience hair loss whether they are on a GLP1 or not)
2. A fairly minor side effect that wouldn't be a strong reason to not prescribe.
Pancreas issues were worried about, but those worries (so far) appear to be unfounded. https://pmc.ncbi.nlm.nih.gov/articles/PMC6382780/ is a meta-analysis of 12 studies (36k patients) over 2 years that showed no evidence of increased pacreatic issues, and https://pubmed.ncbi.nlm.nih.gov/38175642/ is a 7 year analysis of ~33k patients that also shows no increase in issues.
For those who are not interested cutting down daily on what they eat this data would not be valuable to them just as the data their phone captures now how many steps you walked in a day.
Myself I eat Cava bowls for lunch that are less then 600 calories, drink 70 percent water (not consuming calories from what I drink) and unsweet tea (zero calories in tea) with some lemonade to sweeten it a bit as the remainder. Other chains you can find similar meals that are less then 600. If you eat as such and keep at (change ur lifestyle for good) it some weight will be lost if the person wants to as well go for a walk on their lunch break. But again all about to how people want to live and enjoy their lives!
I recently switched from a major tech company to an academic position and lost 5 pounds in the first month. Simply due to lower stress making the healthy habits seem “easy.”
No calorie counter will stop a ramen quest after 90 hours of work. Unfortunately, I worked in environments where these stretches were obligatory.
As an aside, I watched Poor Things this afternoon, and it came with a "Contains Tobacco Depictions" warning at the start. Never seen that before. No warning for the nudity, sex, or profanity.
Maybe I live in a bubble, but I don’t put stuff in my body unwillingly, so yes I control my diet.
It also isn’t rocket science, I know doughnuts have a shit ton of calories and vegetable shortening which will clkg your arteries, so I don’t eat doughnuts. I don’t have to look at the packaging.
Maybe the missing part is a proper education on nutrition in school, but we live in the age of the internet. All the information is there, you can get meal plans, you can figure out what foods are more likely to put you at risk.
Again, I don’t believe awareness is an issue. People know that chips and doughnuts are bad, but they eat them anyways because they are addicted to food which is engineered to be addictive.
The example I'm thinking of is cultures with near-religious obligations to listen to their parents. Like Italian-Americans all act like they'd die if they ever ate less than all of their grandmother's cooking or ever changed any of the traditional recipes. Even though the recipes were all invented in 1970 in NYC and have inhumanly large amounts of carbs.
Somewhat similar to how a carton of cigs contains a big warning that says "THIS WILL KILL YOU DO NOT SMOKE THIS UNDER ANY CIRCUMSTANCES"
Welp...
Often, I think that it’s a bad move, as the clinical effect of losing around 20 kg would have to be matched by some extremely high frequency and severe side effects. Overweight is still not sufficiently appreciated for how dangerous it is, especially after they ramped up production so much that there isn't a real shortage anymore.
Ironically, most of the people who respond well to Ozempic and stay on it have few psychiatric problems. But those who almost desperately want to get off it after a while might be those who have a psychological component to their overeating. The obvious suspect then is eating as emotional regulation. So one could extrapolate, at least as a hypothesis, that the ones who have worse life expectancy due to regained weight after a year of usage are the ones who have a double set of problems stacked against them: overweight and emotional problems. That would have a huge effect on longevity.
This is PURE free association though, no deep analysis behind it.
I have also heard about people with ADHD being on GLP1 agonists that it does a lot for their reward seeking behavior and impulse control.
This makes me wonder two things:
- Whether at some point these molecules will also start being used for ADHD and addiction treatment in general. I think they hold a lot of promise for issues rooted in the reward system.
- Whether a sizable portion of people who struggle with their weight have co-morbid ADHD which creates or worsens their overeating issues.
Have you noticed anything along these lines in your practice?
That being the case, the same behaviours have led me to a compulsive need to plan meals. Doing so has helped me lessen (not eliminate) food noise. Anecdotally, I've noticed with others as well, that this is the way. Prep - be fine. Don't prep - eat a small village.
But to add to this, I feel like there are different kinds of addictive behaviors at play that are more susceptible to one medication or the other and are based on different systems.
For instance, the food-craving reduction in GLP-1 is almost certainly not just related to reward and goal-seeking behavior. It literally affects hormone signaling for satiety, and slows down the movement of food through the stomach, and affects, globally in the body, responses to metabolic signals. And it probably has a global effect on the way every cell in the body works, which might be why there are positive health effects beyond just the weight loss.
ADHD medication, on the other hand, targets the goal-directed activity system directly. It seems much more likely to me that reduced appetite is just as much driven by the focus and "let's get shit done" mode that is artificially increased with dopamine. Both result in reduced eating but through massively different pathways. Basically, you pay attention to the biggest wave in the pond (the waves in the pond being a metaphor for all the things your brain COULD pay attention to). So when the goal-stuff gets increased in size, the food-seeking is automatically smaller by comparison, and less likely to drive your behavior and thinking.
I don't think I can say that there is much of a pattern between ADHD and overeating, just based on how easily I can predict if someone is overeating or not if I know they have ADHD. That is, it would be a coin toss.
The simplistic answer would be: Semaglutide reduces addictive behavior if it's driven by emotional regulation needs, and ADHD medication reduces pure drug-like craving. As seen in studies where people that start lisdexamfetamine (ADHD medication common in the EU) have a huge reduction in actual amphetamine abuse.
Case in point: https://jamanetwork.com/journals/jamapsychiatry/fullarticle/... Findings In this Swedish nationwide cohort study of 13 965 individuals, lisdexamphetamine was significantly associated with a decrease in risk of hospitalization due to substance use disorder, any hospitalization or death, and all-cause mortality.
N=1, I'm on ZepBound and in general my brain is less likely to give in to things that give instant satisfaction.
It was like whatever enjoyment lightbulb that is usually activated was completely unscrewed, or like trying it for the first time as a kid when an adult lets you try a sip on a holiday. Just sitting here typing and thinking about it has me slightly nauseated. I've been telling people recently I CAN'T drink because of some new medicine I've started.
I also have BPD and am in therapy for it, but man. Food is the drug that always works. When I get into a certain mode, it's like I don't care that I'm overweight and have high blood pressure. I just crave the deliciousness and the "full feeling." And it never fails to work! I always feel more calm and happy after I eat.
Incidentally, I had been nagging him about trying ANYTHING (in addition to the therapy we were doing to find a life goal he believes in) that might help him get SOME help. Be it Adderall or Ozempic. But people are complex, and at best, a person is a Venn diagram with massive overlapping "biological susceptibility," "life situation," "negative thinking style," and inertia. The best one can do is to pull at as many threads as possible to hope the suffering unravels. So one of the threads one can pull at are medication.
Not to give advice, but just for shits and giggles, look into "vulnerable narcissism." Many describe stuff like you do and fit those traits. And don't give a shit about the negative associations and stereotypes regarding this personality. I love narcissists! It's one of the coolest personalities there is! But when you are not allowed to be proud of yourself, and all the desire for status and power gets refocused onto self-hate and learned helplessness, then it's a monster of a situation. Had so many people become awesome versions of themselves when they stop being so afraid of being arrogant :) .
Just to remember when you read about it, that the descriptions are only in the context of things having gone wrong. Every trait can manifest as something good or negative. Even psychopaths can have good and prosocial lives. For instance, some of the best ambulance workers often have high loading on psychopathy, and that makes them better at their job. Because they don't get scared. I’d rather be picked up by an ambulance worker that is curious and thinks the situation is interesting than one that is panicking and losing due to anxiety and empathy overload.
This is just a long-shot association/pattern I noticed, though. It's not worth a dime more than the sentences you put into the machine. :P
Have you observed persistent GI side-effects in your own practice, and if so, do you believe these are legitimate? Or… are they a social cover for individuals to get back to eating for psychological coping?
There has been almost a hysteria, it seems, regarding "Pancreatitis." And when I see multiple diagnoses, medications, and reports associated with Pancreatitis, I recognize a pattern I have seen many times before. Both the mental health and medical fields have periodic fixations on certain symptoms or diffuse diagnosis, and when it has the "wave-like" pattern like this, I am willing to bet it's just the latest version of "Fatigue," "Whiplash," "Repetitive Strain Injury", "lactose intolerance" or the dental amalgam controversy. Don't get me wrong. These are real things. But sometimes they just balloon beyond anything reasonable, and an unreasonable amount of people suddenly get diagnosed with it or suspect they have it. Pancreatitis is giving me that vibe over the last year or so. Copy paste this for "Stomach Paralysis".
But let's say the social benefit of alcohol has a value of 100 and a health risk score of 100. I would say that GLP-1 agonists have a health value of 500 and a risk score of 20. Nothing is without risk, but mathematically speaking, if you are overweight, I would be 25x more positive about injecting myself with Ozempic than alcohol... mathematically at least.
And to answer your question, I personally haven't seen many people stop early due to GI symptoms. And if they did stop early, I would think it was because they genuinely had a physical negative response that was horrible for them. Anecdotally, I feel the people that stop so they can get back to eating usually last at least 6 months, and probably more. I am 100% in agreement with the studies that many stop at around 1 year. So if someone stopped at 2 months, I would belive them when they said it was due to GI symptoms. But if they stopped at 1 year and CLAIMED it was due to GI symptoms, I would doubt; and guess that it was driven by missing food.
Please note that I am speculating wildly, and this is just PURELY anecdotal and stream of consciousness.
Overweight due to emotion-eating and stress-eating, taking GLP1.
Now I can binge-eat until I'm full or sick (mostly sick) and maintain weight. If I'd go off GLP1 now my weight would skyrocket.
Are there any alternatives coming out soon or generics?
United States: The main patent is expected to expire around 2032. Monthly Price: $950 - $1,350+ (cash price without insurance)
Norway: The main patent is expected to expire around 2031. Monthly Price: $109 - $301 (cash price equivalent in USD)
Basically, Tirz > Sema > Lira
https://glp1.guide/content/semaglutide-vs-tirzepatide-clinic...
https://glp1.guide/content/semaglutide-liraglutide-continue-...
https://glp1.guide/content/another-generic-liraglutide-launc...
There are group chats with tens of thousands of people and I havent seen any issues with the drug
The article also misses regarding slippage is that Swiss Re in the link calls it a modest increase And that is mainly due to insurers Not performing the same level of medical intake (accelerated versus full underwriting). Increased competition leads to less profits. That’s pretty straightforward and not per se GLP-1s related.
And then the kicker. For not diversified portfolios of mortality risks. Those have been massively profitable for decades, in line with the general increase in age and health. GLP-1s just expands on that profitable aspect. Did I mention that the long term expected rate of return on an insurers book is quite good?
Insurers can weather a bit of slippage. Reinsurers will kick the worst offenders back in line with their AUC performance, because without diversification Or reinsurance it’s hard to stay in the market. (Capital requirements strongly favor diversification. Mono line is very hard.) That’s why Swiss Re is bringing out such rigorous studies of detailed policy events. Signaling to the reinsurance markets and the insurance companies and their actuaries!
The biggest part of that equation is regain part. Most people quit GLP-1s because of costs. Let's fix that.
Took Wegovy (Semaglutide) for about 6 months. Barely lost any weight, would occasionally get nauseous.
Then the doc switched me to Mounjaro (Tirzepatide) + Phentermine, and holy shit, I just don’t feel like eating, almost ever. Lost 20kg in 6 months, which is all I needed to lose, never had any side effects. None.
I did feel a little weird/buzzed the first time I took Phentermine, but it went away the next day.
I feel like for many people it’s not really the physical hunger that makes them fat, it’s that annoying voice in your head telling you to snack something for no reason at all. It sometimes felt almost like drug addiction.
Tirz+Phent are great for that.
"Life insurers can predict when you'll die with about 98% accuracy."
This conclusion isn't supported by the linked document. The document instead is talking about expected vs actual deaths among demographic groups as a whole, not individual people. And that expected vs actual is just history + trends. This doesn't mean that insurance can say that Joe Blow is going to die in June of 2027 with "98% accuracy", obviously.
Will you be one of them? Click here to find out!
Pretty easy to predict if you're willing to make it happen.
The problem continues to be the pharmaceutical and health insurance industries, particularly in the West. Under pressure to deliver infinite growth forever to shareholders on a quarterly basis, companies have a vested interest in making less medication at a higher price, and lobbying the government to prohibit price negotiations while mandating insurance coverage for many of these drugs.
GLP-1s might be the proverbial straw that broke the camel’s back, but there’s decades of research - and bodies - saying this over, and over, and over again.
Which reminds me: I need to call my new health insurance company to get them to cover my medication, and hopefully extend it to 90 day supplies. Because god forbid that just be an automatic thing for someone who’s taken the same medication daily in some form for a decade without adherence issues.
"Life insurers can predict when you'll die with about 98% accuracy."
"98%" appears in the citation[1], but as the ratio of actual deaths to expected deaths. (i.e. 98% of the deaths they expected actually occurred.) Some months that figure was ~104%, so it's not a measure of accuracy.
1: https://www.soa.org/4aa060/globalassets/assets/files/resourc...
Anyway, it's a pretty vague statement. What it sounds like it's saying is for the average person they can predict when they will die, and you have to decide if they mean the day, the year or the decade. But chatgpt gave me an interpretation that seems to make more sense:
> The 98 % figure is about aggregate forecasting, not clairvoyance. It means that when an insurer predicts, say, 10 000 deaths across its book in 2024, the actual count typically falls within roughly ±200. For any single customer, the prediction is still just a probability curve, not a calendar appointment with the Grim Reaper.
And I'm guessing just based on my own experience paying for term life that the actual premia differences aren't actually enough in most cases for the life insurer to simply pay out of pocket themselves; the differences probably add up to a few hundred per year per customer, whereas a year's worth of a GLP-1 agonist probably costs a couple thousand (for now, in 2025, and probably dropping rapidly).
Huh. Second order implementation details aside, this is an extremely fortunate turn of events for us.
I plan on being a GLP-1 for the rest of my life. Perfectly fine with that. It seems like society has more problems with GLP-1s than its users do.
Can you share what dose?
how was this measured?
For me personally, the little bit of help in the form of forward progress on weight loss has given me a reason to be a little more methodical in my strength training, and I'm seeing a slow but consistent payoff. And as far as I can tell, I'm not fighting an uphill battle in terms of adding muscle mass at all because of the GLP-1.
Predictions of when you will die need a range in order to be attached to a number like accuracy. The attached report is not about this but about population-level mortality trends.
When I have a “refill” (here in Australia we call them “repeats”) due, my pharmacy sends me an SMS… I just reply “yes please” and that goes straight to the pharmacist who dispenses, and I get another SMS telling me the dispensed medication is ready to pick up
I’m on tirzepatide and I’m committed but I’m “going a bit slow” because the side effects started to get a bit too much. Still, my base expectation is I’m taking a GLP-1 agonist for the rest of my life, unless my doctor tells me I have to stop for some reason, or I somehow go bankrupt and can’t afford it any more.
Furthermore, there are more people not on GLP-1s than on them (even with the recent surge in popularity) so this population that can give life insurance companies "excess" profits must outnumber those the article describes where the insurance company takes a loss.
Why can't they focus on this profit opportunity?
The social difference is that we frame smoking as an addiction, and smokers as victims of the Tobacco industry. But we frame obesity as a moral failing. So, the former we're ready to jump in and help. But, the latter, we are much more hesitant.
Theoretically, economic outcomes would override these social and moral effects. But leadership is often stupid, so we'll see.
edit: and then Big Annuity lobbying to oppose this
Big Annuity can charge you more, in fact, if it has reason to believe you're going to live unusually long, so playing the GLP-1 dance with them would only be profitable in reverse. Pretend to be the unhealthiest person on the planet, lock in an annuity, then get on the drip stat.
But to your broader point, at least in the US, incentive mis-alignment on all healthcare and health insurance is possibly irredeemably broken.
https://www.labiotech.eu/in-depth/novo-nordisk-semaglutide-p...
The blind spot related to COVID is huge. There are lots of health data going haywire since 2020 and everyone seems to find any other reason but COVID for it.
GLP1 significantly reduces the risk of many mobidities and is increasingly prescribed to older people.
Also, this is incredibly likely to resolve itself once the drugs become common place after patent expiries, the actuaries will update their tables and the curve will smoothe out.
[0]: https://glp1.guide/content/if-glp1-is-so-great-why-dont-peop...
[1]: https://glp1.guide/content/patent-expirations-for-glp1-recep...
1. People do not stay on GLP1s for long, despite how effective they are
2. People often rebound harder from other forms of weight loss (dieting, temporary lifestyle changes, etc)
3. GLP1 reduces a LOT of health risks linked to obesity (heart disease being the most important IMO)
4. Older people are taking GLP1s in droves
5. Once these drugs are everywhere (they will be soon IMO in < 7 years obesity will probably be ~gone), the effects will get "priced in" to actuary tables.
No social commentary or dark humor intended -- GLP1s aren't miracle drugs but the effects (and relative lack of side effects) is miraculous.
I was wondering how big the price differences would be so I set up a quick form to collect some data points from several countries and for several products.
It would be cool if you could provide some data - I would then share it back as a reply to this thread within 1-2 days after closing the survey. The latest data entry will be possible on Sunday.
I live in California and have no claims ever. My home insurance has doubled in 4 years to almost $4000 a year. My car insurance is about $2800/yr.
So I hope insurance companies break. Like Danerys said in Gamr of Thrones, I hope someone breaks the wheel.
Car insurance companies in CA actually lose money on the state, if that makes you feel better: https://money.com/car-insurance-policies-problems-california...
There are laws that prevent them from charging enough to even break-even on the policies.
Pay some broker for a one-off consultation to advise you on how to save money.
Reality is insurance companies are now going though a cycle of "price in the actual risk" rather than "drop prices to gain customers"
Minimal, but minimal progress in the US was/is still progress.
Doesn't disagree with your original claim that there is low incentive for any private insurance to care regarding longevity, but figured I could add some color
If you know a "customer" of yours (an individual employee) is only going to be with you until they either change jobs or go on Medicare, then it seems the name of the game then is to make sure that nothing catastrophic happens to them until you can hand them off to someone else.
In which case, they should definitely go on ozempic. Even if the effects of ozempic immediately come off after usage, it's a short-term enough solution that benefits the insurance company, no?
Most people don’t change jobs or insurance companies every few years. When they do, it’s often within similar regions and industries so the chances of ending up right back under the same insurance company are significant.
Regardless, the issue is more complicated than your line of thinking. Insurance companies have very small profit margins. Current GLP-1 drugs are expensive, around $1,000 per month.
So each patient on GLP-1 drugs costs an extra $12K per year (roughly) or $120K per decade. That would have to offset a lot of other expenditures to break even from a pure cost perspective, which isn’t supported by the math. So the only alternative would be to raise everyone’s rates.
I know the insurance industry is the favorite target for explaining everything people dislike about healthcare right now, but at the end of the day they can’t conjure money out of nothing to cover everything at any cost demanded by drug makers. These drugs are super expensive and honestly it’s kind of amazing that so many people are getting them covered at all.
The article is about life insurance, which is very different from medical insurance.
Medical insurance companies often already go out of their way to pay early to save in the long run (e.g. free preventative care, checkups, etc.). I can’t speak to GLP-1s, but it’s possible that right now there are still active patents when used for obesity that make them crazy expensive for a few more years.
Life insurance is all about models and predictions about when you’re going to die. Any sudden change that massively impacts those models suck, because life insurers are basically gamblers with gobs of historical data they use to hedge their bets.
Literally LOLed when I read this. Health insurance companies might pay lip service to this and make some token gestures like free preventative care, but in my experience health insurance companies frequently shoot themselves in the foot by denying care that later ends up costing them even more when the patient's untreated condition worsens.
But it's also worth remembering the relative risks involved. Obesity isn't quite the ticking time bomb / public menace it's often made out to be... For smoking, you'll find studies with relative risk numbers for lung cancer over 5 for casual 1-4 times a day smokers, and the number quickly exceeds 20 for heavier smokers. In contrast, with obesity, the most severe relative risks for things like heart disease or diabetes you'll find topping out around 4 to 5 for the most obese, even then often under 3, with milder 1.1 to 2 for the bulk of obese people. (Here, ~31% of the US has BMIs between 30-40, and ~9% have BMIs over 40.) For other harms, like there was a study on dementia a few years back, you'll also find pretty mild (1.1ish) relative risks, but these end up being similar with other factors like "stress", "economic status", or "low educational attainment". Just some thought for people thinking about subsidizing or providing free stuff, the cost tradeoff with paying for other things later might not work out so neatly, and there's reason to not focus solely on obesity but also do the same sort of analysis with other factors and severity of a factor as well.
On-patent GLP-1s (all of them right now) are actually extremely expensive. Right around $1000 per month.
I don’t want to discourage anyone who needs them from seeking treatment, but their discontinuation rate can be somewhat higher than you’d think from a life-changing drug because many people don’t like certain effects or even encounter side effects.
Weight loss drugs are also a challenging category for OTC because they’re a target of abuse. People with eating disorders and body dysmorphia already seek out black market GLP-1s at a high rate and it would be a difficult situation if they could pick them up impulsively from the medicine aisle. It’s also common for people to misuse OTC medications by taking very high doses hoping for faster results, which has to be considered.
There’s a libertarian-minded angle where people say “Who cares, that’s their own problem. Medications should be free for everyone to take.” I was persuaded by those arguments when I was younger, but now I have a very different perspective after hearing about the common and strange world of OTC medicine abuse from my friends in the medical field. Just ask your doctor friends if they think Tylenol should still be OTC if you want to hear some very sad stories.
I think the short answer is that these drugs are only cost effective when applied to people actually experiencing costly diseases, rather than simply being obese. A large part of that has to do with the drugs being very expensive still.
For example, fire extinguishers and security cameras will reduce crime by more than their costs, but instead of charging you for them, plus administrative costs, and shipping them to you, your insurance provider will offer you a discount if you have them. (Really it's a price increase if you don't have them, but regulators don't like it when they call it that.)
Not everyone will benefit from GLP-1, so in this case, the most beneficial solution would be to charge higher premiums for anyone that could benefit from GLP-1 but doesn't use it.
In the US, insurance companies are generally legally mandated to cover ACIP recommended vaccines at no cost to the insured, which includes flu vaccines for everyone six months or older without contraindications.
Some do. My insurance requires a prior authorization due to the previous shortage, but it's $12/mo
Medicaid in my state also covers it for $3/mo
That the NHS is getting to a place where it’ll provide it, I’d say yes.
Perhaps that works for some people. I'm glad it seems to have worked for you. But the facts of the world we live in show that it doesn't work for most. "Learn the lesson and be disciplined!" is not effective advice.
In practice, this doesn't happen that often, no, but it's a theoretical goal. Probably because we're in the pre-GLP-1 era with regard to mental health meds. Maybe that will change.
I would say that controlling what you put into your mouth is easier than controlling your anxiety.
GLP-1 in those cases helps manage the problem better.
But for those who are not in those cases where Type 2 Diabetes has sunk in, then they need to use the opportunity to get better while on it and kick themselves into high gear or they will have learned nothing from the experience
GLP-1s don't do that directly.. but at least they might help people move more, and give them confidence to do more for their health instead of seeing it as a lost cause.
There is simply no way around the simple fact that there is only 1 way to eating well long term - that is lesser, more healthy portions. GLP1 may show a person what things could and should look like, what is achievable but the path needs to be walked by themselves. The alternative is either lifelong consumption of this chemical with various bad side effects or premature death (or both, to be seen since nobody has a clue).
Considering it took you a miracle drug to learn the lesson, that seems like a humorously arrogant take.
I also quit smoking with relatively little effort twice (once in my early 20s, and then again a few years ago after I picked up smoking again during COVID). It wasn't easy-easy, but if I hear the struggles some other people go through, it was relatively easy.
Some people are just wired different. I have plenty of other issues, but on this sort of thing, for whatever reason I seem to be lucky.
I have been off since Oct 2024. Also, I did continue to lose weight the traditional way. After I stopped, a coworker told me about Vida which my work offers as a health benefit.
Using the Vida service where I got a registered dietician to show me what to eat, I tracked my food and water intake and tracked my exercise. I had protein and fiber goals to hit.
You can’t do it all on the medicine - it is a lifestyle change. The medicine was the catalyst but not the reason I kept the weight off. I wanted it. But because I wanted it, I wanted to use the support system that my work paid for.
I think there is a lesson to be learned here
This is deeply misguided. I’m glad that the little assist was enough for you, but if “healthy habits” were enough then people who’d lost weight the traditional way would keep it off.
Further, unless you’ve been off it for more than six months, I’d hold your judgement on this one.
After I stopped, a coworker told me about Vida which my work offers as a health benefit.
Using the Vida service where I got a registered dietician to show me what to eat, I tracked my food and water intake and tracked my exercise. I had protein and fiber goals to hit.
You can’t do it all on the medicine - it is a lifestyle change. The medicine was the catalyst but not the reason I kept the weight off. I wanted it. But because I wanted it, I wanted to use the support system that my work paid for.
I think there is a lesson to be learned here
The good news is that it is not impossible, and it really is possible to change bit by bit for most people suffering from obesity.
I don't think somebody who walks 10k+ a day, maybe goes to gym a couple of time a week, limits calorie intake to a comfortable and reasonable 2000 kcal per day, would suddenly bounce back to 130kg!
I've seen a few obese friends of mine lose weight and gain it back. And while I can't put words in their mouths, I have never noticed them have the attitude that "being obese will kill me."
That's because a lot of the "traditional way" methods are pseudoscience at best, outright quackery that's going to send you into serious malnutrition issues or eating disorders at worst. Every two or three months you see a new diet fad pushed through the yellow press rags, and none of it anywhere near being considered scientifically valid - usually it's some VIP shilling some crap story to explain how they lost weight, of course without telling the people that they have the time for training and the money to pay for proper food, 1:1 training and bloodwork analysis.
The safety profile of the drugs with diabetics, and the health benefits that come from the associated weight loss may make permanent use a net benefit for most people. There appears to be little, if any, "course correction" effect from taking it for short periods of time.
I now take a one week break every few months and have not noticed any decline in effects over time.
My suggestion would be to find an endocrinologist that specialises in obesity and these weight loss drugs. They will have dealt with patients who have experienced tolerance and have developed ways to work around it from real life experience. Obviously well-studied protocols with evidence would be preferable, but with how new these drugs are there hasn't been long enough to collect it yet.
Also it should be mostly used as an adjunct to strict diet and exercise.
Letting your weight fluctuate up and down in giant swings is, in many ways, harder on the body than just staying at a steady weight, even if it's overweight.
Making millions of people dependent on a drug to maintain basic health does not strike me as the best of ideas regardless. I understand why it's a good idea for many from an individual perspective and I'm not judging anyone, but from a societal perspective it does not seem like a reasonable solution.
The scale of the solution is allowed to match the scale of the problem which is on the order of 2/3 of adults or 200,000,000 people.
Usually it's prescribed for no more than 3 months, but the doc recommended taking it for longer. He mentioned that addiction risk is negligible for most people. Very solid doctor who specializes in those thing, so I took his word for it after a bit of Googling.
But I had a lot of muscle mass to begin with, due to years of bodybuilding. And I still have significant muscle after the diet, despite of not touching a weight during all this time (I know I should have). People still ask me about my lifting routine even though I didn't lift in like 2+ years.
Knowing myself, it'll come back within a couple of months of lifting weights and getting proper protein, once I get back to it. And I plan on doing exactly that. Being fat kind of made me lose motivation to go to the gym. It's a vicious cycle I imagine many fat people struggle with. So I prioritized losing fat first and foremost.
It has the same effect as starving yourself. Go look up pictures of "ozempic face"
Insurers certaily don't mind you living longer. More payments, less payouts. They just need to update their predictive models or coverage policies to safeguard their margins. The 'problem' is transitory.
There are times when this is a problem, but even then it isn't the insurance companies that are complaining. There was a big "problem" during the beginning of the AIDS epidemic. For reasons I don't quite understand, the holder of the policy (the insured) can sell their policy to a random third party. The seller sells because they need immediate cash for end of life hospice treatment. The buyer buys because they know this person is about to die and they are going to get a cash payout of more than they paid for. This was a guaranteed payout because there was no treatment. This was a rare example of an investment with zero risk and high return. If you got the virus, you were going to be dead in a few months. This is a win-win for both the deceased and the new buyer, and it is neutral for the life insurance company because either way they have to pay the same amount to someone at the time of death.
The arrival of AZT cocktails threw a monkey wrench into the whole plan because suddenly a guaranteed death is no longer guaranteed and it leads to an ethical quandary because the "investor" doesn't get a return for their "investment" unless that person dies, and now they are literally wishing death on someone. (see also: There is no such thing as a risk free investment.)
https://www.theatlantic.com/health/archive/2018/10/viatical-... "The Gay Men Who Have Lived for Years With Someone Waiting on Their Death"
I feel sick for three days in a row after taking it. Even after several months on the same dose. I get horrible gut cramps, sour stomach, near constant nausea, and occasionally vomiting and diarrhea. I have to take my shot on Thursday night because I'll feel bad the next day and supremely sick the next two days. If I took it earlier or later in the week it would absolutely impact my ability to work during the work week.
It has had amazing effects. I've lost about 60 lbs in the last year and my A1c is now around 6.2.
It's a very effective drug, but it is brutal on my body. I'm not sure anything in the medication is causing the weight loss. It just makes me feel so sick that even if I'm hungry I don't feel like eating.
https://glp1.guide/content/are-glp1-side-effects-all-the-sam...
It was a while ago, but IMO the list still plays
I can still eat whatever I want I just choose not to. For example, had burgers, fries and ice-cream for lunch on Saturday with the family and then just a protein shake for dinner.
I also don't snore anymore. I used to snore terribly, my wife would wake me up at least once a night to tell me to roll over. Not at all now.
Most importantly, even though I am on a ton of test and deca, my blood pressure is normal, and my cholesterol has actually gone down.
I don’t think that’s a typical experience for most people, other than the price
As far as I can tell from forums, it's not like 5% have the side effects, it's like 80-90%.
But for the first time in decades, I felt full. I didn't want to finish a meal, it was too much.
My body regulated my food intake in what felt like a natural way.
I hadn't even realized my body had somehow lost that fundamental mechanism of appetite control. It made me realize I wasn't weak willed, something is different about my body than other people.
But it comes with a price. The side effects I had were quite bad and so I stopped (though I now read that if I switch to a different brand, I might be ok).
I often didn't want to leave the house due to a dicky tummy. It could come/go in waves. But often can last a whole week.
Plus you've got to inject yourself every week. Often you can't drink as it makes you sick. Even when you're doing everything 'right' you can feel a bit off.
If you do over-indulge (with food or drink) the side effects can sometimes be massively amplified and you feel terrible for days.
So amazing in some ways, but it's not like taking a vitamin tablet. There are costs and making one slip up can result in suddenly feeling awful for a day or two.
Perhaps I was just particularly prone to the side effects, but it seems to happen to a lot of people (I found Mumsnet threads about it useful, they are quite revealing as they seem to be fairly honest and willing to share their experiences)
I wonder why life insurance isnt funding more research into things like metformin, where we have amazing long standing data but haven't done the real research. See: https://www.afar.org/tame-trial
Did I misread the article, my TL;DR of the article is that GLP-1 reduce the indicators or mortality without modifying the actual mortality (because most users return to normal indicators within about 2 years).
Because they stop taking GLP-1s after 1-2 years, not, it seems, because the meds stop working.
So in addition to the quitters returning back to normal after they got life insurance underwritten when they were healthy, we have the unknown of the longevity of people on the glp-1 drugs.
Then from there, I click through the 65% #, assuming they have a good study on 65% of people stop after a year. Nah, they don't. It's super complex but tl;dr: specific cohort, and somehow the # getting on it in year 2 is higher than the # of people who quit in year 1.
I have a weak to medium prior, after 10m evaluating, that the entire thing might be built on more sand than it admits.
Lot of little slants that create an absolute tone - ex. multiple payouts over the "lifetime" of a life insurance policy. (sure, it's technically possible)
Also there's no citation for the idea this mortality slippage happened because of GLP-1, and it's been out for...what...a year? Maybe two?
That's an awful lot of people who were about to die, saved in the nick of time by...losing weight? Again, possible, I'm sure it even happened in some cases.
Enough to skew mortality slippage from 5.3% to 15.3%?
I thought they were 98% accurate?
Wait...is the slippage graph net life increase slippage? Or any slippage?
Because it's very strange this explosion happened in exactly the year of a global pandemic that had sky-high mortality rates for older people.
Health insurance is one of the rare services where incentives between consumer and business are well aligned. The vast majority of people are healthy. Healthcare is expensive in the US because the uninsured population continues to rise out of "they're not making me pay for it": There are entire tranches (in the US) also don't buy insurance and use the ER and abuse EMTALA for their primary care (most of this is actually unintentional in my opinion, it's less educated populations in the US who are repeatedly taken advantage of and left to ride on government, which is extremely eye-wateringly bad at spending money). Personal experience here working in an ER.
The real pathway in the US to success is getting those populations onto private health insurance. Obama tried a heavy handed "health insurance mandate" that hilariously somehow passed the supreme court, but was so laughable mis-aligned with American ideals even Biden wouldn't enforce it.
What is apparent though is these populations are completely willing to pay bills like their cell service, gasoline, car payments, etc before investing in the most important thing (their health). This gives me hope there is a way forward by riding these perceived essential services somehow. I'm not really sure what the answer is here, but there is at least opportunity for some creative solutions.
I also think the disagreement here between red vs blue isn't the outcome: both want people to be healthy. Red doesn't want single payer, whereas blue does. Red ignores the fact these systems don't exist, blue ignores the fact that no other country in the world has the diversity of America and there are not functional examples.
Seriously, that's just not that big of a deal. It takes like a few days at most for simple term life. Can't speak to the other policies, which I understand are mostly tax vehicles anyway, but it's not hard to simply get a new life insurance policy if your current one goes kaput.
In liquidity preference theory insurers do not have perfect information so they must make a tradeoff between collecting information and acting on the information they already have. There will be a bias towards the present and the past, because more information is available about the past and present than the future. What's being "discounted" is uncertainty, not time. Hence there is also a general bias towards stability and conservatism (sticking with existing decisions, even if they are bound to become obsolete).
Now let's apply this to the article:
The insurers don't know if you can stick with your weight loss, so they will conservatively deny coverage until they are certain that they know your health/risk profile. According to time preference theory this would never happen since the insurer already knows whether you will succeed at weightloss or not.
[citation needed]
However, if you tried stimulants without success, this would be my descending list of things that need to be sorted out:
- Have you tried multiple types of medication? A lot of people give up after 1 or 2 different types. But I have seen MANY people who get completely new lives, but only after the 5th type they tried that matched their biology. - Do a diagnostic re-evaluation to make sure that one is not misdiagnosing ADHD (the most common confusion is anxiety and personality). - Map out the life situation. Circumstances might be a stronger explanation of the situation than internal psychological vulnerabilities. - Make sure that you get a blood-mirror (Norwegian concept) so you know you have proper absorption/amount in blood.
I also used to binge, and meal planning and pre has also helped with that, as I tend to have periods of either really high food drive, or almost no food drive at all leading to not eating for an entire day, then downing 3000+ calories in one meal.
ADHD sucks. It's often trivialized in pop culture, but it makes life so difficult, and those real difficulties are almost never talked about.
Asking for a friend.
People with chronic health conditions spend an inordinate amount of time at the doctor and in hospitals. That could save a significant amount of money if that’s reduced or eliminated. Not to mention the time savings.
I could be wrong, but all things being equal doesn’t it make sense to spend $12k/year on medication than $12/year on doctor and specialist visits in addition to medication?
To put the this in perspective, where I live spends about $10,000/yr/person on health. That's all kinds of health. I'm not sure $5,000/yr (which is about the price here) of GLP-1 would be a generate proportionate decline, but I would not write it off. The $10K is paid by everybody, the $5k would only be for the obese.
Person you responded to suggested P( overeating | undereating ) as opposed to your P( overeating ). I expect the effects of those two conditions would tend to cancel each other out in observations.
> As seen in studies where people that start lisdexamfetamine (ADHD medication common in the EU) have a huge reduction in actual amphetamine abuse.
Perhaps I misunderstand you but lisdexamfetamine _is_ an amphetamine. That reads like saying that people prescribed an opiate exhibit reduced opiate abuse. It seems either tautological (not abuse because permitted) or obvious (cooperative supervised use reduces bad things happening) or perhaps related to drug safety (A simply being safer to use than B).
Lisdexamfetamine is not amphetamine—not chemically, not in terms of its half-life, not in subjective experience, and not in any study that tracks behavioral or long-term effects. At best, it's a prodrug of an enantiomer of amphetamine. You are also mistaken about the study. Reading even the abstract would clear that up for you.
Let me clean up the unnecessary, convoluted language before I answer: Q: Does it stop being called "abuse" once a doctor prescribes it? A: No. The prescription stopped hospitalizations due to amphetamine overdose.
Q: Is it simply safer to use drugs with a doctor's help? A: That was not answerable based on the study's design. It is also not a useful question to ask in this context, since it's comparing apples and oranges. Some of the worst cases of drug abuse are created and maintained by doctors. However, taking drugs collaboratively with a doctor is probably safer on average than getting them from random webpages.
Q: Is this specific amphetamine safer than others? A: Yes, as is the case with any substance we ingest. You can quibble over the details, but beer is safer than hard liquor. Likewise, different medications in the same category or receptor affinity group have different LD_{50} doses (the ratio of the clinically effective threshold to the threshold where 50% of subjects would die).
No, I was merely inquiring after what appeared to be a misunderstanding but apparently wasn't.
> Lisdexamfetamine is not amphetamine
Just to clarify, this topic is always needlessly confusing because "amphetamine" is used to refer to both a distinct chemical as well as an entire class of chemicals. Lisdexamfetamine is _an_ amphetamine in exactly the same way that codeine is an opiate (ie a prodrug of).
I'm not sure why you think I'm mistaken about the study nor why you are so condescending about a misunderstanding rooted in terminology. You yourself state that it is about relative drug safety and the study is also quite clear about this so it would seem that we were in agreement all along.
Emotional regulation issues are one of the most difficult ADHD traits and it's quite under recognized for how badly it affects many of us. This is likely the reason why anxiety misdiagnoses are also fairly common.
You can much more easily use the physicality of your surroundings to physically deny yourself the food than you can deny yourself anxious thoughts.
With eating there are 2 components to it, mental and physical, so you have more opportunities and more options and avenues to potentially control it.
The additional options to control it should IMO make it at least some amount easier to control in the end since some people may be able to take advantage of physical controls to limit themselves where that's not an option for anxiety.
As someone that uses food as a coping mechanism for stress, I agree with the GP - if the underlying problem isn't resolved, the weight will come back.
Then explain why people have so much trouble with it without resorting to a thought-terminating cliche
It’s a massive problem for several of my friends who are doctors. Patients start on something that works incredibly well for them then their insurance pushes them to Litaglutide and they loose all of their progress.
Some of it comes down to a fear of needles, some of it comes down to non-compliance, some of it comes down to access.
Daily injections are fatiguing on people. Its a big challenge with diabetes management.
https://www.theatlantic.com/ideas/archive/2023/06/pharmaceut...
Look at CAR-T therapies (your cells are reprogrammed to fight your cancer). Insured patients got access in the US long before, and to a broader degree, than national healthcare systems.
Today, CAR-T utilization in cancers like lymphoma are double those of Europe in many cases. Interestingly the UK is one of the highest in Europe (despite the controversy over cancer drug spending).
While true that the US has uninsured and not all insurance is equal, suffice to say you stand a better chance to get access to new technologies in the US than most countries.
Mounjaro is between 25-50% of the US price in other countries
Whenever you see a very large number for a medication or service in the United States, the patient doesn’t actually pay that number.
Companies generally have separate coverage programs for people paying out of pocket that drastically reduces the patient pay amount.
Those giant numbers attached to medications are virtually never paid by the patient.
The Lily and Novo Nordisk coupons seem to have quite short availability windows, according to several years of reading the various related subreddits.
The cost difference here is real.
0: https://www.goodrx.com/insurance/health-insurance/weight-los...
If you look elsewhere in my comments, I have no problem calling myself an idiot when I make mistakes. But I hate the noise that is bad faith arguing concealed in fancy words.
The problem is, prediabetic and folks who may have crossed 7.0 A1C once, and just overweight folks with docs who are willing to play fast and loose are demanding it. Skipping metformin and other first line treatment options that are way cheaper. For those folks, complications might be the next guys problem.
SSRI - about 10% chance of major sexual disfunction, often permanent, significant likelihood of sleep disturbance, majority get blunted emotions. Debatably effective.
Not really comparable.
It's completely unrelated to GLP-1s. 5+ years ago, we would have just called it "Anorexic face".
Men under 40 essentially have incredibly low mortality. Once you exclude cars and suicide it drops basically to zero.
Even things that are very very bad for you, like being very obese (BMI>40), are factors that scale a mortality that is massively dominated by age and sex. Even 3x mortality at 25 rounds to zero. At 60 background become 1% per year and a 3x increase would make a huge difference.
I would wager $50 that there are no contiguous collection of zip codes in the USA where the average 40 year old has a higher life expectancy than the average 30 year old in any other contiguous set of zip codes assuming there are over 1000 people of that age in both.
There’s nothing in these drugs that makes you lose more muscle than fat, you don’t lose any more muscle than if you do a regular diet, not even slightly.
Second, the drugs don’t do anything to cause you to gain back mostly fat, and people going off them have more success, not less, than your average person who loses weight rapidly whether through diet or other means.
The average person who is 50lbs overweight because they gained 5lbs a year for a decade will lose all of that weight within 6 months with nearly entirely positive side effects, and if they stop taking it, will regain a bit less than they did before, meaning it would take another decade to get back to where they were. That is unequivocally a huge net positive.
It’s not like Testosterone which does have dramatic negative effects when taken long term and can cause dependency.
It also happens to be extremely effective at reducing bad habits, and yes those habit changes persist after quitting - not perfectly, but surprisingly so. This even works for smoking, drinking, and gambling.
https://glp1.guide/tag/category-side-effects/
https://glp1.guide/tag/category-risks/
I try to tag all the new news of negative side effects there
And which of them are issues that people massively changing their diet and dropping weight, while also making lifestyle changes like exercising more (due to finding it easier after losing weight) would be likely to experience?
I don't think that's too much of a factor?
I mean, check how much (or rather how little) people learn of the stuff that _is_ covered in school. Tweaking the curriculum would just mean that instead of not paying attention in algebra, students would not pay attention in 'health education class'.
I mean the education system is its own mess for other reasons, but it's not a complete failure
(Food assistance is usually coupled with means testing.)
I am not saying that those variations are great from a health point of view, but they are certainly not as bad as staying obese.
what does that mean? in the UK it's for sale from numerous national-chain pharmacies on a private prescription (ie the pharmacy is selling it commercially and customers are paying cash, no insurance and no state subsidy) for less than $US270/month. it seems unlikely to me that the pharmacies or the manufacturers are taking a loss on this, and the UK has at least as strict drug quality standards as the US.
sounds like the US monopoly-holders are just charging a lot more because they can, because the insurance system obfuscates prices and gives everyone involved cover to rip off patients?
Doctors' jobs are to deal with the cases that go wrong. These anecdotes have no relevance without actual data on how often these problems occur.
This thinking seems correct to people who grew up knowing about the dark web, Silk Road, and who believe they could access any substance they want if they wanted it.
It is not accurate for the majority of the population. For the average person, misuse of drugs isn’t a calculated decision. It’s one of convenience and opportunity.
> In 1920, 1970, and now, heroin was legal, illegal with minimal enforcement, and illegal with harsh enforcement (except in SF), and the same percentage of the population was addicted at each time.
This is a very misleading statistic for multiple reasons, as if it was engineered for the purpose of obscuring the problem.
Why pick 3 separate dates and limit only to 1 drug? There is a massive opioid epidemic that was fueled by increased availability of different forms of opioids beyond heroin. In the 1920s and 1970s they didn’t have OxyContin being diverted, Fentanyl flowing into drug distribution networks, or even Kratom products available at the local gas station. The availability and convenience of these different opioids has unquestionably increased opioid addictions.
Even more recently, the widespread legalization of marijuana has led to an increase in the number of daily users and the doses that people consume, even thought the libertarian arguments maintained that no such thing would happen.
At this point I can’t buy any arguments that claim that availability of drugs has no impact on misuse or addiction.
I don't much care whether more people are addicted or not. When alcohol was illegal, booze dealers had machine gun fights in broad daylight on Main Street over it. When's the last time you heard about machine gun fights over whiskey?
Legalize it all. Heroin, cocaine, meth... sell it retail out of liquor stores in plain wholesale packaging. Manufactured by pharmaceutical companies, supervised by pharmaceutical engineers, unadulterated by poisons, measured doses, and include a dose of the antidote in the box. Make the junkies pay a deposit on a red plastic sharps container for their disposable needles.
I do not care how bad you think things will get... they're already that bad, but right now you're able to pretend that they're not. For every soccer mom addicted to oxy that you save, ten undesirables are dying of overdoses of fent in some filthy truck stop restroom somewhere. And we're spending half a trillion every year to do it, too.
You are making my point for me. The harsh restrictions on opioids haven't actually decreased the availability for addicts who are willing to go to black markets and risk dangerous injectibles and fent laced street drugs. All the restrictions have done is make it much more difficult for legitimate users like me. I broke my collar bone a few years back and was barely given any pills and had to live with a lot more pain than I should have. And the justification is that these harsh restrictions make it harder for addicts to get it, but as you pointed out, it actually doesn't even do that.
As for marijuana I would bet that the increase in the number of users has been more due to the decrease in public perception of how harmful it is rather than from its legalization. Is the usage increase limited to the states where it has been legalized? Furthermore, it doesn't matter if the usage increases, only if the problematic usage increases. Is there any indication that this increase corresponds to more serious potheads or just more casual smokers?
> it would be a difficult situation if they could pick them up impulsively from the medicine aisle
It would be a different situation, not necessarily any more or less difficult. Anorexics and bulimics are already in difficult situations. Without research into the actual patterns of GLP-1 abuse and their problems, I'd still bet on it being a better situation. That is, abusing GLP-1s is probably better than destroying your esophagus from bulimia. But perhaps not.
I was persuaded by libertarian-minded arguments when I was younger, too -- though not typically ones framed from "who cares", but rather those rooted in a framework of freedom. People will always be free to destroy themselves in numerous ways, singling these things out to try and curtail destructive use is an unprincipled exception. Furthermore, the methods typically available for such curtailing (laws, law enforcement, and medical gatekeeping) are crude, heavy-handed, and often inconsistently applied themselves, leaving a lot to be desired in preventing abuse while certainly doing a good job impeding legitimate use which causes harm. When you go drug by drug, we also see the argument from other countries with laxer (or no) regulation not becoming anything like what you might predict if you just listen to what medical professionals say will happen if you got rid of requiring them as middlemen.
I'm older now, and I still believe such arguments, for the most part, despite direct experience with people trapped in cycles of abuse, not just anecdotes from people with an incentive in perpetuating the current system. (If you want sad stories, you can hear them from all sorts of people, not just from doctors. If you want tragedy, open your eyes, it's everywhere. Nevertheless such things by themselves aren't evidence and shouldn't weigh strongly in policy decisions.)
The first qualifier to unpack "for the most part" is that I think if society turned a lot more totalitarian, it would be possible to actually prevent almost all abuse. But if we did, we would also need to crack down on already legal and available things. You bring up tylenol, but I raise you alcohol. I don't drink, I think it's bad for you, tens of thousands of deaths each year support my claim, I don't even need all the rest of the non-death negatives affecting/afflicting far more. I'm not going to advocate making it as illegal as fentanyl. I do think there's a missing consistency here though and it's better for policies to be consistent. But consistency and the medical industry mix as well as oil in water. Modafinil, a stimulant that seems as harmless as caffeine, is regulated in the US as Schedule IV (same as Valium, which Eminem and many others were famously addicted to). But adrafinil isn't regulated that way, you used to be able to get it OTC / ordering online e.g. from walmart pharmacy, there's even an over-priced energy drink containing it now https://adraful.com/ yet it metabolizes to modafinil. Fladrafinil works similarly, is unregulated, and you can buy it in powder form by the gram on Amazon. Or just get modafinil from grey market sites (not even on the dark web) that ship generics from India because its status is never enforced, and save your liver some effort.
The second qualifier is that restricting access can sometimes be a good thing, and worth it on margin, when such restriction is considerately targeted and probably temporary. Part of the cycle of abuse for a lot of people is voluntarily committing themselves to a rehab center where their freedom of choice and access to many things is severely restricted for a while, and after enough cycles, it can work out in the end. That's a targeted restriction on the individual level, and having it forced on someone (involuntary commitment) is something hard to do and generally requires other harmful crime. Since fentanyl was brought up in the other reply chain, it's notable that this year fentanyl related deaths in the US continue to decline, this year by quite a lot. NPR gives 8 guesses as to why that is, with the top one being increase of access (just as I want for everything) for naloxone, which can reverse overdoses: https://www.npr.org/2025/03/24/nx-s1-5328157/fentanyl-overdo... Notably none of the theories are directly related to restricting access on top of current efforts, only in reason 2 (weakened product) do they suggest that some have thought the current enforcement in China, Mexico, and the US might be a factor in that. (I would have naively guessed as one of my theories that the current administration's various efforts could have something to do with it.) And notably none of the theories, except weakly 2 (weakened product) and 7 (skillful use) suggest that removing the barriers to getting fentanyl would lead to significantly more deaths. So while I think there's room for the government to make targeted time-limited society-level decisions that can produce marginal benefits by restricting access to something, the current poster child case of fentanyl doesn't seem like a strong candidate to support that view for either it or other drugs (especially those with more positive uses). (Indeed, a common libertarian point is that a lot of fentanyl harm specifically is because of reduced access to other drugs, so users get surprise-fentanyl from their illicit sources. And no, people getting those other drugs is not from growing up with the dark web, it's still often just "I know a guy who knows a guy" -- or just strolling down to various bus stop hubs in major cities like Seattle and looking for the loiterers with hoodies.)
I don't think this is completely true right? Rather, it's more accurate to say that customers that are seen as healthier get to pay less premiums, but customers that are seen as unhealthy have to pay more.
In both scenarios, you, as the insurance company, still want to be minimizing the amount of care you actually pay for.
In other words, to maximize profits, it seems like the best customer is one that's high risk (high premiums), but less likely to require a catastrophic payout. In which case, it feels like an obese high risk patient on ozempic seems like a pretty solid deal.
> In the simplest terms, the 80/20 rule requires that insurance companies spend at least 80 percent of the premiums they collect on medical claims, effectively capping their profit margins. If insurers fall under this threshold, they must rebate the difference to policyholders.
Source: https://www.aeaweb.org/research/regulating-health-insurers-a....
So that would mean that the only way to increase the profit is to reduce over head and keep more of the 20% or increase the amount of claims. Paying out less in claims would mean they have to give rebates back to the customers.
As with everything health care related I'm sure it's more complicated than that and I'm missing something. For instance my health care plan is through my employer so everyone pays the same premium and the provider doesn't get to set it based on how healthy each employee is (although certainly the whole group is negotiated when the contract comes up for renewal).
The trick to avoid it is to put on muscle mass, which regulates your blood glucose levels.
Get after it!
Personally I lost a ton of weight doing full-on keto (I specify, because some people just kinda cut out carbs) and then kept it off for over 2 years. But I put the weight back on after that, albeit slowly (over the course of maybe 7 years).
I've also done Mounjaro, and I can keep it off a while after I go off it, but not that long.
YES, you have to change your habits, maybe lifestyle, maybe deal with other issues in order to keep it off. But I think, not only is that difficult, it's not a "you did it and you're done" deal. It's easy to slip backwards, and I won't make any claims about you personally, but for anyone who's kept it off for less than a year, I think the good money would be on it coming back within another year. I doubt someone is "out of the woods" even two years on.
I don't know what my secret is, I lost 100lb and have kept it off for a good 5 years now. But it is a bit of an uphill battle. If I wanted to, I could easily just give in to temptation and slip right back but it hasn't happened yet.
I've had pretty good hb1ac's when my blood sugar's were all over the place and in no way healthy.
I've known many, many, people to lose weight via extreme diets such as keto. Such diets are unsustainable for almost everyone. It will work for a year or two, but inevitably, they will falter. Often it only takes a very small amount of stress - maybe a hard project at work.
I have never met anyone who uses something like keto successfully. It has always failed, with everyone I've talked to. That doesn't your diet is as extreme as keto. But, it does mean you're not out of the woods, and your perspective on this isn't exactly trustworthy.
In order for me to gain all that weight back, I would have to eat a ton of calories per day and completely stop moving/exercise.
It’s been nearly a year since I started losing all that weight and I haven’t slide back on my diet. It does take discipline
Yes, this is what usually happens. You've spent far, far more time with those calories than without.
> It’s been nearly a year
Okay, that's not a very long time is my point. It's much too early to think it's over.
I'm not saying that it's not possible to get off GLP-1s and maintain a good lifestyle. I'm saying that I don't think it's a moral failing or a lack of... sigh... "discipline" if people need to be on these drugs for life. Frankly, I think it's very rich that a baby skinny person is lecturing us on discipline. You've been doing this for less than a year. Discipline means sticking to habits for a long period of time, even when times are tough. I would not classify less than a year as that.
I notice no ill effects, I just had my three month checkup with the doctor and he thinks I’m good on maintenance mode at max dose, I’ve still got about 34 pounds as my total weight loss goal. Really an ideal case.
For my wife on the other hand she just has constant diarrhea which she blames on the drug, and is only on 5mg. She also gets headaches from the medicine. She’s lost only 20 pounds, even though she needs to lose another 120 or so to be “healthy weight”.
However, before she started taking Zepbound she was only able to walk a few hundred feet at a time, because her back hurt so terribly. The anti inflammatory “side effects” she’s experiencing have massively improved her quality of life, even without huge amounts of weight loss.
My lowest sleeping heart rate is now at least 10 beats higher than before starting (it comes down during the week to about 10 over)
The night after taking the injection my sleep is crap, and the heart rate is 5+ higher again
I have lost 20lbs since mid March with no real effort, and we’re about to do some blood tests for specific cholesterol numbers, which was one of the reasons to try this out.
Like if your stomach really hated taco bell and you start taking a pill and now you get the same effect from artificial sweeteners you don't care because you're still within what's normal.
That's the level of side effects these things have.
Look, I hope you're right. If in 20 years time we look back at these comments and no negative effects have manifested then I'll happily buy you a beer to celebrate. Hell, I'll buy you an entire crate of beer. But I think this is one hell of a risk to take.
The obesity trend has happened almost in lockstep with the proliferation of highly processed foods. Butter and animal fats being replaced with low quality, hydrogenated vegetable oils. Cane sugar being replaced with high fructose corn syrup and other highly processed sweeteners. Sodas and sugary juices replacing water. Food like substances with little to no nutritional value designed solely for taste and texture.
These things are calorically dense while containing nothing the body needs to thrive (though the calories will allow it to survive). They are easy to eat in large amounts and leave you feeling hungry. And unfortunately, these are the most affordable and readily available foods in the United States.
I don't think this is a conspiracy. It's just capitalism. These low quality ingredients are cheap and extremely shelf stable. In addition, the government subsidizes the production of this garbage.
So to say obesity has persisted through everything we've tried is a bit backwards. It would be more accurate to say "a percentage of the population has managed to avoid obesity despite all of the things we've tried."
- Make healthier food options more affordable and readily available - Better nutrition education - And if you really want to get the government involved, ban the use of some additives, oils, sweeteners, and dyes that allow the creation of many of these highly processed foods
But people want Ozempic, they will actively seek it out, and in numbers that can actually make a dent in the problem. In a way that people don't seek out healthy alternatives or exercise. Because people don't want to be healthy, they want to be skinny. You can't control people, you can only respond to them and, ya know, whatever works man.
I think there's more than one way to achieve that. It doesn't have to be bans or subsidies. A lot of it has to do with education and competition. Unfortunately, they are kind of a circular dependency.
- There's so much cheap, highly processed food out there. The companies pay for prime real estate on the shelves and expensive marketing. It is chemically engineered to exploit your pleasure senses when you eat it. That is a hard beast to fight without proper education. And not just the food pyramid, but in depth explanations on why you should avoid it and what to eat instead. There are large groups of the population that have no idea that pop tart or cereal are not a healthy breakfast option.
- If there were more companies creating and promoting healthy, less-processed food options, the price would naturally comedown due to competition. But without the education, these products just do not sell as well. If I gave you some natural peanut butter or almond butter (just almonds or peanuts - 1 ingredient) and I gave you a jar of a more common peanut butter like JIF (sugar + hydrogenated oil for better consistency) and you had no other information at all, you're choosing JIF 10 out of 10 times. It's cheaper, it taste better, and you don't have to stir it. These megacorps prey on that lack of knowledge.
More education -> make better choices when buying -> more companies selling those choices -> cheaper prices on those choices.
The thing with healthy food is not that they are expensive, because they aren't, raw veggies, whole grains, raw chicken, raw pork are not that expensive, especially if you buy in bulk. The problem is that it takes time to cook them, which people may not have, and in general (at least the USA), I feel like people suck at cooking, and don't really have a good food culture of enjoying cooking, like italians do for example.
I believe something similar happened to cigarettes, they are super taxed as well as all the health campaigning around them.
Matt Levine in his column actually addressed that GLP1 could cause the junk food/alcohol/other addictive stuff industries to lose a lot of money due to less consumption.
It's possible that junk food becomes a niche thing given enough time and GLP1.
Regarding the graph about slippage: yes, that looks like the Covid peak. However, even assuming this recent trend is an anomaly, the industry is in a changing landscape and needs to adapt. New metrics and criteria, and the fastest mover will capture the market. Business as usual.
I don't feel sad except for the people who managed to bring their health issues under control and now can't get life insurance.
[0] https://www.swissre.com/reinsurance/life-and-health/l-h-risk...
But then I just wanna talk about how long life is in terms of weight gain! Even two years is an “short” amount of time!
Last month, I looked over my doc where I keep track of my weight and I’ve been gaining about 1 pound a year since I started tracking it… 20 years ago. That’s a significant amount and I maybe have 30 years left to go! (this comment is not about you specifically, just musing on how long life is in terms of weight gain)
Since that happened, it really kicked us into motion plus shaking the COVID funk!
I wish you the best as well
As I stated, I originally tried semaglutide with no luck. I didn't try tirzepatide. I've been taking a very low dose of retatrutide - about .5mg twice a week. It seemed to be waning in effectiveness a bit so I upped the dose to 2mg/week for now. It's a night and day difference. Most days I go to the bathroom maybe two times, as opposed to the maybe 5-10 times I would need to unmedicated.
To be clear, this isn't an approved use of the medications (and retatrutide isn't approved at all yet, though it pretty clearly will be). However, they slow down gut motility - and as a bonus for your refusing to eat during week-long work trips, they'd probably at least help with that too, in terms of hunger.
That's kinda wild, because it seems like holy shit if you're taking a drug that lets you drop 10-20% of your body weight from obese down to normal why would you stop taking it, but people do.
Gating it behind mandatory expensive, difficult-to-schedule appointments with a specialist who is in abruptly short supply where the insurance company is doing their damndest to kick as many of them off their network as they can without getting caught to keep the shortage going is certainly part of that strategy. And the result is “people do not stay on the drug”, which is their goal, and if they don’t meet that goal they have an even bigger problem and can’t continue to exist as a functioning company.
Source: UK based friend who says the pharmacy will refuse to sell them once they fall under BMI 25 (still overweight). They'd prefer to be on the tiny maintenance dose but it seems to be very hard to achieve (unless you're going off the market completely).
We'll also keep you on a small maintenance dose if you want, that's a conversation you'll have with your clinician and they'll judge whether it's medically appropriate. As far as I know, there's usually no reason to prevent you, though.
I understand that's not really how it works, but people often go very much by feel more than anything else.
In this sense it's like any diet: they "work", but if you don't permanently modify your food intake, the weight comes back as soon as you go off the diet.
I think that in a few more years the number may stay at 25% (or whatever) but that the makeup of the 25% may be different. That is, people will go off it and back on it if they see their progress reverse but that will happen to different people at different times.
Source? Everyone I know who stopped taking it rebounded a bit, but not to where they were. And no literature shows 100% rebound to my knowledge.
Some of the prediabetics I knew who stopped taking it (N = 2) stopped being prediabetic (N = 1).
Happy people with no issues are less likely to post, or post as often.
That said, much sympathy for the people who do experience particularly bad side effects.
This must be an existing named bias, but my google foo is failing me.
- change your diet. you can't eat the same food at the same volume. or even is smaller volume if the food is a burger, etc.
- watch your drinking, your tolerance for alcohol is reset, and again on the volume thing
- drink a lot of water. apparently opposite to all the volume warnings above, lol
- split dosage and inject twice a week. (i dunno, talk to your doctor. also this only works when you have a vial and not the auto-injectors, though apparently the autoinjectors are way more expensive)
On the other hand, when i ask about what happens if you go on a bender and eat two burgers and lots of fries and drink a six pack?? From people that used to gladly do that: "gross, why would i do that?" That there is the real change.
> If you do over-indulge (with food or drink) the side effects can sometimes be massively amplified and you feel terrible for days.
Never had anything like that.
This is likely a sampling error, and you see it with all drugs to some extent. No-one goes on a forum to announce to the world that they’re not having any side effects from [whatever].
While I have no doubt that obese people have gradually made appetite control harder for themselves, the full feeling you get on GLP meds is in no way the way us normal-weight people feel.
I too, could easy eat a whole bag of doritos after some pizza and then decide I want ice cream. I don’t do that because I know it’s an awful idea and so I maybe just have a pickle after the pizza instead.
On GLP-1 medications at a decent dose I don’t know if I could force myself to eat anything after half of my normal serving of pizza.
That’s not the way the rest of us normally are apart from rare exceptions, I assure you.
Personally, I really like how, on the medication, it's easy to say "nah, I'd better not". Off the medication, it's impossible, as I have to eat whatever is in front of me, or I won't stop thinking about it.
I literally have no feeling of 'full'. I used to. I have no idea when it stopped working, but it definitely stopped working.
You can't know what I feel. I can't know what you feel. I'm fit, I have zero appetite control.
If I stop doing tons of exercise, boom, problems. I got old, I stopped moving as much, boom, problems.
People like you are part of the problem, not the solution.
Honestly, you wouldn't say this shit to someone's face.
It was honestly hard enough posting this here in the first place and then a dick like you comes along.
Cheers thanks for ruining my day you prat.
I wouldn't recommend that to everyone, but it helped a lot for me.
The simple fact is, when it comes to drugs, the development is basically paid for by Americans.
I would feel bummed out, but not angry or like I actually got ripped off, in other words. When I signed up for the 20-year term, part of what I was being asked to do was estimate how likely I think it is for this firm to actually be around for that full 20 years. That's just part of the game.
People with more complex medical conditions often can get life insurance from smaller, specialized providers... and at much higher rates. But the big mass-market players offering inexpensive term life products are only offering them that cheaply because they really control the risk profile during underwriting.
Yes, some life insurance companies can make mistakes or get unlucky. after a few went bankrupt from whatever you are imagining, you'd think that the remaining companies would change their risk models or simply charge higher premiums?
That, in fact, is the general (and beneficial) function of insurance: You only need to provision for the expected loss (plus some fee for the insurance), not the maximum loss (which many people could not afford).
It's not a gamble, you transfer your risk to a collective.
I'd argue that it should be illegal again, as a moral hazard (directly contributing to countless murders and other schemes) and as a particularly morbid form of gambling.
Jeez.... I guess in that scenario I become a billionaire because it will be very easy to scoop up some VC money to snoop up some of those newly unemployed actuaries to monopolize the market at a profit margin an order of magnitude larger than any of my now non-existent competition, because this is a financial product and doesn't require months of building a factory or something to offer.
How many years experience do you have in the insurance industry that you're so confident to talk like this?
> because this is a financial product and doesn't require months of building a factory or something to offer.
How many financial instruments have you launched? If the answer is zero, you should refrain from any conversations on the topic because your opinion literally means nothing.
Novo lawyers messed up, didn't renew the patent filing over a payment dispute. Hilarity is ensuing.
https://www.cnbc.com/2025/07/09/hims-hers-generic-semaglutid...
And once generics for GLP-1s are going in Canada, Section 804 of the FD&C act becomes VERY interesting: https://www.fda.gov/about-fda/reports/importation-program-un...
Reimports of generics from Canada into the US here. we. go.
>Novo Nordisk’s lawyers requested a refund for the paid 2017 maintenance fee of $250 Canadian dollars ($185) because the company wanted more time to see if it wanted to pay it, according to letters included in the documents.
>Two years later, the office sent a letter saying the fee, which now included a late charge bringing the total to CA$450, was not received by the prescribed due date.
>Novo Nordisk had a one-year grace period to pay, but never did, and so its patent lapsed in Canada. It lapsed in 2020 when the fee was not received, but it doesn’t expire until January.
Tirzepatide is the most potent GLP1
https://glp1.guide/content/semaglutide-vs-tirzepatide-clinic...
Before I started experiments on "my lab rat" with retatrutide, I found that combination of the about half max dose of semaglutide and 1/3 of Max dose of tirzepatide had the best combination of losing weight and lowering side effects. But another "lab rat" did not respond that well to this combo and we keep adjusting it.
Retatrutide so far looks the most compatible, but it is sample of 1.
That said, Reta is a triple agonist[0] and it seems to be quite amazing with good muscle retention as well -- it's unclear if this is just the people who are taking it being more likely to be gym goers. Up until now the only formulation I've seen that specifically targets preserving muscle is GLP1s in combination with bimagrumab[1].
[0]: https://glp1.guide/content/a-new-glp1-retatrutide/
[1]: https://glp1.guide/content/preserving-muscle-glp1s-with-bima...
A fancy way of saying: I *think* Semaglutide is best.
Unless you mean that Semaglutide worked best for you, right now the research points at Tirzepatide being most effective for weight loss (says nothing about t2d though).
While 2032 seems very far away now, its actually remarkably soon in the grand scheme of society.
My understanding is one of their defendable moats is the patent not on the compound itself, but on the injectors. Which is far longer.
They have also made a business of either stifling or “catch and kill”ing of the generics for their products. It’s cheaper to pay off a generic manufacturer to not compete with the new thing than it is to lose price elasticity of the n non-generic.
That is very typical in the drug/medical industry. To the point where it is sometimes (often? usually?) an intentional strategy.
There are dozens of autoinjector manufacturers, and generics can and do change manufacturers. It looks like semaglutide uses an off the shelf Yposomate pen, although Novo Nordisk uses different injectors depending on the country and indication.
Novo Nordisk also has an in house pen, but this would not prevent someone from competing, unless patients simply prefer that design to a generic one.
Eminent domain would still require fair compensation to the company, so you'd have to pay them more or less what they'd lose from not having the patent anymore.
(Though I think the term you might be looking for is 'compulsory licensing' or so? Not sure.)
The drug companies are presumably pricing optimally for profit (but not for maximum public benefit, for which the optimum price is ~0). You could calculate the net present value of the drug companies' total profits attributable to the patent, add on 10% as a bonus, and pay them off. If the welfare gains of having cheap drugs are genuinely greater than the value of the patent to the holder, this would be win/win.
“If you invest hundreds of millions and it turns out to be life changing, we’re going to seize it”
The point is that you don't get to withhold the drug from people to maximize profits.
What dosing are you on? If you’re still doing 2.5mg (smallest available in the auto injectors) perhaps try a compounding pharmacy for a month or two and you can experiment with lower doses and a different dosing schedule?
During my peak weight loss period I found that matching my injection schedule to the 5 day half life of Tirzepatide and adjusting the dose downwards to match this schedule helped with any side effects - including the “fading” of effects those last 2 or 3 days for me. There are half life calculator spreadsheets available on the internet that can help dial it in and keep your theoretical concentration more flatline vs peaks and valleys.
The current dosing regime is based on the single FDA trial that LLY did and is certainly not going to be the common practice a decade from now. It’s largely designed around patient compliance than anything else.
That said - everyone responds to this drug much differently. My little group I’m in is all over the map. Some folks lose weight consistently with tiny doses every 2 weeks, some are going above the recommended maximum weekly dose.
I also found food choices matter. A lot. The best part of tirz for me was being given mental space to stop eating shit food and start eating “clean” consistently. When on high dosing I absolutely would have a bad day if I decided to take my shot and then eat a typical American diet later.
The primary mode of action from the drug is simply you eat less. But it shouldn’t be due to you feeling too sick to keep anything down. That sounds pretty horrible.
tbqh being extremely overweight sucks in a whole lot of ways. While the side effects sound miserable, they will only be temporary. The damage done to my body and metabolism as a result of being this heavy for this long piles up every day, so if I have to suffer like this then I'd rather do that than have a stroke and die in front of my family.
The hardest part about this diet for me has been finding sources of protein that get me at my goal with the small sizes of the meals I do eat.
I am at the second dose up from the starting dose (5 mg vs 2.5mg), and the side effects are about the same between the two doses. They didn't start out that way, but they ended up at about the same level of misery.
I tried Trulicity when it first came out. It was not as effective, but the side effects for me personally were less.
I'm on Mounjaro for type 2 diabetes, not weight loss, so my main focus is on how it treats my t2d. The weight loss is a nice side benefit.
The medication does make me feel fuller faster, so I eat less when I do eat, and I stay fuller longer. This helps me lose weight because it reduces the number of calories I consume.
The side effects make me feel so sick in those days after that I am effectively fasting all day (I have a small dinner, but keep drinking water so I don't dehydrate). That helps in losing weight.
That said, my original comment was meant slightly tongue in cheek - I know it is effective, but sometimes it's kind of darkly funny to think feeling bad from it is having the highest impact.
This might be the left-wing analog of climate denialism.
I don't think it's possible to send dms here....
As far as I know, though, you can move to us from another pharmacy even with a BMI of < 25, as maintenance has different criteria than new prescription.
I'm not a clinician, though, so I may be wrong. If you want to email me, I can ask the clinicians and tell you for sure.
The 'collective' part is a distraction when trying to understand insurance.
Similar for insurance to work you don't need to have a group of people who are in the same situation as you: in principle an insurer can work out the risks, even if you are in a unique situation.
It's just that working these things out costs time and money, so it's cheaper for you, if you are like everyone else.
But eg if you are a famous singer, you can insure your voice just fine. Companies also regularly purchase insurance against customers winning prizes. See https://en.wikipedia.org/wiki/Prize_indemnity_insurance
Do you have any data on how much of a problem that is?
But it's enough of a problem that there are quite a lot of legal journal articles about it, e.g.: https://scholarship.law.campbell.edu/cgi/viewcontent.cgi?art...
Life insurance has killed a lot of people. People who would otherwise be alive but for the existence of payouts upon their deaths.
If I sign up for a big life insurance, those guys better give me a body guard and a food sniffer to protect themselves from a big payout.
Suppose you want to insure your home against fire, which could create damage of say $1m with probability 0.1%.
Without insurance, you'd have to put aside savings of $1m (the maximum loss), that would remain untouched with 99.9% probability, and be used to cover the fire damage otherwise.
With insurance, you'd pay the insurer $1m * 0.1% = $1000, plus a bit on top to cover their cost and profit. In case of fire, they cover your loss. Everyone wins.
So, with insurance you replace provisioning for the maximum loss by provisioning for the expected loss plus a fee.
(That's why one should not get insurance for small items (where one can cover the max), such as baggage or mobile phones or so, but for large items, such as house, life, health).
Similarly, I can't really understand insuring against expenditures that are certain. Eg insuring for the cost of routine pregnancy (as opposed to insuring for complications only). Or even worse: yearly allowances like 100 dollars flat for new glasses: just decrease my insurance premiums by that 100 dollars, please. (Unless it's a tax dodge, then it makes sense.)
My comment was a quick and sloppy summary from my memory of an interview from several years ago. I think it was the EconTalk with the author of Drug Wars.
A more detailed and comprehensive list of these tactics to reduce competition either during or after patent expiry:
Patent-related strategies:
• Building “patent thickets” by filing multiple patents on different aspects of the same drug (formulation, dosing, manufacturing processes) • “Evergreening” - seeking new patents on minor modifications to extend exclusivity periods • Filing continuation patents and divisional applications to extend patent timelines Product lifecycle management: • “Product hopping” - making minor reformulations or switching to extended-release versions just before generic entry to move patients to the new version • Discontinuing older versions that generics would reference
Legal and regulatory tactics:
• Pay-for-delay settlements where brand companies pay generics to postpone market entry • Manipulating FDA safety programs (REMS) to make it difficult for generics to obtain necessary samples for testing • Citizen petitions to the FDA raising questions about generic equivalence
Market-based approaches:
• Launching “authorized generics” through subsidiaries to capture generic market share • Exclusive dealing arrangements with pharmacy benefit managers
https://pmc.ncbi.nlm.nih.gov/articles/PMC11457043/
That articulates it better than I will
There are some bad patents that should never have been granted, like Novartis' famous 631 patent [1]. However, those are the exception, not the rule. If you want to put a generic drug into an auto injector, there are a dozen generic autoinjector companies looking to take your money. Drug + autoinjector does not pass the US patent office non-obviousness test (for obvious reasons). What gets patents is custom design features - bells and whistles. New features are part of the roadmap because customers will prefer them over competition without them, not because it magically extends prior IP (that isn't a thing).
https://www.fiercepharma.com/pharma/regeneron-advances-antit...
It’s rarely because of a new technological breakthrough, but rather a way of drug companies lengthening the time they can profit off a drug.
If they released it earlier they would simply take market share from themselves, but by releasing it close to the time of generics they take market share from generics.
Why didn’t Wegovy come out 5 years sooner? Why does it use a different injector than Ozempic? I don’t know but sounds quite similar to the ER/XR strategy.
Here are some choice parts:
> Drug manufacturers listed 22 patents after FDA approval of the 10 products in the cohort...Post-approval patents only extended the duration of protection on 2 products (median 4.6 years.
This is makes sense if there is actually something novel to add [keeping in mind the authors are treating any IP as if it protects the entirety of the product. A sugar coating or whatever wont protect the non-sugar coated pill.
To the extent I agree with the paper, it is that the 30 month hold is weaponized and should be reviewed and the issue with settlements should be addressed
Right now, it would be hard for an amateur to make a living starting up a new life insurance company, because there's lots of competent competition.
However, _if_ all existing life insurers went bankrupts, then, yes, you could easily make a killing by starting a new slightly less incompetent life insurance company.
Onus is on you to prove that if every single life insurance provider was suddenly Thanos snapped out of existence tomorrow, we wouldn't see a swarm of hungry financial professionals swoop right back in to recreate the service within weeks. That seems like a laughable claim to me, but maybe you know something I don't.
(Edit, for future readers: ecb_penguin seems to have missed the question earlier in the thread I was responding to:
>... and the question was about the aggregate effect. What happens if all life insurers go bankrupt?
Emphasis mine. This was to clarify that yes, the original commenter meant literally all providers.)
> Term life is just not that complicated a product at heart
Sure, it's easy if you don't know what you're talking about and just make stuff up!
> Onus is on you to prove that if every single life insurance provider was suddenly Thanos snapped out of existence tomorrow
Literally nobody said that would happen. Now you're arguing points that nobody made.
You have no experience in the area, arguing things nobody said. You're perfect for VC money, lmao.
> That seems like a laughable claim to me
Nobody made that claim. Why are you laughing at things nobody is saying? That's weird.
> That seems like a laughable claim to me, but maybe you know something I don't.
I would 100% guarantee people that have worked in an industry know more about it than you do.
Textbook demonstration of the Dunning-Kruger effect. You have no knowledge or experience in an area, but you're confident you know how it works, moreso than the actual experts. https://en.wikipedia.org/wiki/Dunning%E2%80%93Kruger_effect
I think this very accurately sums up your comments.
Their study was mostly just a statistical artifact.
You do not want the drug meant to subcutaneous to go into the blood steam. This is true for GPL-1s (all peptides for that matter), as well as insulin, and definitely mRNA vaccines.
I'll add that while it isn't a big deal, I definitely feel the needle; sometimes worse than others. (I'm using 8mm 30 gauge needles.)
If you have very little body fat, your glutes are probably a better place.
Source: I take HCG and have to use injection 2x a week. 27G is my favorite..
https://medneedles.ca/products/1ml-27g-x-1-2-sol-care%E2%84%...
Eli Lilly will soon release key data on its weight loss pill orforglipron - https://news.ycombinator.com/item?id=43465346 - March 2025
I don't think it's made any difference to any addictive tendencies or my bad habits (and with ADHD, those certainly exist). It certainly helps with the appetite of course.
This is definitely anecdotal evidence, but it's wise to hold on longer for more data to come in before advocating for it on those grounds alone.
I’ve never had an addictive personality but I also found I gave up a couple habits while on it.
I wonder if ADHD specifically isn’t as prone to positive effects there.
The auto pen misfired the other day and I called Eli Lilly and they immediately emailed me a voucher for a free 4 pack of the shots. It’s also eliminated my sleep apnea (via the weight loss).
The pen has about 4 doses in it so you twist it to set your dose. You attach a needle tip to the pen and give yourself a poke, press an inject button on the top and a spring loaded ratchet system pumps in the dose amount you set (making a wonderful ticking noise as it progresses). Pull out and toss the needle and put it back in the fridge for next week.
I do manual injection which involves doing the full prep work. It takes about 3x as long to setup but is still only about a 3-5 minute process in total.
Most companies move to improve their product when needed to stay ahead of the competition.
That's how you get improvement.
It’s a rapidly absorbed peptide suspended in water, it could even be used with a transdermal patch, so it doesn’t matter that much where it gets in or how deep. Best to avoid painful areas though.
My heartburn I suffered from is completely gone but that’s because I just absolutely stuffed my face, I felt like I could never eat enough food.
To say 'billions', I'd assume you'd want at least 2?
I've never used Ozempic, but my understanding was it used a device similar to insulin pens--dial you dosage, attach needle, insert needle, press at the base of the pen to inject the selected amount. Also no way to pull back to see if you hit a vein/artery.
Either way super simple and quick. Fairly painless. I had a weird rash one time, but apart from that a total of about 15 injections haven't had any issues on either Ozempic or Trulicity in terms of injections. Others may have difficulties, but it's been super easy IMO.
Peptides don’t have the same negatives as say insulin, but preferable to not have them in your bloodstream nonetheless.
And it's mostly for people who have plenty of stomach fat, so even less chance of hitting something else.
I went down this rabbit hole after being handed a 100 pack of insulin needles and an estradiol vial with zero instruction - seemed irresponsible at first, but it turns out it's pretty hard to mess up.
https://www.cmh.edu/siteassets/media-documents-for-depts-sec...
SubQ has an even lesser risk of hitting a blood vessel.