6 ms·

I am a doctor, so let me give you the perspective from the other side. A friend of mine who works in primary care has a policy of not prescribing semaglutide u

I am a doctor, so let me give you the perspective from the other side. A friend of mine who works in primary care has a policy of not prescribing semaglutide unless a patient has tried at least three months of diet/exercise first. She now has a long list of patients who decide to screw that and self-refer to a specialist who'd write them the script. I don't work in primary care myself, but this more or less matches my own experience - 95% of people do not want to put in the effort of changing diet, exercise, and other lifestyle habits. They want a quick fix. In the words of Ronnie Coleman, "Everybody wants to be a bodybuilder, but nobody wants to lift no heavy-ass weights." So I really do think the popularity of semaglutide is a bottom up phenomenon. There is has been huge consumer demand for a weight loss drug for decades, and pharma is only now meeting that demand. > doctors having intimate financial relationships with pharma is already a public secret A small number of elite doctors have intimate relationships with pharma. The other 99% who are prescribing semaglutide do not profit from it. In fact, it's the other way around. You can't bill for the act of prescribing medications, but there are dedicated billing codes for counseling a patient on diet/lifestyle modification.

ddorian43 2y ago
What most people don't know is that patients are terrible. I'm not a doctor but I know some doctors and patients. Many are unlucky to have unforgiving disorders. This is easily seen in T2D which is mostly diet related and fixable.
CalRobert 2y ago
I agree with you, but people shouldn't really have to put in the effort to change diet or exercise or lifestyle habits. But the environment that produces those habits SHOULD change. I lost a bunch of weight when I moved to Dublin and started walking everywhere. Then I moved to the Netherlands and lost even more, and got stronger. I didn't particularly try, I just lived somewhere where I used my own body to get around and the "normal" portion sizes were actually somewhat sane (a bag of Doritos here is maybe a third the size of one in the US). I was 280 pounds when I lived in suburban California. I'm 180 pounds now. Build bike lanes and public transport, put schools where kids can walk to them, and maybe don't sell a thousand calories of chips in a personal-sized and marketed bag, and it should get better. As an added bonus you get a lot less air pollution (and noise pollution, etc.) and less people being run over!
- Earw0rm 2y ago
  The logic of public health and product design applied to urban/spatial planning basically. And, unsurprisingly, it works wonders.
  - CalRobert 2y ago
    And it’s a happier, less lonely life!
- hollerith 2y ago
  >you get a lot less air pollution I know what you meant, but according to a comment here once, European city streets actually have worse air pollution than US ones because Europe went hard for diesel engines (to reduce CO2 emissions) for its cars, and diesel produces a lot of very small carbon particles, which turned out to be more harmful than most people suspected back when the diesel decision was made.
  - twiss 2y ago
    Amsterdam has banned most diesel vehicles [1], so at least this is not universally true (anymore). [1]: https://www.amsterdam.nl/en/traffic-transport/low-emission-zone/ https://www.amsterdam.nl/en/traffic-transport/low-emission-z...
  - CalRobert 2y ago
    Indeed, and I’m worried about the same old mistakes being made with EV’s. They produce lots of tyre particulates thanks to being so heavy, which then get in to our brains. Of course, Volkswagen lying about their diesels and killing people in the aggregate didn’t help. What we need is car-free or low-car cities, not just different cars.
    - bryanlarsen 2y ago
      Due to it being a common anti-EV talking point, tire longevity has been a strong selling point for EV tires. Longer lasting tires produce less particulates, so this natural pressure should also produce fewer particulates. Popular EV's aren't significantly heavier than ICE vehicles. A Tesla model 3 and a BMW model 3 are both about 3500 pounds. Range is a huge selling feature for EV's and weight has a significant impact on range, so there is strong evolutionary pressure to lighten EV's. Crappy EV's like the Hummer are heavy; but popular EV's like Tesla's and Hyundai's have weight comparable to normal cars so that they can have impressive ranges without too many expensive and heavy batteries. EV's increased tire wire is due to their massive torque at low range. If you want your tires to last, just don't drive like a hooligan. We got 70,000 km out of our first set of EV tires. Tire particulates are an "all cars a bad" issue. EV's are not significantly worse than petrol vehicles vis a vis tire particulates. Their lack of exhaust particulates means that an EV produces about ~half the total number of particulates.
arkh 2y ago
> put in the effort of changing diet If the genetic / hormonal explanation is right, it would mean the "effort" is not the same for everyone. So expecting people on the wrong side of the equation to not go for a solution to right the scales demonstrate a lack of empathy. Would you call cochlear implants a quick fix for people who have problem hearing?
- jonahx 2y ago
  It's not a "lack of empathy". GP is just stating the fact that most people are physically capable of losing weight, but since it is uncomfortable and hard they don't. It's not analogous to being unable to hear. There's nothing with wanting a quick fix to make it easier and less unpleasant. I'd happily use a provably safe one. The only issue is that currently that fix carries unknown risks.
  - pjerem 2y ago
    The whole discussion here is about the environment though. In absolute, changing diet is not inherently hard : it's pretty easy to eat a balanced diet and get pleasure from it. But it's not enough to just say "eat better", "do more sports" : people can't change the way the lived their whole life if you don't educate and help them to make the change. The education on this topic is so poor that we are still confusing balanced diet and low-calorie diet. And then there is the elephant in the room which is the refined sugar : for some dubious reason, most scientists agree that refined sugar acts like a hard drug but nobody officially wants to call it a drug. Recent research are saying that the addictive effects of refined sugar are akin to heroin. That's a serious issue then. What it means is that a doctor asking his patient to eat less sugar / eat a balanced diet without further guidance or help is just like saying to an heroin addict that he should stop. I'm relatively overweight and pretty self educated on the topic but I still decided to work with a nutritionist to change my diet and we are talking about months if not years of follow-up. Eating habits are largely automated by our biology : willpower and education are nothing against an hypoglycemia induced sugar craving. Like drugs, most people need help and guidance on the long term to change those habits. But what's even worse is that unlike drugs, unhealthy products are basically everywhere in your supermarket, your TV ads, your billboards, your friends lifestyle, and even worse, profoundly ingrained in the culture. You have to fight the "drug" but also the whole capitalist world around you.
torginus 2y ago
I'm glad you mentioned bodybuilding, since its known to even laymen that taking anabolic steroids gives you an edge that is impossible to replicate just with diet and exercise. This ozempic study seems to suggest something similar. Self-discipline is a noble concept, and probably important in the grand scheme of things, but sometimes medicine and technology outpaces what is naturally possible, which inevitably results in a moral backlash.
latentcall 2y ago
> 95% of people do not want to put in the effort of changing diet, exercise, and other lifestyle habits. They want a quick fix. Well yes obviously that is difficult to do. Our society (American society, that is) is about “me” and convenience. Nobody seems to want to say what is obvious to me: ban junk food. Sugary white bread, Cheez Its, Oreos, candy, ice cream, highly processed frozen burritos, frozen pizza, Little Debbie’s, potato chips , all of it. It is crazy to me the C levels of poison food companies do not rot in jail for the rest of their lives for knowingly selling poison and lying about it. It is crazy to me how a group of people can conspire to harm the citizens of a nation in the name of profit and not receive any consequences. It’s crazy to me the governments of that nation actually enjoy it and don’t care.
paulpauper 2y ago
A friend of mine who works in primary care has a policy of not prescribing semaglutide unless a patient has tried at least three months of diet/exercise first. She now has a long list of patients who decide to screw that and self-refer to a specialist who'd write them the script. I don't work in primary care myself, but this more or less matches my own experience - 95% of people do not want to put in the effort of changing diet, exercise, and other lifestyle habits. They want a quick fix. The data however shows that diet and exercise fails for most people though. I don't see it as entirely irrational to go strait to the more effective drugs.

ddorian43 2y ago

What most people don't know is that patients are terrible. I'm not a doctor but I know some doctors and patients. Many are unlucky to have unforgiving disorders. This is easily seen in T2D which is mostly diet related and fixable.

CalRobert 2y ago

I agree with you, but people shouldn't really have to put in the effort to change diet or exercise or lifestyle habits. But the environment that produces those habits SHOULD change. I lost a bunch of weight when I moved to Dublin and started walking everywhere. Then I moved to the Netherlands and lost even more, and got stronger. I didn't particularly try, I just lived somewhere where I used my own body to get around and the "normal" portion sizes were actually somewhat sane (a bag of Doritos here is maybe a third the size of one in the US). I was 280 pounds when I lived in suburban California. I'm 180 pounds now. Build bike lanes and public transport, put schools where kids can walk to them, and maybe don't sell a thousand calories of chips in a personal-sized and marketed bag, and it should get better. As an added bonus you get a lot less air pollution (and noise pollution, etc.) and less people being run over!

Earw0rm 2y ago
The logic of public health and product design applied to urban/spatial planning basically. And, unsurprisingly, it works wonders.
- CalRobert 2y ago
  And it’s a happier, less lonely life!
hollerith 2y ago
>you get a lot less air pollution I know what you meant, but according to a comment here once, European city streets actually have worse air pollution than US ones because Europe went hard for diesel engines (to reduce CO2 emissions) for its cars, and diesel produces a lot of very small carbon particles, which turned out to be more harmful than most people suspected back when the diesel decision was made.
- twiss 2y ago
  Amsterdam has banned most diesel vehicles [1], so at least this is not universally true (anymore). [1]: https://www.amsterdam.nl/en/traffic-transport/low-emission-zone/ https://www.amsterdam.nl/en/traffic-transport/low-emission-z...
- CalRobert 2y ago
  Indeed, and I’m worried about the same old mistakes being made with EV’s. They produce lots of tyre particulates thanks to being so heavy, which then get in to our brains. Of course, Volkswagen lying about their diesels and killing people in the aggregate didn’t help. What we need is car-free or low-car cities, not just different cars.
  - bryanlarsen 2y ago
    Due to it being a common anti-EV talking point, tire longevity has been a strong selling point for EV tires. Longer lasting tires produce less particulates, so this natural pressure should also produce fewer particulates. Popular EV's aren't significantly heavier than ICE vehicles. A Tesla model 3 and a BMW model 3 are both about 3500 pounds. Range is a huge selling feature for EV's and weight has a significant impact on range, so there is strong evolutionary pressure to lighten EV's. Crappy EV's like the Hummer are heavy; but popular EV's like Tesla's and Hyundai's have weight comparable to normal cars so that they can have impressive ranges without too many expensive and heavy batteries. EV's increased tire wire is due to their massive torque at low range. If you want your tires to last, just don't drive like a hooligan. We got 70,000 km out of our first set of EV tires. Tire particulates are an "all cars a bad" issue. EV's are not significantly worse than petrol vehicles vis a vis tire particulates. Their lack of exhaust particulates means that an EV produces about ~half the total number of particulates.

arkh 2y ago

> put in the effort of changing diet If the genetic / hormonal explanation is right, it would mean the "effort" is not the same for everyone. So expecting people on the wrong side of the equation to not go for a solution to right the scales demonstrate a lack of empathy. Would you call cochlear implants a quick fix for people who have problem hearing?

jonahx 2y ago
It's not a "lack of empathy". GP is just stating the fact that most people are physically capable of losing weight, but since it is uncomfortable and hard they don't. It's not analogous to being unable to hear. There's nothing with wanting a quick fix to make it easier and less unpleasant. I'd happily use a provably safe one. The only issue is that currently that fix carries unknown risks.
- pjerem 2y ago
  The whole discussion here is about the environment though. In absolute, changing diet is not inherently hard : it's pretty easy to eat a balanced diet and get pleasure from it. But it's not enough to just say "eat better", "do more sports" : people can't change the way the lived their whole life if you don't educate and help them to make the change. The education on this topic is so poor that we are still confusing balanced diet and low-calorie diet. And then there is the elephant in the room which is the refined sugar : for some dubious reason, most scientists agree that refined sugar acts like a hard drug but nobody officially wants to call it a drug. Recent research are saying that the addictive effects of refined sugar are akin to heroin. That's a serious issue then. What it means is that a doctor asking his patient to eat less sugar / eat a balanced diet without further guidance or help is just like saying to an heroin addict that he should stop. I'm relatively overweight and pretty self educated on the topic but I still decided to work with a nutritionist to change my diet and we are talking about months if not years of follow-up. Eating habits are largely automated by our biology : willpower and education are nothing against an hypoglycemia induced sugar craving. Like drugs, most people need help and guidance on the long term to change those habits. But what's even worse is that unlike drugs, unhealthy products are basically everywhere in your supermarket, your TV ads, your billboards, your friends lifestyle, and even worse, profoundly ingrained in the culture. You have to fight the "drug" but also the whole capitalist world around you.

torginus 2y ago

I'm glad you mentioned bodybuilding, since its known to even laymen that taking anabolic steroids gives you an edge that is impossible to replicate just with diet and exercise. This ozempic study seems to suggest something similar. Self-discipline is a noble concept, and probably important in the grand scheme of things, but sometimes medicine and technology outpaces what is naturally possible, which inevitably results in a moral backlash.

latentcall 2y ago

> 95% of people do not want to put in the effort of changing diet, exercise, and other lifestyle habits. They want a quick fix. Well yes obviously that is difficult to do. Our society (American society, that is) is about “me” and convenience. Nobody seems to want to say what is obvious to me: ban junk food. Sugary white bread, Cheez Its, Oreos, candy, ice cream, highly processed frozen burritos, frozen pizza, Little Debbie’s, potato chips , all of it. It is crazy to me the C levels of poison food companies do not rot in jail for the rest of their lives for knowingly selling poison and lying about it. It is crazy to me how a group of people can conspire to harm the citizens of a nation in the name of profit and not receive any consequences. It’s crazy to me the governments of that nation actually enjoy it and don’t care.

paulpauper 2y ago

A friend of mine who works in primary care has a policy of not prescribing semaglutide unless a patient has tried at least three months of diet/exercise first. She now has a long list of patients who decide to screw that and self-refer to a specialist who'd write them the script. I don't work in primary care myself, but this more or less matches my own experience - 95% of people do not want to put in the effort of changing diet, exercise, and other lifestyle habits. They want a quick fix. The data however shows that diet and exercise fails for most people though. I don't see it as entirely irrational to go strait to the more effective drugs.