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>There's a miracle drug powerful enough to robustly lower people's all cause mortality Did I misread the article, my TL;DR of the article is that GLP-1 reduce

>There's a miracle drug powerful enough to robustly lower people's all cause mortality 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).

yumraj 1y ago
> 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.
- alistairSH 1y ago
  They do? I was under the impression people stopped taking them because they’re massively expensive. And weekly injections is a bit annoying (though should be less annoying than diabetes or death or whatever else).
  - saratogacx 1y ago
    There is a set of the population, and not a small one, that will quit the drug as soon as they hit the weight they feel is good enough. Even if they can afford it and are used to the shots they just feel that it is done and don't feel like they'll rebound (although most do) once off it.
readthenotes1 1y ago
"If we assume about 65% of people who start GLP-1 medications quit by the end of year one, that creates a big problem. When someone stops the medication, they'll usually regain the weight they lost, and in two years, most of those key health indicators (like BMI, blood pressure, blood sugar and cholesterol) bounce back to their starting point. " 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.
- paulpauper 1y ago
  Except for extreme obesity, it is about the same as people not on the drugs . Even moderate obesity only lowers life expectancy by a few years in men and about none in women. of course, quality of life will may be worse. Obesity only meaningfully lowers life expectancy at a BMI of 40-45+ for men
  - readthenotes1 1y ago
    I meant: we don't know the longevity effects of people being on a glp-1 drug for decades.
refulgentis 1y ago
Subtly different: you read "most...return to normal...within 2 years", it says "When someone stops the medication, they'll [return to baseline]" 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.
- samus 1y ago
  Since it's so new, of course there aren't any long-term data on GLP-1 takers. However, relying on prior knowledge about people who are good on the metrics, it can be presumed that they will do fine. And won't create financial risk for the insurer due to passing on earlier than expected. But only if they keep taking their meds and/or fix any underlying behavioral and health issues that made them obese in the first case! 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.
  - alvah 1y ago
    GLP-1 isn’t new - the first trials were 20 years ago & there’s a lot of long term data from its use in diabetes management, prior to the weight loss application.
pie_flavor 1y ago
No, it's a miracle drug that drops mortality by a ton. The indicators aren't being faked. The weight causes the mortality, and the weight loss reduces it, and the weight regain reintroduces it. GLP1RAs introduce some noise to the indicators but not enough to cause what you're implying.
dragonwriter 1y ago
It's a maintenance medicine, not a cure, so if people stop taking it, they return to the same problems they had without it.
- aetherson 1y ago
  And it's under-commented upon because it's counterintuitive, but most people stop taking it. Like, two year continuation of use is about 25%. 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.
  - catdog 1y ago
    Side effects? Also many might not be able to afford it long term as it's quite expensive.
  - AndrewDucker 1y ago
    Cost is a big factor. When it becomes generic then I suspect people will stay on it for a lot longer.
  - decimalenough 1y ago
    Because they're now "normal", so why would they continue paying for it, taking unpleasant injections, and enduring the side effects? 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.
    - sroussey 1y ago
      Another way of putting it is that people achieve their goals and wind down the usage of the drug that got them there. 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.
  - 1y ago
paulpauper 1y ago
The drugs do not reduce mortality much or even at all. Such drugs may improve quality of life though. Except for severe obesity, 40+ BMI, life expectancy is not lowered much in men and even less in women in the setting of obesity. It's just that being obese makes all sorts of markers worse, yet people do not die much sooner. It's more about improving quality of life.
- eru 1y ago
  I guess similar to smoking a handful of cigarettes a day? (Not a whole pack. More like five.)

yumraj 1y ago

> 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.

alistairSH 1y ago
They do? I was under the impression people stopped taking them because they’re massively expensive. And weekly injections is a bit annoying (though should be less annoying than diabetes or death or whatever else).
- saratogacx 1y ago
  There is a set of the population, and not a small one, that will quit the drug as soon as they hit the weight they feel is good enough. Even if they can afford it and are used to the shots they just feel that it is done and don't feel like they'll rebound (although most do) once off it.

readthenotes1 1y ago

"If we assume about 65% of people who start GLP-1 medications quit by the end of year one, that creates a big problem. When someone stops the medication, they'll usually regain the weight they lost, and in two years, most of those key health indicators (like BMI, blood pressure, blood sugar and cholesterol) bounce back to their starting point. " 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.

paulpauper 1y ago
Except for extreme obesity, it is about the same as people not on the drugs . Even moderate obesity only lowers life expectancy by a few years in men and about none in women. of course, quality of life will may be worse. Obesity only meaningfully lowers life expectancy at a BMI of 40-45+ for men
- readthenotes1 1y ago
  I meant: we don't know the longevity effects of people being on a glp-1 drug for decades.

refulgentis 1y ago

Subtly different: you read "most...return to normal...within 2 years", it says "When someone stops the medication, they'll [return to baseline]" 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.

samus 1y ago
Since it's so new, of course there aren't any long-term data on GLP-1 takers. However, relying on prior knowledge about people who are good on the metrics, it can be presumed that they will do fine. And won't create financial risk for the insurer due to passing on earlier than expected. But only if they keep taking their meds and/or fix any underlying behavioral and health issues that made them obese in the first case! 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.
- alvah 1y ago
  GLP-1 isn’t new - the first trials were 20 years ago & there’s a lot of long term data from its use in diabetes management, prior to the weight loss application.

pie_flavor 1y ago

No, it's a miracle drug that drops mortality by a ton. The indicators aren't being faked. The weight causes the mortality, and the weight loss reduces it, and the weight regain reintroduces it. GLP1RAs introduce some noise to the indicators but not enough to cause what you're implying.

dragonwriter 1y ago

It's a maintenance medicine, not a cure, so if people stop taking it, they return to the same problems they had without it.

aetherson 1y ago
And it's under-commented upon because it's counterintuitive, but most people stop taking it. Like, two year continuation of use is about 25%. 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.
- catdog 1y ago
  Side effects? Also many might not be able to afford it long term as it's quite expensive.
- AndrewDucker 1y ago
  Cost is a big factor. When it becomes generic then I suspect people will stay on it for a lot longer.
- decimalenough 1y ago
  Because they're now "normal", so why would they continue paying for it, taking unpleasant injections, and enduring the side effects? 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.
  - sroussey 1y ago
    Another way of putting it is that people achieve their goals and wind down the usage of the drug that got them there. 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.
- 1y ago

paulpauper 1y ago

The drugs do not reduce mortality much or even at all. Such drugs may improve quality of life though. Except for severe obesity, 40+ BMI, life expectancy is not lowered much in men and even less in women in the setting of obesity. It's just that being obese makes all sorts of markers worse, yet people do not die much sooner. It's more about improving quality of life.

eru 1y ago
I guess similar to smoking a handful of cigarettes a day? (Not a whole pack. More like five.)