12 ms·

I was wondering if there really are no negative long term side effects, could this finally lead to universal healthcare in the US? It seems like a lot of our co

I was wondering if there really are no negative long term side effects, could this finally lead to universal healthcare in the US? It seems like a lot of our costs (aside from the obvious medical industrial complex skimming massive profits) comes from health complications related to our obesity epidemic.

anon7725 2y ago
IIRC the GLP-1 drugs have a black box warning for thyroid cancer, as well as some other potential side effects. Still, I think NNT < NNH all things considered.
- toomuchtodo 2y ago
  Fractyl Healthcare is working on a gene therapy targeting this pathway. Chronic maintenance is a temporary hack imho. Long term fix is patching the genetic bug around a miswired reward center. https://news.ycombinator.com/item?id=38495653 https://news.ycombinator.com/item?id=38495653
  - readthenotes1 2y ago
    So a drug to counteract the effects of the drug to counteract the effects of a poisonous calory-provisioning industry. Perfect!
    - deleted 2y ago
      [deleted]
    - toomuchtodo 2y ago
      Sort of? Gene therapy is a permanent fix where as GLP-1 agonist compounds are needed perpetually for maintenance. https://getyarn.io/yarn-clip/dd4f2296-2186-45d6-b42a-10966b4f9263 https://getyarn.io/yarn-clip/dd4f2296-2186-45d6-b42a-10966b4...
  - fragmede 2y ago
    there's also ultrasonic brain surgery to fix the miswired reward center. https://youtu.be/7BGtVJ3lBdE?t=869 https://youtu.be/7BGtVJ3lBdE?t=869
marcuskane2 2y ago
1) There are very serious long term side effects, people are just either unaware or value weight loss enough to tolerate/accept the risks and harms. 2) Your "aside" there is the whole thing though. Obesity drives a lot of costs sure, but Obamacare legislation enshrined health insurance companies and pharmacy benefit managers as essentially government-backed money printing machines, so it's going to take tremendous effort to change any legislation, because they can and will spend literally billions of dollars to keep their monopolistic position.
- Fernicia 2y ago
  What, in your view, are the "very serious long term side effects" of semaglutide/GLP-1 agonists?
  - ughjkiu 2y ago
    [flagged]
    - choilive 2y ago
      The very serious long term side effects of obesity definitely seem worse than of glp-1 agonists, although time will tell.
      - ughjkiu 2y ago
        [flagged]
        choilive 2y ago
        Severe obesity can take off 10+ years off your life. I would say thats a pretty serious side effect. Heart disease, diabetes, liver diseases, kidney diseases, gallbladder diseases, pancreas diseases, cancer, sleep issues, fertility issues, sexual health disfunction, mental health problems, to name a few obesity related side effects
readthenotes1 2y ago
It's pretty awkward to talk about making people form a lifelong addiction to one drug (semaglutide) to counteract the effects of making people form a lifelong addiction to a poison (sugar). If we spent half the money involved in this scam in removing added sugar from the grocery store shelves we'd beat that epidemic (don't believe me? Look at pictures of people living before the low-fat high carb poisoning in the 80s and 90s)
- Zelphyr 2y ago
  I would add ultra-processed foods to this as well. I firmly believe that, decades from now, we will look back in horror at what food manufacturers have done to us.
- diffeomorphism 2y ago
  Why is this an "instead"? We already know that people on semaglutides buy less junk food because to them it is less addictive. Less demand, less supply. If anything, this seems like a useful way to smooth the transition to less unhealthy food supply.
  - alamortsubite 2y ago
    People are effectively on these medications permanently or they regain whatever weight they lost on them. So unfortunately the transition isn't so much to healthier diets, but to taking weight-loss drugs forever.
    - orwin 2y ago
      Is this true? Is the rebound effect as high as you think? Because I know 2 people who took it for like 3 years, and while they took some weight back, they're not obese anymore.
      - alamortsubite 2y ago
        Not according to Novo Nordisk. https://www.bbc.com/future/article/20240521-what-happens-when-you-stop-taking-ozempic https://www.bbc.com/future/article/20240521-what-happens-whe... The same trend was seen after the 2021 trial, known as Step 1. After 68 weeks of semaglutide injections, the average patient lost more than 15% of their body weight, but within 12 months of treatment ending, patients regained two thirds of their prior weight loss on average. This was associated with a similar level of reversion to the patients' original baselines in some markers of their cardiometabolic health – a category which includes conditions such as diabetes and heart attacks. Both Rubino and other experts around the world have seen similar patterns when administering GLP-1 drugs in their clinics. "There will be a small proportion of people, 10% maximum, that are able to maintain [all] the weight they've lost," says Alex Miras, a clinical professor of medicine at Ulster University.
matwood 2y ago
Not sure on leading to universal healthcare, but it will absolutely impact healthcare. The obvious ones like less heart disease are huge. Then others like fewer knee replacements, and fewer CPAP machines required, the list goes on. GLP1s have also shown to help with drug and alcohol cravings so there's an entire other area to explore. I could see where the government simply makes them available to most people.
malfist 2y ago
Buying the stuff from the drug manufacturers is crazy expensive. Over $1000 a month. Going through a compounding phramacy is much cheaper, I pay around $249/month for my script. You can go even cheaper and buy the peptide yourself from places like peptide sciences and compound it yourself, less than $100 for a 3 months supply, but you increase your risk profile pretty significantly going that route. My partner is a pharmacist and that type of mixing (assuming you do everything correctly) is considered acceptable for "immediate emergency use", not mix up and use for a month or three and keep it in the fridge in the meantime. It's a small risk to be sure, but non-sterile compounding at home is riskier than having a compounding pharmacy do it the right way.
theevilsharpie 2y ago
> I was wondering if there really are no negative long term side effects Weight loss via caloric restriction inevitably results in losing lean muscle mass along with body fat. That's why diet and exercise are paired -- diet loses the weight, and exercise helps to reduce the loss of muscle. While there's nothing stopping people from pairing Ozempic with exercise to achieve a similar result, I doubt many are. Those ecstatic about the rapid weight loss achieved by these drugs may not be so happy if they were viewing their progress on something that measured their full body composition, rather than just their weight. These are miracle drugs for people who are morbidly obese and suffering from severe weight-related problems. Those folks can use Ozempic to rapidly lose fat and muscle to get them out of their immediate crisis, and then work to rebuild as much of that lean muscle mass as they can later. However, people who are just using Ozempic as an easier alternative to diet and exercise are not only taking away supply of this drug from people who really need it to deal with morbid obesity, they're setting themselves up for health problems later in life if enough of their muscle mass has degraded that they start struggling to do everyday activities. Unfortunately, by the time people reach this point, it's unlikely that they'll be able to do anything about other than resort to assistive technology like wheelchairs to regain their mobility.
- toomuchtodo 2y ago
  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4383600/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4383600/ ("Pharmacology of manipulating lean body mass") https://newatlas.com/medical/drug-mimics-exercise-weight-loss/ https://newatlas.com/medical/drug-mimics-exercise-weight-los... ("Drug that mimics exercise triggers weight loss and builds lean muscle") https://en.wikipedia.org/wiki/Exercise_mimetic https://en.wikipedia.org/wiki/Exercise_mimetic
  - spacemadness 2y ago
    Sorry, what’s the point of these links? Don’t worry, another pill is on the way to solve the exercise problem?
    - toomuchtodo 2y ago
choilive 2y ago
Only one way to know for sure on the long term effects.. However, we do know the long term side effects of obesity - and it is quite costly, by some estimates $200B+/year in the US alone. Not as bad as smoking ($300B+/yr), but entirely preventable regardless.
- nunez 2y ago
  This is not entirely true. Most of the data defending the economic harms of obesity are deeply flawed for various reasons, such as: - Generally low-quality data - Data that ignores external factors - Data that doesn't account for behavioral issues like doctors ignoring or minimizing medical complaints made by obese people simply because they're obese - Data that overemphasizes BMI, an extremely flawed health metric, etc.) - The criteria for "obesity" itself having changed over the years (based on BMI, of course), - and others. There are definitely issues that obesity exacerbates in many people (mobility and cardiovascular), but the overarching purpose behind stats like the ones that you pointed out is to shame people who are (a) naturally hungrier than the average person with a "socially acceptable" frame, while (b) living in car-centric suburbs that discourage things like walking because (c) these suburbs are cheaper than living in cities that have somewhat-functional public transportation because they were created before the car was invented. - Why BMI is flawed, from Nature: https://www.nature.com/articles/d41586-023-03143-x https://www.nature.com/articles/d41586-023-03143-x - Everything You Know About Obesity is Wrong, from Huffington Post (the author co-runs a podcast on the topic): https://highline.huffingtonpost.com/articles/en/everything-you-know-about-obesity-is-wrong/ https://highline.huffingtonpost.com/articles/en/everything-y... - Obesity was long considered a personal failing. Science shows it's not, from USA Today: https://www.usatoday.com/in-depth/news/health/2022/07/26/america-obesity-rate-not-personal-failing/9479046002/ https://www.usatoday.com/in-depth/news/health/2022/07/26/ame...
paulmd 2y ago
No, actually it will make it worse since obesity generally lowers lifetime healthcare spending. This is counterintuitive but we barely spend anything on anyone who’s not a senior, so anything that helps people live longer generally results in higher costs. Dying of heart failure at 50 is comparably cheap to lingering for 10 years in assisted living and bouncing in and out of a hospital for 3 years before the end. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2225430/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2225430/ This is broadly confirmed across a number of studies, a study of European healthcare found lifetime spending increases too. https://pubmed.ncbi.nlm.nih.gov/37222003/ https://pubmed.ncbi.nlm.nih.gov/37222003/ What’s even worse is that from a financial sense, private insurance generally covers the deaths earlier in life, while ozempic (or any other anti-obesity drug) will push a lot more of that spending onto the federal Medicare budget in the long term. Ozempic is apocalyptic for the Medicare and social security budgets, even if it were free (and Medicare doesn’t cover anyone who’s not a senior anyway). Any drug that broadly extents life would be - we would be equally affected by a free pill that gave everyone another 2 years of life, too. We budgeted based on X number of fat people paying in, but never receiving benefits (via life-expectancy actuarial tables), if you extend life then the payout increases.
hi-v-rocknroll 2y ago
Magical thinking. Universal healthcare will not happen in the US because for-profit hospital owners and big pharma would lobby against it. US healthcare costs 2x as much per person than other countries but outcomes are worse. Outcomes are not a concern, profits are.
nunez 2y ago
If there are no long-term side effects to taking GLP1 agonists (remains to be seen), then I think the following will happen: - In the short term, the fitness industry (a multi-billion dollar market) and its dependents will crater, - Smaller, European-like, serving sizes will become the norm, and - You'll see more and much larger investments in de-alcoholifying beers, wines and spirits. I do not think this class of drugs will accelerate the adoption of universal healthcare in the US. For one, the healthcare industry employs a ton of people in towns like Bowling Green. (HCA, the biggest healthcare network in the US, is headquarted in Nashville, TN. Nashville is definitely bigger than Bowling Green, but people that lie in Murfreesboro and other small towns around Nashville work at HCA. Also, many insurance companies are headquartered in the Midwest, where jobs are relatively scant compared to the big coastal cities.) Any policy that ends with "and tens of thousands of jobs will be lost" is political suicide. Also, the modern healthcare industry in the US was built and designed around private, employer-provided health insurance. Reverse-engineering decades-old business logic and institutional process to fit a government-provided system would be a gigantic and extremely expensive underatking that we would pay for (through taxes).

anon7725 2y ago

IIRC the GLP-1 drugs have a black box warning for thyroid cancer, as well as some other potential side effects. Still, I think NNT < NNH all things considered.

toomuchtodo 2y ago
Fractyl Healthcare is working on a gene therapy targeting this pathway. Chronic maintenance is a temporary hack imho. Long term fix is patching the genetic bug around a miswired reward center. https://news.ycombinator.com/item?id=38495653 https://news.ycombinator.com/item?id=38495653
- readthenotes1 2y ago
  So a drug to counteract the effects of the drug to counteract the effects of a poisonous calory-provisioning industry. Perfect!
  - deleted 2y ago
    [deleted]
  - toomuchtodo 2y ago
    Sort of? Gene therapy is a permanent fix where as GLP-1 agonist compounds are needed perpetually for maintenance. https://getyarn.io/yarn-clip/dd4f2296-2186-45d6-b42a-10966b4f9263 https://getyarn.io/yarn-clip/dd4f2296-2186-45d6-b42a-10966b4...
- fragmede 2y ago
  there's also ultrasonic brain surgery to fix the miswired reward center. https://youtu.be/7BGtVJ3lBdE?t=869 https://youtu.be/7BGtVJ3lBdE?t=869

marcuskane2 2y ago

1) There are very serious long term side effects, people are just either unaware or value weight loss enough to tolerate/accept the risks and harms. 2) Your "aside" there is the whole thing though. Obesity drives a lot of costs sure, but Obamacare legislation enshrined health insurance companies and pharmacy benefit managers as essentially government-backed money printing machines, so it's going to take tremendous effort to change any legislation, because they can and will spend literally billions of dollars to keep their monopolistic position.

Fernicia 2y ago
What, in your view, are the "very serious long term side effects" of semaglutide/GLP-1 agonists?
- ughjkiu 2y ago
  [flagged]
  - choilive 2y ago
    The very serious long term side effects of obesity definitely seem worse than of glp-1 agonists, although time will tell.
    - ughjkiu 2y ago
      [flagged]
      - choilive 2y ago
        Severe obesity can take off 10+ years off your life. I would say thats a pretty serious side effect. Heart disease, diabetes, liver diseases, kidney diseases, gallbladder diseases, pancreas diseases, cancer, sleep issues, fertility issues, sexual health disfunction, mental health problems, to name a few obesity related side effects

readthenotes1 2y ago

It's pretty awkward to talk about making people form a lifelong addiction to one drug (semaglutide) to counteract the effects of making people form a lifelong addiction to a poison (sugar). If we spent half the money involved in this scam in removing added sugar from the grocery store shelves we'd beat that epidemic (don't believe me? Look at pictures of people living before the low-fat high carb poisoning in the 80s and 90s)

Zelphyr 2y ago
I would add ultra-processed foods to this as well. I firmly believe that, decades from now, we will look back in horror at what food manufacturers have done to us.
diffeomorphism 2y ago
Why is this an "instead"? We already know that people on semaglutides buy less junk food because to them it is less addictive. Less demand, less supply. If anything, this seems like a useful way to smooth the transition to less unhealthy food supply.
- alamortsubite 2y ago
  People are effectively on these medications permanently or they regain whatever weight they lost on them. So unfortunately the transition isn't so much to healthier diets, but to taking weight-loss drugs forever.
  - orwin 2y ago
    Is this true? Is the rebound effect as high as you think? Because I know 2 people who took it for like 3 years, and while they took some weight back, they're not obese anymore.
    - alamortsubite 2y ago
      Not according to Novo Nordisk. https://www.bbc.com/future/article/20240521-what-happens-when-you-stop-taking-ozempic https://www.bbc.com/future/article/20240521-what-happens-whe... The same trend was seen after the 2021 trial, known as Step 1. After 68 weeks of semaglutide injections, the average patient lost more than 15% of their body weight, but within 12 months of treatment ending, patients regained two thirds of their prior weight loss on average. This was associated with a similar level of reversion to the patients' original baselines in some markers of their cardiometabolic health – a category which includes conditions such as diabetes and heart attacks. Both Rubino and other experts around the world have seen similar patterns when administering GLP-1 drugs in their clinics. "There will be a small proportion of people, 10% maximum, that are able to maintain [all] the weight they've lost," says Alex Miras, a clinical professor of medicine at Ulster University.

matwood 2y ago

Not sure on leading to universal healthcare, but it will absolutely impact healthcare. The obvious ones like less heart disease are huge. Then others like fewer knee replacements, and fewer CPAP machines required, the list goes on. GLP1s have also shown to help with drug and alcohol cravings so there's an entire other area to explore. I could see where the government simply makes them available to most people.

malfist 2y ago

Buying the stuff from the drug manufacturers is crazy expensive. Over $1000 a month. Going through a compounding phramacy is much cheaper, I pay around $249/month for my script. You can go even cheaper and buy the peptide yourself from places like peptide sciences and compound it yourself, less than $100 for a 3 months supply, but you increase your risk profile pretty significantly going that route. My partner is a pharmacist and that type of mixing (assuming you do everything correctly) is considered acceptable for "immediate emergency use", not mix up and use for a month or three and keep it in the fridge in the meantime. It's a small risk to be sure, but non-sterile compounding at home is riskier than having a compounding pharmacy do it the right way.

theevilsharpie 2y ago

> I was wondering if there really are no negative long term side effects Weight loss via caloric restriction inevitably results in losing lean muscle mass along with body fat. That's why diet and exercise are paired -- diet loses the weight, and exercise helps to reduce the loss of muscle. While there's nothing stopping people from pairing Ozempic with exercise to achieve a similar result, I doubt many are. Those ecstatic about the rapid weight loss achieved by these drugs may not be so happy if they were viewing their progress on something that measured their full body composition, rather than just their weight. These are miracle drugs for people who are morbidly obese and suffering from severe weight-related problems. Those folks can use Ozempic to rapidly lose fat and muscle to get them out of their immediate crisis, and then work to rebuild as much of that lean muscle mass as they can later. However, people who are just using Ozempic as an easier alternative to diet and exercise are not only taking away supply of this drug from people who really need it to deal with morbid obesity, they're setting themselves up for health problems later in life if enough of their muscle mass has degraded that they start struggling to do everyday activities. Unfortunately, by the time people reach this point, it's unlikely that they'll be able to do anything about other than resort to assistive technology like wheelchairs to regain their mobility.

toomuchtodo 2y ago
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4383600/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4383600/ ("Pharmacology of manipulating lean body mass") https://newatlas.com/medical/drug-mimics-exercise-weight-loss/ https://newatlas.com/medical/drug-mimics-exercise-weight-los... ("Drug that mimics exercise triggers weight loss and builds lean muscle") https://en.wikipedia.org/wiki/Exercise_mimetic https://en.wikipedia.org/wiki/Exercise_mimetic
- spacemadness 2y ago
  Sorry, what’s the point of these links? Don’t worry, another pill is on the way to solve the exercise problem?
  - toomuchtodo 2y ago

choilive 2y ago

Only one way to know for sure on the long term effects.. However, we do know the long term side effects of obesity - and it is quite costly, by some estimates $200B+/year in the US alone. Not as bad as smoking ($300B+/yr), but entirely preventable regardless.

nunez 2y ago
This is not entirely true. Most of the data defending the economic harms of obesity are deeply flawed for various reasons, such as: - Generally low-quality data - Data that ignores external factors - Data that doesn't account for behavioral issues like doctors ignoring or minimizing medical complaints made by obese people simply because they're obese - Data that overemphasizes BMI, an extremely flawed health metric, etc.) - The criteria for "obesity" itself having changed over the years (based on BMI, of course), - and others. There are definitely issues that obesity exacerbates in many people (mobility and cardiovascular), but the overarching purpose behind stats like the ones that you pointed out is to shame people who are (a) naturally hungrier than the average person with a "socially acceptable" frame, while (b) living in car-centric suburbs that discourage things like walking because (c) these suburbs are cheaper than living in cities that have somewhat-functional public transportation because they were created before the car was invented. - Why BMI is flawed, from Nature: https://www.nature.com/articles/d41586-023-03143-x https://www.nature.com/articles/d41586-023-03143-x - Everything You Know About Obesity is Wrong, from Huffington Post (the author co-runs a podcast on the topic): https://highline.huffingtonpost.com/articles/en/everything-you-know-about-obesity-is-wrong/ https://highline.huffingtonpost.com/articles/en/everything-y... - Obesity was long considered a personal failing. Science shows it's not, from USA Today: https://www.usatoday.com/in-depth/news/health/2022/07/26/america-obesity-rate-not-personal-failing/9479046002/ https://www.usatoday.com/in-depth/news/health/2022/07/26/ame...

paulmd 2y ago

No, actually it will make it worse since obesity generally lowers lifetime healthcare spending. This is counterintuitive but we barely spend anything on anyone who’s not a senior, so anything that helps people live longer generally results in higher costs. Dying of heart failure at 50 is comparably cheap to lingering for 10 years in assisted living and bouncing in and out of a hospital for 3 years before the end. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2225430/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2225430/ This is broadly confirmed across a number of studies, a study of European healthcare found lifetime spending increases too. https://pubmed.ncbi.nlm.nih.gov/37222003/ https://pubmed.ncbi.nlm.nih.gov/37222003/ What’s even worse is that from a financial sense, private insurance generally covers the deaths earlier in life, while ozempic (or any other anti-obesity drug) will push a lot more of that spending onto the federal Medicare budget in the long term. Ozempic is apocalyptic for the Medicare and social security budgets, even if it were free (and Medicare doesn’t cover anyone who’s not a senior anyway). Any drug that broadly extents life would be - we would be equally affected by a free pill that gave everyone another 2 years of life, too. We budgeted based on X number of fat people paying in, but never receiving benefits (via life-expectancy actuarial tables), if you extend life then the payout increases.

hi-v-rocknroll 2y ago

Magical thinking. Universal healthcare will not happen in the US because for-profit hospital owners and big pharma would lobby against it. US healthcare costs 2x as much per person than other countries but outcomes are worse. Outcomes are not a concern, profits are.

nunez 2y ago

If there are no long-term side effects to taking GLP1 agonists (remains to be seen), then I think the following will happen: - In the short term, the fitness industry (a multi-billion dollar market) and its dependents will crater, - Smaller, European-like, serving sizes will become the norm, and - You'll see more and much larger investments in de-alcoholifying beers, wines and spirits. I do not think this class of drugs will accelerate the adoption of universal healthcare in the US. For one, the healthcare industry employs a ton of people in towns like Bowling Green. (HCA, the biggest healthcare network in the US, is headquarted in Nashville, TN. Nashville is definitely bigger than Bowling Green, but people that lie in Murfreesboro and other small towns around Nashville work at HCA. Also, many insurance companies are headquartered in the Midwest, where jobs are relatively scant compared to the big coastal cities.) Any policy that ends with "and tens of thousands of jobs will be lost" is political suicide. Also, the modern healthcare industry in the US was built and designed around private, employer-provided health insurance. Reverse-engineering decades-old business logic and institutional process to fit a government-provided system would be a gigantic and extremely expensive underatking that we would pay for (through taxes).