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I find it fascinating how much a pretty large group of people just hate semaglutides and seemingly need to believe that it's some kind of Faustian bargain. I'm

I find it fascinating how much a pretty large group of people just hate semaglutides and seemingly need to believe that it's some kind of Faustian bargain. I'm not talking about the people who are cautious or suspicious, that's more than reasonable, but it's clear that it's not cautious optimism in many.

jbentley1 1y ago
Naturally skinny people hate Ozempic for the same reason I know many talented engineers who hate AI coding.
- kmeisthax 1y ago
  As a talented engineer, I hate AI coding because it doesn't do what it says on the tin. If GLPs made people hallucinate weight loss that wasn't actually happening, I'd be angry about them too.
  - thaumasiotes 1y ago
    Ever seen "Shallow Hal"?
- amelius 1y ago
  It is not fun when your superpower becomes a commodity.
- stronglikedan 1y ago
  I'd wager that you can only call an engineer talented if they know enough to hate AI coding.
- zer00eyz 1y ago
  > I know many talented engineers who hate AI coding. People whos primary skill is coding, hate AI coding. No talented engineer hates AI coding. The distinction is this: a coder knows how to use their tools, an engineer knows how to work with people, understands product, process, users, and knows how to use their tools. Talented engineers hate the HYPE around AI. And those of us old enough to remember sigh and think "This is just dreamweaver all over again". It is ESB's with "drag and drop" workflow tools. AI is just another useful tool that a good engineer can pick up and put down where appropriate.
- eddythompson80 1y ago
  Thank you for your service
- devmor 1y ago
  I think those engineers don’t like you because you find unrelated subjects to justify your favorite scam.
- Der_Einzige 1y ago
  Was waiting to see this comparison. Glad to see that meritocracy is becoming the pejorative it was always meant to be. Meritocrats are unironically bigots.
- mensetmanusman 1y ago
  They are living rent free in your head, they really don’t care.
qgin 1y ago
There were even people who felt this way about anesthesia too. To survive in that era, they had to believe that suffering was somehow good for healing (or at least good spiritually) and talked about anesthesia as if it were cheating the natural god-given order.
- readthenotes1 1y ago
  Are you talking about MMother Teresa? She wasn't that long ago...
- zoeysmithe 1y ago
  I think this might be revisionism. A lot of people feared early anesthesia because it was far more dangerous than today. I also notice people will make note that 'eccentrics' from the 1940s-1950s hated air conditioning but it helps to understand it was a dangerous technology that regularly injured and killed people back then, especially in its earlier days the adults of that period were children during. AC didn't get safe until fairly recently in the 70s, 80s and 90s. It would catch fire or leak poison that killed people in their sleep. Some people just saw it as an unnecessary risk. Same with early fridges. When they leaked, that leak could be fatal as poison or explosion. It wasnt until later that these technologies got safer and even now today, we consider full anesthesia a last resort and will always try to get away with local or twilight anesthesia because full anesthesia does regularly injure, disable, and kill people. Evolution didnt design us to be trivially "shut off" like this. Injecting us with substances like that will always come with risk. In other words, a lot of those people weren't mindless luddites, but people who assessed their personal risk and said "nope, not worth it." I think that's perfectly fine. I'd argue the revisionism of today and the ego justifications of the time were just that, ego protection. Its far easier to say "Well, I'm tough, I don't need that," then "I'm scared of that." The former is rewarded in our individualist capitalist society. The latter is vulnerability and honestly which is often only punished in a society like ours. We see it today with people with limited access and affordability to healthcare in the USA putting off care or engaging in various home remedies, alt-medicine, supplements, or conspiracy-culture-esque pharma drugs gotten cheaply via the gray market.
  - 1y ago
hollerith 1y ago
The drug companies are very good at making new drugs with high profit potential look better than they are. I'm worried semaglutides are another fen-phen, Vioxx, Quaaludes, Trovafloxacin or OxyContin. One thing to watch for is effect size: how big of an anti-aging effect does Ozempic confer relative to other good interventions? Were the subjects doing other solid anti-aging interventions like the Fasting Mimicking Diet (FMD)? If not, the 2 interventions might affect the same pathways with the result that if you are doing FMD, you get no additional benefit from Ozempic. Fen-phen is particularly interesting here because people reported that not only did it help them lose weight, it gave them more willpower and changed their personalities for the better.
- some_random 1y ago
  I think that's a completely reasonable concern to have, it doesn't seem to be the case wrt obesity but for the myriad of other potential effects it's important to keep in mind.
  - hollerith 1y ago
    I'm not even ready to concede that it is a good weight-loss drug -- but then I haven't really investigated much, so I'm just repeating what I heard from researcher Ben Bikman and maybe other researchers. I heard that most people choose to discontinue it after 4 or 5 years or less, regain most or all of the weight, then refuse to go back on it.
    - throwforfeds 1y ago
      I've had a few friends on it. They definitely lost weight, but the GI issues were too much and when they went off of it they gained it all back.
      - alistairSH 1y ago
        I've read (anecdotes from people in the fitness/body-building space) that the default dosing could be too high for many people. And the side-effects seem to ramp up with the dose. IE, if you're getting weight loss at 1/2 the default dose, you might want to stay there, even if your MD wants you to increase to the default. [default uses loosely here - people build up from a low dose over the span of weeks/months] And the weight gain is due to a lack of lifestyle change. The drug just numbs your appetite, so you don't eat as much. If you go off the drug and return to over-eating, yep, you gain the weight back. I also suspect many people lose the weight too fast and go too far. "Ozempic butt" is a joke for a reason - people loose a bunch of fat, but the massive calorie deficit also means they aren't exercising (no energy, and they probably weren't before the drug either), so they've probably crashed their metabolism.
noah_buddy 1y ago
Many people (will only speak to America), view being fat as a literal moral failing. Gluttony or overeating are not the sin, but being fat. (From that perspective:)a miracle cure that allows someone to stop being fat is like an indulgence (in the Roman Catholic sense). It’s a cheat, a shortcut that allows the unworthy to reach a state they do not deserve. My opinion is to wait long enough to validate there are no long term harms, but beyond that, yeah, adjust the priors, it could be a modern aspirin.
- NoMoreNicksLeft 1y ago
  >My opinion is to wait long enough to validate there are no long term harms, What's your threshold on that? How many years is "long enough"? Trying to calibrate my own sense of risk.
  - dexwiz 1y ago
    Not OP but 10-15 years for most drugs. Took about a decade for the general consensus around Oxy to change.
    - 2OEH8eoCRo0 1y ago
      Haven't these been out for a very long time, just not for weight loss? A quick Wikipedia search shows Exenatide was FDA approved in 2005 for diabetes.
      - mapontosevenths 1y ago
        Ozempic itself has been in use for almost a decade now (originally approved for type 2 diabetes in 2017). Many millions of people have taken it, without much in the way of serious complication. Exenatide had been in use since about 2005, and by 2019 had more than a million people on it. Some of those patients have literally been on it for 20 years. It does have a worse side-effect profile than Ozempic (or the more modern GLP-1's like zepbound), but even then the benefits outweigh the risk for those diabetics. Today it is hard to argue the benefits of modern GLP-1s don't outweigh their risks. They've been extensively tested, the class of drug has been around for decades, and they are used by many millions of people. I personally lost 120 pounds on Zepbound in a little less than a year. It's been life changing, and anyone who thinks I might be less healthy now is very clearly wrong. Literally every aspect of my life has been greatly improved.
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gameman144 1y ago
I think there's a justifiable fear/dread when things that used to demonstrate virtues no longer do so. For instance, being in shape used to (usually) demonstrate discipline. Art or music used to demonstrate attention to craft and practice. Knowledge demonstrated time devoted to study. This isn't to say that the world is worse with these advances (I'd be hopeless without search engines, and I am grateful that people get to live longer and healthier with semaglutide), but I think a little bit of mourning is understandable: what used to be the fruits of hard work are now a dime-a-dozen commodity.
- throwaway6041 1y ago
  > being in shape used to (usually) demonstrate discipline. Putting on weight may demonstrate a lack of discipline or awareness, but those losing weight should not be treated as only undisciplined. Scientific research shows that obesity changes the body in ways that actively work against you when you decide to lose weight. You may be able to loose the first pounds with "discipline", but it becomes increasingly harder the more you lose. Once you have lost a few pounds, the body actively works against you to get back to what it thinks should be the baseline.
Barrin92 1y ago
>seemingly need to believe that it's some kind of Faustian bargain I mean, that's because that's literally what they need to believe. A majority of people has been brought up on an incredibly moralized account of human behavior, and if it turns out you can just pour some GLP-1 drugs into the drinking water and basically fix a whole bunch of issues it will become obvious that a therapeutic framing is the appropriate way to look at these things. For people who live in a world of vices and sinners who have to swear off the devil, this throws a pretty big wrench into the whole story, it's much more than just a drug.
- losvedir 1y ago
  I think it's a similar thing to those who are morally invested in human overpopulation and not consuming resources for climate change reasons and such. The techno-optimist GLP analogs like solving these things with clean energy and other modern marvels throws a wrench into that story.
- astrange 1y ago
  I personally believe the theory that obesity in the US is caused by other things in the water supply[0], so adding GLP-1 inhibitors would cancel them out. [0] obesity appears to be caused by moving downstream/to lower altitudes, and has increased in farm and lab animals at the same rates as humans.
cm2187 1y ago
I agree, and I am a consumer of those myself, which did absolute wonders. And of course I will assign vastly more weight to my own experience, than to the opinion of some random guy on the internet who only read about it. However, we also need to be conscious that this is a very very big business, and given the size of the market, is happy to pour billions into some studies that will demonstrate that it has all the benefits in the world and cures everything. Addressing obesity is a humongous benefit in itself, and helps with all the medical conditions that result from it (which in balance makes most mild side effects irrelevant). I am a lot more skeptical about those dozens of claims that it improves X by Y% (often low single digit). Most medical studies in general are dodgy, show minor benefits on small samples in a massively multivariate environment, which more often than not are statistical noise carefully selected, when the approach don't have outright flaws or fraud.
jjice 1y ago
I was kind of scared of these when Ozempic starting picking of steam for weight loss. I was worried that this would be having more negative effects. Turns out, generally speaking, if used with you doctor, these things are pretty safe, especially comparatively to some of the negatives of being overweight. And then I saw some of the stories on HN about how it's changed peoples lives for the better. And then people in my life started taking it and singing its praises. I'm very bullish on GLP-1s now and I've very excited to see all the lives it improves. I'm not saying this thing is 100% miracle with no downsides, but this seems to be a generally large net positive. It's a bit hard for me to comprehend how big of an impact this can have for someone since I've been very fortunate to never struggle with my weight, but I'm (slightly embarrassingly) tearing up writing this because of how many people I've seen have huge positive effects on their physical and mental health (due to body image).
- radiofreeeuropa 1y ago
  It's great because we had no other way to address this problem at a population level. Not any realistic ones, anyway. Like, I figured we were just never going to solve it, given the two possibilities were "radically re-engineer US culture such that moving to the US doesn't make previously-skinny people fatter" (with other countries heading the same direction as us needing to make similar moves, one supposes) or "find a miracle drug". Neither seemed likely. Turns out, decent odds we've managed the latter! Which was always the more likely of the two, but I still wouldn't have rated it as very likely.
  - throwawaylaptop 1y ago
    I helped my dad lose 50 lbs by finally, after 10 years, getting him to give up bread, sugar, potatoes. It took buying him 2 months of a bluetooth glucose monitor. Once he saw what certain foods do, he believed me finally. At 65 years old, healthier than I remember since he was 40 and I was a teen. It doesn't require some weird injection.
    - XorNot 1y ago
      No but its a lot easier for people who've had trouble and gets results, which is all that matters.
y-curious 1y ago
I am one of those people to some extent. For me, it's the naturalistic fallacy I can't get over. I drink caffeine daily, but the idea of hijacking my hunger with an injectable induces dread. I would like to believe that there are no long-term side effects, but: 1. We have to trust the data of for-profit pharmaceutical companies and their trials. They are incentivized to produce optimistic results. 2. It's relatively new (insofar that a lot of people are taking it). Opiates were touted in a similar way until the other shoe dropped. There exists an undefined line in time where I would feel more comfortable. 3. It is/was made of a poison from an animal. 4. The extreme benefits are overwhelmingly in obese candidates. Keto is the same way; I tried it and it was not for me because I am not obese. I'm actually open to any sort of evidence that will change my mind. No name calling please.
- bobsmooth 1y ago
  >It is/was made of a poison from an animal. Caffeine is an insecticide.
  - y-curious 1y ago
    Right, and it's also not something naturally in the human body. But sugar is also an insecticide when you cook it into a jam. It doesn't really make me comfortable with giant lizard poison
    - ACCount36 1y ago
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      - y-curious 1y ago
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        ACCount36 1y ago
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genewitch 1y ago
every time in recorded human history when there's be a panacea or cure-all it's generally been snake-oil. There are a lot of side effects, of this type of medicine - many which were not really prevalent when it was prescribed on-label.
- smt88 1y ago
  There are lots of miraculous, life-saving drugs that have minimal side effects and aren't snake oil. Metformin, insulin, many vaccines, some statins, and some antibiotics are clearly on that list.
  - genewitch 1y ago
    > panacea or cure-all specifically, is what i said.
    - smt88 1y ago
      "GLP-1s are beneficial for many conditions downstream of liver dysfunction and metabolic disease" is a much milder claim than "cure-all".
      - genewitch 1y ago
        also in the news in the last couple months was "promising for breast cancer" and another cancer (can't remember, don't care), and depression as well as some other mental health disorder. If you would like to give me money i would be happy to do the research on what claims have been published about GLP-1 inhibitors since they became prescribed off-label. I assure you it's more than "many conditions downstream of [...]", unless you want to concede that mental health like depression and dementia are related to gut bacteria, then we can be friends. also, i caught wind that by December 2025 it's going to be recommended / "proven" to work for erectile dysfunction. At a certain point, we're mincing words.
        nwienert 1y ago
Petersipoi 1y ago
Just about every single adult woman in my wife's extended family is on Ozempic. None of them are obese at all. Or diabetic. They are all using it to "lose a few pounds" (we're talking like less than 20 pounds; Yes, as you might expect, there are some unrealistic beauty/success standards in my wife's family). So I think there are a lot of people who are annoyed by that, because of the message it sends to completely healthy-weight girls/young women who don't look like professional super models in a swimsuit. Since we have young daughters, that aspect of Ozempic really bothers my wife. Though she would have no issue with obese/diabetic people using it to get healthy. Personally I do think it is a miracle drug and I'm glad people are getting healthy because of it.
- angmarsbane 1y ago
  I fall into the same category as your wife's extended family. I used it to get to the weight I feel most comfortable and I've gone back on it periodically (like after 5 weeks of work travel) to get back within 5 lbs of that weight (where I can manage the additional weight loss on my own). When being fat becomes more of a deliberate choice (due to the drug accessibility) I do wonder how society and society's expectations Will change. Will women be even more pressured to "bounce back" during postpartum? Will the "baby fat" we only get to have during adolescence be eliminated and drop out of the shared experience of growing up? There's also a lot of concern within the eating disorder community about the potential for abuse, because these drugs are so easy to get a hold of by lying on telehealth (could be argued that I've abused them by getting them when they're not truly necessary).
- brcmthrowaway 1y ago
  How does one get Ozempic without being overweight?
  - Der_Einzige 1y ago
    There’s armies of grey market don’t ask don’t tell e doctors who will give it to you with no request for evidence of being overweight. Thank god for poor regulation. Unironically thank god and may this situation continue.
kulahan 1y ago
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- cjbgkagh 1y ago
  Semaglutide is a signaling peptide, these are basically in a different class of medication that has traditionally been largely ignored. Partly due to difficulty defending patents for a class of medication that the body produces naturally, I.e. the instructions are in the DNA. Even if a drug company patents one GLP-1A they can’t patent all of them and any of them will work much the same way. Because it’s a naturally occurring signaling peptide there already exist people who have too much of it and too little of it due to normal genetic variation.
  - kulahan 1y ago
    We didn't even know what "junk DNA" did until like 25 years ago. We've discovered a couple new body parts in the last 50 years. We don't have any real understanding of how basic, foundational parts of medicine work - things like anesthesia and antidepressants and even pain differences between men and women. Tests are regularly performed on highly homogenous groups, or even tested on groups completely different from the target audience. The US allows us to advertise medicines on TV, and this gets people thinking they have some vague understanding of medicine - which they do not. I mean, maybe the unreasonably smart audience of this site may, but for the extreme majority of Americans, they do not. I think our massive advancement in the computer industry has confused people into thinking other industries which use computers are also advanced, but this is not the case. Pharmacology is an extremely immature field. Edit: I think the only field more immature than this would be psychology? And I don't think many are silly enough to trust a field who still worships a dude that believed every thought you had was somehow actually about sex, and has made zero advancements beyond borrowing meditation and a few other ideas from other cultures.
    - Ponet1945 1y ago
      Jesus I can't tell if this comment is a joke or peak techbro arrogance. I think your mind would break if you tried to learn what goes into modern drug design, like quantum chemistry. Statistical analysis was basically invented to solve problems in psychology and biology, like measuring intelligence and understanding genetic inheritance. Pretty much all the advancement in the computer industry is on the hardware side. Software engineering is the most immature field of them all.
godshatter 1y ago
I'm not a fan because it's expensive and once you go off of the drug the weight comes back on (at least from what I've read). That's not a trade-off I want to take lightly. There's also something to be said for gaining the discipline to do it yourself along the way, which may lead to keeping more of the weight off in the long run. We also don't know what the long term side effects of it will be, if any. I don't find any of that unreasonable to me. I'm saying this as a type-2 diabetic who could stand to lose a lot of weight.
- Someone1234 1y ago
  > We also don't know what the long term side effects of it will be, if any. The first GLP‑1 receptor agonist was commercially released in April 2005, meaning 20+ years. People who often repeat this: If 20-years, and tens of trials, isn't long enough to "know" then where is the line exactly? Thalidomide by contrast was available for 4-years, Vioxx for 5-years, and Rezulin for 3-years by contrast. > There's also something to be said for gaining the discipline to do it yourself along the way, which may lead to keeping more of the weight off in the long run. That doesn't work; we know it doesn't work both from small and large scale studies, and population evidence since 1970s. So you're promoting the same thing we've been doing, and failing at, for beyond all of my lifetime. Feels like a religious belief at this point, rather than following the data and what we know from it (i.e. that objectively does not work, and has never worked). Is there something new you know that health experts haven't known as Obesity as increase up through 40.3%+ (with overweight being 73.6%+)?
- deleted 1y ago
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- jonny_eh 1y ago
  > We also don't know what the long term side effects of it will be, if any. What are the long term side effects of NOT taking it? The article implies it could be early death.
- glp1guide 1y ago
  > I'm not a fan because it's expensive and once you go off of the drug the weight comes back on (at least from what I've read). That's not a trade-off I want to take lightly. This isn't true https://glp1.guide/content/do-people-regain-all-the-weight-lost-on-glp1-receptor-agonists/ https://glp1.guide/content/do-people-regain-all-the-weight-l... The rest of the incorrect points other people have basically covered, so won't repeat. Is teaching the discipline lesson worth the shorter life people would live without this medication? Maybe we could find another way to teach people discipline that doesn't maintain a threat to their health? > I don't find any of that unreasonable to me. I'm saying this as a type-2 diabetic who could stand to lose a lot of weight. Gonna be incredibly blunt, but talk to your doctor and get on GLP1s. Take a low dose if you want. GLP1s are incredibly well researched and effective. Imagine dying of a heart attack early because you refused to properly research effective, low-risk medication that is being used by millions and recommended by professional organizations and doctors widely. Real Steve Jobs energy.
lenerdenator 1y ago
There are people who are going to hate anything like that, because it makes a very difficult task (losing weight) significantly easier. And we hate it when the damned kids, what, with their Tok-Clock and deadass rizz, have it easier than we did back in the day. That being said, the fact that we let our society in North America get to the point where something like semaglutides are such a huge deal is something to honestly hate, and I think some of the misdirected hate is really a hatred for that.
hinkley 1y ago
You've got a crowd of people raised in a Calvinist society who think nothing good comes without suffering, you've got people who feel this is a cheat where discipline should win out, and you have a bunch of people who are used to all easy solutions coming with either a bad lottery ticket or externalities on other people/the environment. They can all agree that they're waiting for the other shoe to drop. That said, we are at a point where people are overweight enough that getting exercise has its own risks, and taking a medication that allows you to be more active is likely to cancel out some of those downsides. As long as you do both I have no problem with people taking ozempic, mounjaro, etc. I would prefer if we figured out what other than cultural changes is making everyone have symptoms of inflammatory dysfunctions. There is more than one thing going on. Processed foods, contamination, some microbe that doesn't culture in agar. And it's spreading to more of the world.
- rglover 1y ago
  > That said, we are at a point where people are overweight enough that getting exercise has its own risks, and taking a medication that allows you to be more active is likely to cancel out some of those downsides. And yet we rarely ask or say "maybe I should just eat fewer calories?" Unless you have some other disorder that prevents normal bodily function, that does work (and would be viable I'd imagine for the majority of people being prescribed). But it requires patience and discipline which are basically non-existent for the majority of the population.
  - eclipxe 1y ago
    You think that is rarely asked?
    - rglover 1y ago
      In an honest way? Absolutely. Most people suffer from severe self-delusion to avoid the mental pain of coming face to face with their shortcomings.
  - gtr 1y ago
    As someone who has been fat and not-fat throughout my life, I think literally everyone knows that it is simple to lose weight by eating fewer calories. That does not mean it is easy. If you are already fat, which can happen almost without you noticing by eating 200-300 calories too much a day over a year say, or as a result of some brain malfunction (both have happened to me), then eating the calorie deficit require to lose weight is mentally very hard to to. As a thought experiment, imagine what you eat per day. Now halve it. Would you be having a good time?
rglover 1y ago
Well, considering that the drug was originally developed not for weight loss but for type 2 diabetes management, it's not terribly radical to be skeptical or outright dismissive of it as some miracle weight loss drug (even if that is a consistent side-effect). The whole rush to get people on the thing feels like an opportunistic pharma grab (because it is). The outcome of those sorts of things is never in favor of the individual or their well being.
bsder 1y ago
> I find it fascinating how much a pretty large group of people just hate semaglutides and seemingly need to believe that it's some kind of Faustian bargain. Some of us also remember previous weight loss drugs which had similar levels of hype and later got pulled because of really bad side effects. If I needed to lose 100+ pounds, I'd be at my doctor tomorrow asking for it. The side effects of 100+ pounds are way worse than anything semaglutide might cause. For people who are using it to lose 10-20 pounds, the tradeoff isn't as clear. I am cautiously optimistic and hope that semaglutide lives up to the hype. lots of people will benefit if it does.
aydyn 1y ago
> find it fascinating how much a pretty large group of people just hate semaglutides and seemingly need to believe that it's some kind of Faustian bargain. Its just inductive reasoning. Most things are not free, let alone miracles. Nearly everything in life has a cost.
danielvaughn 1y ago
I’m in the cautiously optimistic camp. I’ve seen two people puke their guts out the day of their doses, but nausea isn’t so bad compared to the health consequences of being overweight.
jonny_eh 1y ago
It’s the same people that hate vaccines, fluoride, and sugar substitutes. They feel like those interventions are too good to be true.
anitil 1y ago
I see a similar hesitancy around anti-alcohol addition treatments like naltrexone. People almost _want_ it to be difficult to quit (or lose weight), like there should be some moral struggle associated with it
- radicaldreamer 1y ago
  Its the same root cause: they think alcoholism or alcohol dependency is a moral failing so there should be struggle and punishment to overcome it.
  - nlitened 1y ago
    Alcoholism is a moral failing, and the struggle and punishment are real, and come not only from outside, but also from within. One can try to rationally argue their way out of alcoholism being a moral failing, but then one notices that in a similar way they can “whitewash” any other moral failing, and the words lose their meaning completely. Yet people use these words to mean something, and abuse of alcohol falls under that meaning, and every society in existence has always cautioned against and condemned it.
    - anitil 1y ago
      If it is a moral failing, how can a pill resolve it? Does the pill put morals back in the user? While I agree that alcohol abuse is bad (and might make people do bad things, and hurts people around them etc), I'm not sure if the moral argument adds anything to the discussion
      - nlitened 1y ago
        > If it is a moral failing, how can a pill resolve it? It doesn't. If thievery is a moral failing, how can chopping off thief's hands resolve it? It does resolve further thievery, but doesn't resolve the moral failing of it.
        1y ago
HWR_14 1y ago
In part that's because historically weight loss drugs have had nasty side effects that only become apparent after years of use.
diego_sandoval 1y ago
It's similar to the hate that some people have for SSRIs when they've never tried one.
myvoiceismypass 1y ago
Apologies if this sounds argumentative but I would be super curious of the cross-section of people that are pro-semaglutides and also anti-vaccine. I am fascinated by that too! (And I trust that HN will share a lot of great datapoints)
mlyle 1y ago
> I'm not talking about the people who are cautious or suspicious, that's more than reasonable Yah.. The track record for public health related items that have a really rapid uptake after release is not great.
strken 1y ago
"No free lunch" is a reasonable question to ask when evaluating medication, if it would improve the evolutionary fitness of the majority of people. I think this is behind some of the skepticism. If Ozempic is so great then how come our bodies don't just produce more GLP-1? How come we aren't like chimps, with eternally shredded bodies and cheese grater abs, provided we get the protein to support them? I would guess that getting fat in times of plenty was a feature and not a bug in the ancestral environment, and that's why we get fat today, which is obvious if you think about it. Still, it means GLP-1 agonists are smacking into quick "is it bullshit?" heuristics for a lot of people. The second point I haven't seen discussed is that weight loss drugs prior to GLP-1 agonists include cigarettes, which (worst case) give you cancer; stimulants, which cause your heart to fail; parasitic intestinal worms, which can kill you but more importantly are just plain gross; and mitochondrial uncouplers, which set you on fire at a cellular level. That's a long history of miracle weight loss drugs which turn out to have horrible side effects. It's not reasonable to think GLP-1 is bad just because of other drugs with different mechanisms, but it certainly causes some skepticism anyway.
- rbranson 1y ago
  none of the things you cited are “miracle weight loss drugs.” they are things people did to lose weight. these are the first class of drugs that actually cause people to lose weight.
  - strken 1y ago
    I would have to check my sources but I'm pretty sure some of them have been prescribed for weight loss at various times. DNP and stimulants I'm more confident of, nicotine and tape worms I'm a bit iffy about.
    - King-Aaron 1y ago
      The American Tobacco Company marketed cigarettes for women's weight control in the 1920's. Lucky Strikes 'Reach for a Lucky" campaign was a big example of this as well, although they marketed it as an appetite suppressant rather than simply a miracle weight loss cure.
djtango 1y ago
I studied chemistry at university and my master's was in medicinal chemistry. My main takeaway was that "chemicals = bad" is a better heuristic for a starting point where you then look for exceptions or accept them as the last resort after exhausting other options. Would you let AI loose on the software of your airplanes or nuclear power plants? Medicine is like a sensible idea that should be ok but is hard to rein in and localise to just the area of effect, we hope that it only makes the change we ask from it but we ultimately can't really say with certainty that it isn't also doing something else I'm actually generally more surprised that people are so trusting of taking medicines and pop pills like they're candy
anal_reactor 1y ago
I think Ozempic is just a symbol of what modern life looks like. Obesity is a problem that 100% could be solved with a cultural shift (see Japan), but instead we decide to use medicine. It's like, humanity at large grew such big brains because there was evolutionary pressure to be intelligent, but now we're using intelligence to remove that pressure. Which would make sense if we redirected that intelligence to something else, but we don't. I think the reason why we don't see aliens is that intelligent life isn't sustainable long-term, and there's a long list of reasons why intelligence leads to self-destruction.
- rvba 1y ago
  Sure, a lot of problems could be solved with a cultural shift, but most people are in a rat race to survive And those in politics are not interested in change since because (the cynical part starts here) they are selected / sponsored by billionaires who own the media, or go to politics as a job and not to help anyone but themselves On a side note storing fat to feed the brain in case of bad times makes sense. In the past there were no convinience stores, nor refridgerators
  - anal_reactor 1y ago
    > And those in politics are not interested in change since because It's not about "big media", it's about the fact that average voter is an idiot. This a fundamental flaw of democracy.
- Fargren 1y ago
  The way Japan "solves" obesity is quite cruel on those it does not work for. Overweight natives are not treated kindly. I think creating a medicine to make this easier is a moral good, and a sign of kindness and intelligence. Hopefully the aliens also agree.
  - anal_reactor 1y ago
    What is more cruel: a) emotional damage b) heart disease
Cthulhu_ 1y ago
Some studies have shown people just drop back to their old habits when they stop, and that long-term use isn't good (pancreas, kidneys, etc). It's life changing for some, but like any medication, it shouldn't be used casually.
RataNova 1y ago
Part of it probably stems from how fast they went mainstream, especially with the weight loss hype
arkh 1y ago
> I find it fascinating how much a pretty large group of people just hate semaglutides and seemingly need to believe that it's some kind of Faustian bargain. There have been some scandals about "miracle drugs" which bad effects have been found only years after being on the market. And side effects can be crazy: I use D2 agonists which works wonder to handle a prolactinoma (like shrinking a tumor with a simple pill every 2 weeks wonder), side effects of this kind of medication can be different addictions (sex, gambling, purchasing etc.) which is always fun when you're one in a thousands to get it.
ggm 1y ago
I think you've got to the nub of it. I worry about e.g. gall stones risk in 10y. But, friends worry it shows a lack of moral fibre or something. They aren't the same kind of worry. One is paranoia about past drug emerging issues and the other is tied up in belief eg poor addicts own their own fate, fat people should htf and eat less, depression isn't real... it's usually a short path to "I don't want to have socialised medicine for poor and old people"
lm28469 1y ago
It's a tool, like anti antidepressants. When used right and in the good settings they can be amazing, when used as a magical pill without treating the underlying issues and not understanding its mechanism of action you're in trouble. I know people who used anti depressants for a few weeks, while going to therapy and fixing their shit, they were out of trouble in less than 6 months. But I also know people who've been basically been taking pills for their entire adult life with absolutely no sign of getting better, the pills just make them cope slightly with their shitty routine/job/&c. while completely destroying their body and making them numb to everything. Same for ozempic, I know people who think you just swallow the pill and that's it, they still have horrendous diets, drink 800cal stabucks "coffee", snacks on sweets all day long, and they're actually gaining weight... Another good example would be sleeping pills, take them once a year to fix your jetlag and they're amazing. Take them for 10 years because you can't fix your routineof watching tv shows in bed until 1am and "need" pills to fall asleep quickly, you'll just fuck up your circadian rhythm for good and it'll be 10 times harder to get out of the cycle If you truly want to fix your shit virtually any tool is good, but if you just want a magic pill without putting any work you're doomed, the main issue is that it's advertised and sold as a magic pill
RivieraKid 1y ago
It can result in a loss of relative status or self-esteem for the people who are fit. If I'm fit thanks to some combination of genetics and lifestyle, this fact is probably a source of my self-esteem, it's something that makes me better than most people in a certain aspect.
gadders 1y ago
I don't think it is unequivocally a good thing, but it is probably significantly less bad for you than being morbidly obese.
sjw987 1y ago
I think it's because their use comes across for many users as lazy. It reflects poorly on peoples state of discipline and willpower. I wouldn't judge somebody morbidly obese using these to get down to a lower weight to healthily exercise and eat less. But I definitely judge people who are taking these who are only marginally overweight or actually normal weight. Imagine kids that want to eat chicken nuggets and sweets and don't want to do any exercise because it's hard or makes them briefly uncomfortable. Then apply that image to people over the age of 10. When I started gaining weight in the past, I changed my diet (permanently up to this point) and got set on a fitness path. These things greatly improved my life and improved my outlook on life. Somebody who just grabs an injection isn't getting that same change in outlook. They're just handling the symptoms instead of addressing the root cause.
wkat4242 1y ago
Yeah they are often the people that don't understand overweight because it's an issue they don't have. They view it as an easy out. Which it is but the harder solution is much more difficult for some people. It's the same with people without mental illness. They often have this "just don't be depressed" attitude.
tomxor 1y ago
I find it amusing that a pretty large group of people need to believe it's some kind of elixir of youth. Did you read the abstract? It "reduces aging" in a highly selective group of people with accelerated aging from secondary effects of obesity. > people with HIV-associated lipohypertrophy disease, a condition characterized by excess fat accumulation and accelerated cellular aging What's next? "Ozempic shows anti-gravity effects in humans"? Yes it makes you less hungry, no that's not a solution to the underlying issue of economically induced, nationwide shit nutrition and the enevitble overeating and health issues that ensue.. it's a dodgy crutch.
glenstein 1y ago
>and seemingly need to believe that it's some kind of Faustian bargain. I've seen the same thing and it's simultaneously depressing and fascinating. I think it's a variation of the just world hypothesis. People think in terms of narratives, and so if something bad happened, there must be some moral or reason that rationalizes it. And if something's just good, there must be some catch or hidden secret. So we can't have a conversation about the positive effects of ozempic without people coming in by the droves speculating that it's part of some hidden trade-off. Because it feels like doing that even without evidence counts as informed skepticism.
koliber 1y ago
I was one of them, and changed my mind. Ozempic seemed like too much of a wonder drug. Being conditioned that some things just seem too good to be true I avoided it for many years. But as the number of years passed and the amount of evidence of ill effects remained steady, the scale flipped and I got enough assurance that it's not just brilliant marketing or malicious evidence hiding. I guess that I would like to define myself as "cautiously optimistic" but in the back of my mind it seemed like there was something there that was not being revealed. I've been taking it for a few months now and it really does seem like a wonder drug. All the benefits I needed without any noticeable drawbacks. It's weirdly good.

jbentley1 1y ago

Naturally skinny people hate Ozempic for the same reason I know many talented engineers who hate AI coding.

kmeisthax 1y ago
As a talented engineer, I hate AI coding because it doesn't do what it says on the tin. If GLPs made people hallucinate weight loss that wasn't actually happening, I'd be angry about them too.
- thaumasiotes 1y ago
  Ever seen "Shallow Hal"?
amelius 1y ago
It is not fun when your superpower becomes a commodity.
stronglikedan 1y ago
I'd wager that you can only call an engineer talented if they know enough to hate AI coding.
zer00eyz 1y ago
> I know many talented engineers who hate AI coding. People whos primary skill is coding, hate AI coding. No talented engineer hates AI coding. The distinction is this: a coder knows how to use their tools, an engineer knows how to work with people, understands product, process, users, and knows how to use their tools. Talented engineers hate the HYPE around AI. And those of us old enough to remember sigh and think "This is just dreamweaver all over again". It is ESB's with "drag and drop" workflow tools. AI is just another useful tool that a good engineer can pick up and put down where appropriate.
eddythompson80 1y ago
Thank you for your service
devmor 1y ago
I think those engineers don’t like you because you find unrelated subjects to justify your favorite scam.
Der_Einzige 1y ago
Was waiting to see this comparison. Glad to see that meritocracy is becoming the pejorative it was always meant to be. Meritocrats are unironically bigots.
mensetmanusman 1y ago
They are living rent free in your head, they really don’t care.

qgin 1y ago

There were even people who felt this way about anesthesia too. To survive in that era, they had to believe that suffering was somehow good for healing (or at least good spiritually) and talked about anesthesia as if it were cheating the natural god-given order.

readthenotes1 1y ago
Are you talking about MMother Teresa? She wasn't that long ago...
zoeysmithe 1y ago
I think this might be revisionism. A lot of people feared early anesthesia because it was far more dangerous than today. I also notice people will make note that 'eccentrics' from the 1940s-1950s hated air conditioning but it helps to understand it was a dangerous technology that regularly injured and killed people back then, especially in its earlier days the adults of that period were children during. AC didn't get safe until fairly recently in the 70s, 80s and 90s. It would catch fire or leak poison that killed people in their sleep. Some people just saw it as an unnecessary risk. Same with early fridges. When they leaked, that leak could be fatal as poison or explosion. It wasnt until later that these technologies got safer and even now today, we consider full anesthesia a last resort and will always try to get away with local or twilight anesthesia because full anesthesia does regularly injure, disable, and kill people. Evolution didnt design us to be trivially "shut off" like this. Injecting us with substances like that will always come with risk. In other words, a lot of those people weren't mindless luddites, but people who assessed their personal risk and said "nope, not worth it." I think that's perfectly fine. I'd argue the revisionism of today and the ego justifications of the time were just that, ego protection. Its far easier to say "Well, I'm tough, I don't need that," then "I'm scared of that." The former is rewarded in our individualist capitalist society. The latter is vulnerability and honestly which is often only punished in a society like ours. We see it today with people with limited access and affordability to healthcare in the USA putting off care or engaging in various home remedies, alt-medicine, supplements, or conspiracy-culture-esque pharma drugs gotten cheaply via the gray market.
- 1y ago

hollerith 1y ago

The drug companies are very good at making new drugs with high profit potential look better than they are. I'm worried semaglutides are another fen-phen, Vioxx, Quaaludes, Trovafloxacin or OxyContin. One thing to watch for is effect size: how big of an anti-aging effect does Ozempic confer relative to other good interventions? Were the subjects doing other solid anti-aging interventions like the Fasting Mimicking Diet (FMD)? If not, the 2 interventions might affect the same pathways with the result that if you are doing FMD, you get no additional benefit from Ozempic. Fen-phen is particularly interesting here because people reported that not only did it help them lose weight, it gave them more willpower and changed their personalities for the better.

some_random 1y ago
I think that's a completely reasonable concern to have, it doesn't seem to be the case wrt obesity but for the myriad of other potential effects it's important to keep in mind.
- hollerith 1y ago
  I'm not even ready to concede that it is a good weight-loss drug -- but then I haven't really investigated much, so I'm just repeating what I heard from researcher Ben Bikman and maybe other researchers. I heard that most people choose to discontinue it after 4 or 5 years or less, regain most or all of the weight, then refuse to go back on it.
  - throwforfeds 1y ago
    I've had a few friends on it. They definitely lost weight, but the GI issues were too much and when they went off of it they gained it all back.
    - alistairSH 1y ago
      I've read (anecdotes from people in the fitness/body-building space) that the default dosing could be too high for many people. And the side-effects seem to ramp up with the dose. IE, if you're getting weight loss at 1/2 the default dose, you might want to stay there, even if your MD wants you to increase to the default. [default uses loosely here - people build up from a low dose over the span of weeks/months] And the weight gain is due to a lack of lifestyle change. The drug just numbs your appetite, so you don't eat as much. If you go off the drug and return to over-eating, yep, you gain the weight back. I also suspect many people lose the weight too fast and go too far. "Ozempic butt" is a joke for a reason - people loose a bunch of fat, but the massive calorie deficit also means they aren't exercising (no energy, and they probably weren't before the drug either), so they've probably crashed their metabolism.

noah_buddy 1y ago

Many people (will only speak to America), view being fat as a literal moral failing. Gluttony or overeating are not the sin, but being fat. (From that perspective:)a miracle cure that allows someone to stop being fat is like an indulgence (in the Roman Catholic sense). It’s a cheat, a shortcut that allows the unworthy to reach a state they do not deserve. My opinion is to wait long enough to validate there are no long term harms, but beyond that, yeah, adjust the priors, it could be a modern aspirin.

NoMoreNicksLeft 1y ago
>My opinion is to wait long enough to validate there are no long term harms, What's your threshold on that? How many years is "long enough"? Trying to calibrate my own sense of risk.
- dexwiz 1y ago
  Not OP but 10-15 years for most drugs. Took about a decade for the general consensus around Oxy to change.
  - 2OEH8eoCRo0 1y ago
    Haven't these been out for a very long time, just not for weight loss? A quick Wikipedia search shows Exenatide was FDA approved in 2005 for diabetes.
    - mapontosevenths 1y ago
      Ozempic itself has been in use for almost a decade now (originally approved for type 2 diabetes in 2017). Many millions of people have taken it, without much in the way of serious complication. Exenatide had been in use since about 2005, and by 2019 had more than a million people on it. Some of those patients have literally been on it for 20 years. It does have a worse side-effect profile than Ozempic (or the more modern GLP-1's like zepbound), but even then the benefits outweigh the risk for those diabetics. Today it is hard to argue the benefits of modern GLP-1s don't outweigh their risks. They've been extensively tested, the class of drug has been around for decades, and they are used by many millions of people. I personally lost 120 pounds on Zepbound in a little less than a year. It's been life changing, and anyone who thinks I might be less healthy now is very clearly wrong. Literally every aspect of my life has been greatly improved.

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gameman144 1y ago

I think there's a justifiable fear/dread when things that used to demonstrate virtues no longer do so. For instance, being in shape used to (usually) demonstrate discipline. Art or music used to demonstrate attention to craft and practice. Knowledge demonstrated time devoted to study. This isn't to say that the world is worse with these advances (I'd be hopeless without search engines, and I am grateful that people get to live longer and healthier with semaglutide), but I think a little bit of mourning is understandable: what used to be the fruits of hard work are now a dime-a-dozen commodity.

throwaway6041 1y ago
> being in shape used to (usually) demonstrate discipline. Putting on weight may demonstrate a lack of discipline or awareness, but those losing weight should not be treated as only undisciplined. Scientific research shows that obesity changes the body in ways that actively work against you when you decide to lose weight. You may be able to loose the first pounds with "discipline", but it becomes increasingly harder the more you lose. Once you have lost a few pounds, the body actively works against you to get back to what it thinks should be the baseline.

Barrin92 1y ago

>seemingly need to believe that it's some kind of Faustian bargain I mean, that's because that's literally what they need to believe. A majority of people has been brought up on an incredibly moralized account of human behavior, and if it turns out you can just pour some GLP-1 drugs into the drinking water and basically fix a whole bunch of issues it will become obvious that a therapeutic framing is the appropriate way to look at these things. For people who live in a world of vices and sinners who have to swear off the devil, this throws a pretty big wrench into the whole story, it's much more than just a drug.

losvedir 1y ago
I think it's a similar thing to those who are morally invested in human overpopulation and not consuming resources for climate change reasons and such. The techno-optimist GLP analogs like solving these things with clean energy and other modern marvels throws a wrench into that story.
astrange 1y ago
I personally believe the theory that obesity in the US is caused by other things in the water supply[0], so adding GLP-1 inhibitors would cancel them out. [0] obesity appears to be caused by moving downstream/to lower altitudes, and has increased in farm and lab animals at the same rates as humans.

cm2187 1y ago

I agree, and I am a consumer of those myself, which did absolute wonders. And of course I will assign vastly more weight to my own experience, than to the opinion of some random guy on the internet who only read about it. However, we also need to be conscious that this is a very very big business, and given the size of the market, is happy to pour billions into some studies that will demonstrate that it has all the benefits in the world and cures everything. Addressing obesity is a humongous benefit in itself, and helps with all the medical conditions that result from it (which in balance makes most mild side effects irrelevant). I am a lot more skeptical about those dozens of claims that it improves X by Y% (often low single digit). Most medical studies in general are dodgy, show minor benefits on small samples in a massively multivariate environment, which more often than not are statistical noise carefully selected, when the approach don't have outright flaws or fraud.

jjice 1y ago

I was kind of scared of these when Ozempic starting picking of steam for weight loss. I was worried that this would be having more negative effects. Turns out, generally speaking, if used with you doctor, these things are pretty safe, especially comparatively to some of the negatives of being overweight. And then I saw some of the stories on HN about how it's changed peoples lives for the better. And then people in my life started taking it and singing its praises. I'm very bullish on GLP-1s now and I've very excited to see all the lives it improves. I'm not saying this thing is 100% miracle with no downsides, but this seems to be a generally large net positive. It's a bit hard for me to comprehend how big of an impact this can have for someone since I've been very fortunate to never struggle with my weight, but I'm (slightly embarrassingly) tearing up writing this because of how many people I've seen have huge positive effects on their physical and mental health (due to body image).

radiofreeeuropa 1y ago
It's great because we had no other way to address this problem at a population level. Not any realistic ones, anyway. Like, I figured we were just never going to solve it, given the two possibilities were "radically re-engineer US culture such that moving to the US doesn't make previously-skinny people fatter" (with other countries heading the same direction as us needing to make similar moves, one supposes) or "find a miracle drug". Neither seemed likely. Turns out, decent odds we've managed the latter! Which was always the more likely of the two, but I still wouldn't have rated it as very likely.
- throwawaylaptop 1y ago
  I helped my dad lose 50 lbs by finally, after 10 years, getting him to give up bread, sugar, potatoes. It took buying him 2 months of a bluetooth glucose monitor. Once he saw what certain foods do, he believed me finally. At 65 years old, healthier than I remember since he was 40 and I was a teen. It doesn't require some weird injection.
  - XorNot 1y ago
    No but its a lot easier for people who've had trouble and gets results, which is all that matters.

y-curious 1y ago

I am one of those people to some extent. For me, it's the naturalistic fallacy I can't get over. I drink caffeine daily, but the idea of hijacking my hunger with an injectable induces dread. I would like to believe that there are no long-term side effects, but: 1. We have to trust the data of for-profit pharmaceutical companies and their trials. They are incentivized to produce optimistic results. 2. It's relatively new (insofar that a lot of people are taking it). Opiates were touted in a similar way until the other shoe dropped. There exists an undefined line in time where I would feel more comfortable. 3. It is/was made of a poison from an animal. 4. The extreme benefits are overwhelmingly in obese candidates. Keto is the same way; I tried it and it was not for me because I am not obese. I'm actually open to any sort of evidence that will change my mind. No name calling please.

bobsmooth 1y ago
>It is/was made of a poison from an animal. Caffeine is an insecticide.
- y-curious 1y ago
  Right, and it's also not something naturally in the human body. But sugar is also an insecticide when you cook it into a jam. It doesn't really make me comfortable with giant lizard poison
  - ACCount36 1y ago
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genewitch 1y ago

every time in recorded human history when there's be a panacea or cure-all it's generally been snake-oil. There are a lot of side effects, of this type of medicine - many which were not really prevalent when it was prescribed on-label.

smt88 1y ago
There are lots of miraculous, life-saving drugs that have minimal side effects and aren't snake oil. Metformin, insulin, many vaccines, some statins, and some antibiotics are clearly on that list.
- genewitch 1y ago
  > panacea or cure-all specifically, is what i said.
  - smt88 1y ago
    "GLP-1s are beneficial for many conditions downstream of liver dysfunction and metabolic disease" is a much milder claim than "cure-all".
    - genewitch 1y ago
      also in the news in the last couple months was "promising for breast cancer" and another cancer (can't remember, don't care), and depression as well as some other mental health disorder. If you would like to give me money i would be happy to do the research on what claims have been published about GLP-1 inhibitors since they became prescribed off-label. I assure you it's more than "many conditions downstream of [...]", unless you want to concede that mental health like depression and dementia are related to gut bacteria, then we can be friends. also, i caught wind that by December 2025 it's going to be recommended / "proven" to work for erectile dysfunction. At a certain point, we're mincing words.
      - nwienert 1y ago

Petersipoi 1y ago

Just about every single adult woman in my wife's extended family is on Ozempic. None of them are obese at all. Or diabetic. They are all using it to "lose a few pounds" (we're talking like less than 20 pounds; Yes, as you might expect, there are some unrealistic beauty/success standards in my wife's family). So I think there are a lot of people who are annoyed by that, because of the message it sends to completely healthy-weight girls/young women who don't look like professional super models in a swimsuit. Since we have young daughters, that aspect of Ozempic really bothers my wife. Though she would have no issue with obese/diabetic people using it to get healthy. Personally I do think it is a miracle drug and I'm glad people are getting healthy because of it.

angmarsbane 1y ago
I fall into the same category as your wife's extended family. I used it to get to the weight I feel most comfortable and I've gone back on it periodically (like after 5 weeks of work travel) to get back within 5 lbs of that weight (where I can manage the additional weight loss on my own). When being fat becomes more of a deliberate choice (due to the drug accessibility) I do wonder how society and society's expectations Will change. Will women be even more pressured to "bounce back" during postpartum? Will the "baby fat" we only get to have during adolescence be eliminated and drop out of the shared experience of growing up? There's also a lot of concern within the eating disorder community about the potential for abuse, because these drugs are so easy to get a hold of by lying on telehealth (could be argued that I've abused them by getting them when they're not truly necessary).
brcmthrowaway 1y ago
How does one get Ozempic without being overweight?
- Der_Einzige 1y ago
  There’s armies of grey market don’t ask don’t tell e doctors who will give it to you with no request for evidence of being overweight. Thank god for poor regulation. Unironically thank god and may this situation continue.

kulahan 1y ago

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cjbgkagh 1y ago
Semaglutide is a signaling peptide, these are basically in a different class of medication that has traditionally been largely ignored. Partly due to difficulty defending patents for a class of medication that the body produces naturally, I.e. the instructions are in the DNA. Even if a drug company patents one GLP-1A they can’t patent all of them and any of them will work much the same way. Because it’s a naturally occurring signaling peptide there already exist people who have too much of it and too little of it due to normal genetic variation.
- kulahan 1y ago
  We didn't even know what "junk DNA" did until like 25 years ago. We've discovered a couple new body parts in the last 50 years. We don't have any real understanding of how basic, foundational parts of medicine work - things like anesthesia and antidepressants and even pain differences between men and women. Tests are regularly performed on highly homogenous groups, or even tested on groups completely different from the target audience. The US allows us to advertise medicines on TV, and this gets people thinking they have some vague understanding of medicine - which they do not. I mean, maybe the unreasonably smart audience of this site may, but for the extreme majority of Americans, they do not. I think our massive advancement in the computer industry has confused people into thinking other industries which use computers are also advanced, but this is not the case. Pharmacology is an extremely immature field. Edit: I think the only field more immature than this would be psychology? And I don't think many are silly enough to trust a field who still worships a dude that believed every thought you had was somehow actually about sex, and has made zero advancements beyond borrowing meditation and a few other ideas from other cultures.
  - Ponet1945 1y ago
    Jesus I can't tell if this comment is a joke or peak techbro arrogance. I think your mind would break if you tried to learn what goes into modern drug design, like quantum chemistry. Statistical analysis was basically invented to solve problems in psychology and biology, like measuring intelligence and understanding genetic inheritance. Pretty much all the advancement in the computer industry is on the hardware side. Software engineering is the most immature field of them all.

godshatter 1y ago

I'm not a fan because it's expensive and once you go off of the drug the weight comes back on (at least from what I've read). That's not a trade-off I want to take lightly. There's also something to be said for gaining the discipline to do it yourself along the way, which may lead to keeping more of the weight off in the long run. We also don't know what the long term side effects of it will be, if any. I don't find any of that unreasonable to me. I'm saying this as a type-2 diabetic who could stand to lose a lot of weight.

Someone1234 1y ago
> We also don't know what the long term side effects of it will be, if any. The first GLP‑1 receptor agonist was commercially released in April 2005, meaning 20+ years. People who often repeat this: If 20-years, and tens of trials, isn't long enough to "know" then where is the line exactly? Thalidomide by contrast was available for 4-years, Vioxx for 5-years, and Rezulin for 3-years by contrast. > There's also something to be said for gaining the discipline to do it yourself along the way, which may lead to keeping more of the weight off in the long run. That doesn't work; we know it doesn't work both from small and large scale studies, and population evidence since 1970s. So you're promoting the same thing we've been doing, and failing at, for beyond all of my lifetime. Feels like a religious belief at this point, rather than following the data and what we know from it (i.e. that objectively does not work, and has never worked). Is there something new you know that health experts haven't known as Obesity as increase up through 40.3%+ (with overweight being 73.6%+)?
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jonny_eh 1y ago
> We also don't know what the long term side effects of it will be, if any. What are the long term side effects of NOT taking it? The article implies it could be early death.
glp1guide 1y ago
> I'm not a fan because it's expensive and once you go off of the drug the weight comes back on (at least from what I've read). That's not a trade-off I want to take lightly. This isn't true https://glp1.guide/content/do-people-regain-all-the-weight-lost-on-glp1-receptor-agonists/ https://glp1.guide/content/do-people-regain-all-the-weight-l... The rest of the incorrect points other people have basically covered, so won't repeat. Is teaching the discipline lesson worth the shorter life people would live without this medication? Maybe we could find another way to teach people discipline that doesn't maintain a threat to their health? > I don't find any of that unreasonable to me. I'm saying this as a type-2 diabetic who could stand to lose a lot of weight. Gonna be incredibly blunt, but talk to your doctor and get on GLP1s. Take a low dose if you want. GLP1s are incredibly well researched and effective. Imagine dying of a heart attack early because you refused to properly research effective, low-risk medication that is being used by millions and recommended by professional organizations and doctors widely. Real Steve Jobs energy.

lenerdenator 1y ago

There are people who are going to hate anything like that, because it makes a very difficult task (losing weight) significantly easier. And we hate it when the damned kids, what, with their Tok-Clock and deadass rizz, have it easier than we did back in the day. That being said, the fact that we let our society in North America get to the point where something like semaglutides are such a huge deal is something to honestly hate, and I think some of the misdirected hate is really a hatred for that.

hinkley 1y ago

You've got a crowd of people raised in a Calvinist society who think nothing good comes without suffering, you've got people who feel this is a cheat where discipline should win out, and you have a bunch of people who are used to all easy solutions coming with either a bad lottery ticket or externalities on other people/the environment. They can all agree that they're waiting for the other shoe to drop. That said, we are at a point where people are overweight enough that getting exercise has its own risks, and taking a medication that allows you to be more active is likely to cancel out some of those downsides. As long as you do both I have no problem with people taking ozempic, mounjaro, etc. I would prefer if we figured out what other than cultural changes is making everyone have symptoms of inflammatory dysfunctions. There is more than one thing going on. Processed foods, contamination, some microbe that doesn't culture in agar. And it's spreading to more of the world.

rglover 1y ago
> That said, we are at a point where people are overweight enough that getting exercise has its own risks, and taking a medication that allows you to be more active is likely to cancel out some of those downsides. And yet we rarely ask or say "maybe I should just eat fewer calories?" Unless you have some other disorder that prevents normal bodily function, that does work (and would be viable I'd imagine for the majority of people being prescribed). But it requires patience and discipline which are basically non-existent for the majority of the population.
- eclipxe 1y ago
  You think that is rarely asked?
  - rglover 1y ago
    In an honest way? Absolutely. Most people suffer from severe self-delusion to avoid the mental pain of coming face to face with their shortcomings.
- gtr 1y ago
  As someone who has been fat and not-fat throughout my life, I think literally everyone knows that it is simple to lose weight by eating fewer calories. That does not mean it is easy. If you are already fat, which can happen almost without you noticing by eating 200-300 calories too much a day over a year say, or as a result of some brain malfunction (both have happened to me), then eating the calorie deficit require to lose weight is mentally very hard to to. As a thought experiment, imagine what you eat per day. Now halve it. Would you be having a good time?

rglover 1y ago

Well, considering that the drug was originally developed not for weight loss but for type 2 diabetes management, it's not terribly radical to be skeptical or outright dismissive of it as some miracle weight loss drug (even if that is a consistent side-effect). The whole rush to get people on the thing feels like an opportunistic pharma grab (because it is). The outcome of those sorts of things is never in favor of the individual or their well being.

bsder 1y ago

> I find it fascinating how much a pretty large group of people just hate semaglutides and seemingly need to believe that it's some kind of Faustian bargain. Some of us also remember previous weight loss drugs which had similar levels of hype and later got pulled because of really bad side effects. If I needed to lose 100+ pounds, I'd be at my doctor tomorrow asking for it. The side effects of 100+ pounds are way worse than anything semaglutide might cause. For people who are using it to lose 10-20 pounds, the tradeoff isn't as clear. I am cautiously optimistic and hope that semaglutide lives up to the hype. lots of people will benefit if it does.

aydyn 1y ago

> find it fascinating how much a pretty large group of people just hate semaglutides and seemingly need to believe that it's some kind of Faustian bargain. Its just inductive reasoning. Most things are not free, let alone miracles. Nearly everything in life has a cost.

danielvaughn 1y ago

I’m in the cautiously optimistic camp. I’ve seen two people puke their guts out the day of their doses, but nausea isn’t so bad compared to the health consequences of being overweight.

jonny_eh 1y ago

It’s the same people that hate vaccines, fluoride, and sugar substitutes. They feel like those interventions are too good to be true.

anitil 1y ago

I see a similar hesitancy around anti-alcohol addition treatments like naltrexone. People almost _want_ it to be difficult to quit (or lose weight), like there should be some moral struggle associated with it

radicaldreamer 1y ago
Its the same root cause: they think alcoholism or alcohol dependency is a moral failing so there should be struggle and punishment to overcome it.
- nlitened 1y ago
  Alcoholism is a moral failing, and the struggle and punishment are real, and come not only from outside, but also from within. One can try to rationally argue their way out of alcoholism being a moral failing, but then one notices that in a similar way they can “whitewash” any other moral failing, and the words lose their meaning completely. Yet people use these words to mean something, and abuse of alcohol falls under that meaning, and every society in existence has always cautioned against and condemned it.
  - anitil 1y ago
    If it is a moral failing, how can a pill resolve it? Does the pill put morals back in the user? While I agree that alcohol abuse is bad (and might make people do bad things, and hurts people around them etc), I'm not sure if the moral argument adds anything to the discussion
    - nlitened 1y ago
      > If it is a moral failing, how can a pill resolve it? It doesn't. If thievery is a moral failing, how can chopping off thief's hands resolve it? It does resolve further thievery, but doesn't resolve the moral failing of it.
      - 1y ago

HWR_14 1y ago

In part that's because historically weight loss drugs have had nasty side effects that only become apparent after years of use.

diego_sandoval 1y ago

It's similar to the hate that some people have for SSRIs when they've never tried one.

myvoiceismypass 1y ago

Apologies if this sounds argumentative but I would be super curious of the cross-section of people that are pro-semaglutides and also anti-vaccine. I am fascinated by that too! (And I trust that HN will share a lot of great datapoints)

mlyle 1y ago

> I'm not talking about the people who are cautious or suspicious, that's more than reasonable Yah.. The track record for public health related items that have a really rapid uptake after release is not great.

strken 1y ago

"No free lunch" is a reasonable question to ask when evaluating medication, if it would improve the evolutionary fitness of the majority of people. I think this is behind some of the skepticism. If Ozempic is so great then how come our bodies don't just produce more GLP-1? How come we aren't like chimps, with eternally shredded bodies and cheese grater abs, provided we get the protein to support them? I would guess that getting fat in times of plenty was a feature and not a bug in the ancestral environment, and that's why we get fat today, which is obvious if you think about it. Still, it means GLP-1 agonists are smacking into quick "is it bullshit?" heuristics for a lot of people. The second point I haven't seen discussed is that weight loss drugs prior to GLP-1 agonists include cigarettes, which (worst case) give you cancer; stimulants, which cause your heart to fail; parasitic intestinal worms, which can kill you but more importantly are just plain gross; and mitochondrial uncouplers, which set you on fire at a cellular level. That's a long history of miracle weight loss drugs which turn out to have horrible side effects. It's not reasonable to think GLP-1 is bad just because of other drugs with different mechanisms, but it certainly causes some skepticism anyway.

rbranson 1y ago
none of the things you cited are “miracle weight loss drugs.” they are things people did to lose weight. these are the first class of drugs that actually cause people to lose weight.
- strken 1y ago
  I would have to check my sources but I'm pretty sure some of them have been prescribed for weight loss at various times. DNP and stimulants I'm more confident of, nicotine and tape worms I'm a bit iffy about.
  - King-Aaron 1y ago
    The American Tobacco Company marketed cigarettes for women's weight control in the 1920's. Lucky Strikes 'Reach for a Lucky" campaign was a big example of this as well, although they marketed it as an appetite suppressant rather than simply a miracle weight loss cure.

djtango 1y ago

I studied chemistry at university and my master's was in medicinal chemistry. My main takeaway was that "chemicals = bad" is a better heuristic for a starting point where you then look for exceptions or accept them as the last resort after exhausting other options. Would you let AI loose on the software of your airplanes or nuclear power plants? Medicine is like a sensible idea that should be ok but is hard to rein in and localise to just the area of effect, we hope that it only makes the change we ask from it but we ultimately can't really say with certainty that it isn't also doing something else I'm actually generally more surprised that people are so trusting of taking medicines and pop pills like they're candy

anal_reactor 1y ago

I think Ozempic is just a symbol of what modern life looks like. Obesity is a problem that 100% could be solved with a cultural shift (see Japan), but instead we decide to use medicine. It's like, humanity at large grew such big brains because there was evolutionary pressure to be intelligent, but now we're using intelligence to remove that pressure. Which would make sense if we redirected that intelligence to something else, but we don't. I think the reason why we don't see aliens is that intelligent life isn't sustainable long-term, and there's a long list of reasons why intelligence leads to self-destruction.

rvba 1y ago
Sure, a lot of problems could be solved with a cultural shift, but most people are in a rat race to survive And those in politics are not interested in change since because (the cynical part starts here) they are selected / sponsored by billionaires who own the media, or go to politics as a job and not to help anyone but themselves On a side note storing fat to feed the brain in case of bad times makes sense. In the past there were no convinience stores, nor refridgerators
- anal_reactor 1y ago
  > And those in politics are not interested in change since because It's not about "big media", it's about the fact that average voter is an idiot. This a fundamental flaw of democracy.
Fargren 1y ago
The way Japan "solves" obesity is quite cruel on those it does not work for. Overweight natives are not treated kindly. I think creating a medicine to make this easier is a moral good, and a sign of kindness and intelligence. Hopefully the aliens also agree.
- anal_reactor 1y ago
  What is more cruel: a) emotional damage b) heart disease

Cthulhu_ 1y ago

Some studies have shown people just drop back to their old habits when they stop, and that long-term use isn't good (pancreas, kidneys, etc). It's life changing for some, but like any medication, it shouldn't be used casually.

RataNova 1y ago

Part of it probably stems from how fast they went mainstream, especially with the weight loss hype

arkh 1y ago

> I find it fascinating how much a pretty large group of people just hate semaglutides and seemingly need to believe that it's some kind of Faustian bargain. There have been some scandals about "miracle drugs" which bad effects have been found only years after being on the market. And side effects can be crazy: I use D2 agonists which works wonder to handle a prolactinoma (like shrinking a tumor with a simple pill every 2 weeks wonder), side effects of this kind of medication can be different addictions (sex, gambling, purchasing etc.) which is always fun when you're one in a thousands to get it.

ggm 1y ago

I think you've got to the nub of it. I worry about e.g. gall stones risk in 10y. But, friends worry it shows a lack of moral fibre or something. They aren't the same kind of worry. One is paranoia about past drug emerging issues and the other is tied up in belief eg poor addicts own their own fate, fat people should htf and eat less, depression isn't real... it's usually a short path to "I don't want to have socialised medicine for poor and old people"

lm28469 1y ago

It's a tool, like anti antidepressants. When used right and in the good settings they can be amazing, when used as a magical pill without treating the underlying issues and not understanding its mechanism of action you're in trouble. I know people who used anti depressants for a few weeks, while going to therapy and fixing their shit, they were out of trouble in less than 6 months. But I also know people who've been basically been taking pills for their entire adult life with absolutely no sign of getting better, the pills just make them cope slightly with their shitty routine/job/&c. while completely destroying their body and making them numb to everything. Same for ozempic, I know people who think you just swallow the pill and that's it, they still have horrendous diets, drink 800cal stabucks "coffee", snacks on sweets all day long, and they're actually gaining weight... Another good example would be sleeping pills, take them once a year to fix your jetlag and they're amazing. Take them for 10 years because you can't fix your routineof watching tv shows in bed until 1am and "need" pills to fall asleep quickly, you'll just fuck up your circadian rhythm for good and it'll be 10 times harder to get out of the cycle If you truly want to fix your shit virtually any tool is good, but if you just want a magic pill without putting any work you're doomed, the main issue is that it's advertised and sold as a magic pill

RivieraKid 1y ago

It can result in a loss of relative status or self-esteem for the people who are fit. If I'm fit thanks to some combination of genetics and lifestyle, this fact is probably a source of my self-esteem, it's something that makes me better than most people in a certain aspect.

gadders 1y ago

I don't think it is unequivocally a good thing, but it is probably significantly less bad for you than being morbidly obese.

sjw987 1y ago

I think it's because their use comes across for many users as lazy. It reflects poorly on peoples state of discipline and willpower. I wouldn't judge somebody morbidly obese using these to get down to a lower weight to healthily exercise and eat less. But I definitely judge people who are taking these who are only marginally overweight or actually normal weight. Imagine kids that want to eat chicken nuggets and sweets and don't want to do any exercise because it's hard or makes them briefly uncomfortable. Then apply that image to people over the age of 10. When I started gaining weight in the past, I changed my diet (permanently up to this point) and got set on a fitness path. These things greatly improved my life and improved my outlook on life. Somebody who just grabs an injection isn't getting that same change in outlook. They're just handling the symptoms instead of addressing the root cause.

wkat4242 1y ago

Yeah they are often the people that don't understand overweight because it's an issue they don't have. They view it as an easy out. Which it is but the harder solution is much more difficult for some people. It's the same with people without mental illness. They often have this "just don't be depressed" attitude.

tomxor 1y ago

I find it amusing that a pretty large group of people need to believe it's some kind of elixir of youth. Did you read the abstract? It "reduces aging" in a highly selective group of people with accelerated aging from secondary effects of obesity. > people with HIV-associated lipohypertrophy disease, a condition characterized by excess fat accumulation and accelerated cellular aging What's next? "Ozempic shows anti-gravity effects in humans"? Yes it makes you less hungry, no that's not a solution to the underlying issue of economically induced, nationwide shit nutrition and the enevitble overeating and health issues that ensue.. it's a dodgy crutch.

glenstein 1y ago

>and seemingly need to believe that it's some kind of Faustian bargain. I've seen the same thing and it's simultaneously depressing and fascinating. I think it's a variation of the just world hypothesis. People think in terms of narratives, and so if something bad happened, there must be some moral or reason that rationalizes it. And if something's just good, there must be some catch or hidden secret. So we can't have a conversation about the positive effects of ozempic without people coming in by the droves speculating that it's part of some hidden trade-off. Because it feels like doing that even without evidence counts as informed skepticism.

koliber 1y ago

I was one of them, and changed my mind. Ozempic seemed like too much of a wonder drug. Being conditioned that some things just seem too good to be true I avoided it for many years. But as the number of years passed and the amount of evidence of ill effects remained steady, the scale flipped and I got enough assurance that it's not just brilliant marketing or malicious evidence hiding. I guess that I would like to define myself as "cautiously optimistic" but in the back of my mind it seemed like there was something there that was not being revealed. I've been taking it for a few months now and it really does seem like a wonder drug. All the benefits I needed without any noticeable drawbacks. It's weirdly good.