7 ms·

I really wish these weren’t forever drugs. I would be next in line.

estearum 2mo ago
Do you have the same concerns about water or food? Why does it matter that it stops benefitting you if you stop taking it?
- dd8601fn 2mo ago
  Oh god… if only I could quit food, too.
  - estearum 2mo ago
    No but like... why is it a concern? Money? The health problems that GLPs produce help people avoid are way more costly than the drugs will ever be. Especially now that the market is so competitive and will only get moreso.
    - treis 2mo ago
      For me, historically drugs like this for ADHD or depression or gastric bypass or whatever tend to lose effectiveness over time as the body adjusts. Not for everyone but for enough where you've got a short term gain that ultimately compounds the original problem. Medication can be a slippery slope into side effects and rotating dosages/medicines. Especially for behavioral medicines.
      - astrange 2mo ago
        ADHD medications do not lose effectiveness over time. That's magnesium deficiency.
        disgruntledphd2 2mo ago
        > ADHD medications do not lose effectiveness over time. I mean, they're mostly stimulants, which definitely lose effectiveness over time. It would be really weird if they didn't as that's basically how our bodies work in general. Note: I have been prescribed said medication, but have not started taking them yet so I might be entirely wrong in the practicalities (and how would one disentangle the psychological impact of medication from the physiological impact?).
        estearum 2mo ago
        I had the same intuition as you but I looked it up in light of GP's comment and it actually seems not so clear that's how it works. Apparently the physiological effects of prescription ADHD meds will tend to still be ~same intensity for years and years. Patients often report weakened cognitive/psychological effectiveness, but obviously that's very hard to compare...
        disgruntledphd2 2mo ago
        > Apparently the physiological effects of prescription ADHD meds will tend to still be ~same intensity for years and years. I'm not sure how one would even measure this. Like, back in the halcyon days of my youth I took a bunch of stimulants, and experentially there was definitely less impact over time (habituation is a thing). And given that ADHD is predominantly a psychological issue, then the only measure that matters is that of the patients themselves. Do you have some of the sources you mentioned available, I'd be interested to understand the details?
        astrange 2mo ago
        > Like, back in the halcyon days of my youth I took a bunch of stimulants, and experentially there was definitely less impact over time (habituation is a thing). That's magnesium deficiency. Promise. (Or side effects from getting worse sleep.)
        disgruntledphd2 2mo ago
    - dd8601fn 2mo ago
      Yeah, money, and just signing up to regularly inject a thing forever. Anything that’s “starting tomorrow and until the day you die” just seems like a thing I shouldn’t take lightly. Also I’m not badly, badly overweight. So it’s not like “it’s this or cardiac arrest in a year or two”, for me. I should probably be dealing with my issues the old timey way. The stakes look very different for other people, obviously.
- logicchains 2mo ago
  Water and food have a milder risk profile. The FDA (https://glp-1.health/blog/glp1-obesity-eligibility-bmi-chart/ https://glp-1.health/blog/glp1-obesity-eligibility-bmi-chart...) recommends "GLP-1 weight loss medications (Wegovy, Zepbound) if your BMI is 30 or higher, or if your BMI is 27 or higher with at least one weight-related health condition such as high blood pressure, type 2 diabetes, or sleep apnea". This is because there are side effects such that GLP-1 meds have not been shown to produce a net positive benefit-to-risk ratio for people who are only mildly overweight.
  - estearum 2mo ago
    > This is because there are side effects such that GLP-1 meds have not been shown to produce a net positive benefit-to-risk ratio for people who are only mildly overweight. Importantly, this is different from "GLP-1 meds have been shown not to produce a net positive benefit-to-risk ratio" Anyway nearly all of the side effects for these drugs are just discomfort. Not even really obvious they should be called "risks." Meanwhile, the vast majority of Americans who are not already diabetic or have HTN will soon, and it would be quite a surprise to learn these drugs don't have protective effect.
- jollyllama 2mo ago
  It's possible to secure those independently in a wide variety of scenarios. It's harder to DIY your own GLPs.
dnautics 2mo ago
uniquely among maintenance drugs some people report saving money on GLP-1s, they spend less on food than the drugs cost... But think of the farmers!
Analemma_ 2mo ago
Bariatric surgery has most of the same upsides as GLP-1s and is a one-time cost. But I agree with the other commenters that "forever drug" is mostly fretting without an actual reason. The Hunger that engineered foods are deliberately designed to induce is a forever thing too, now there's a counterweapon.
- dd8601fn 2mo ago
  If it sounded like I don’t think other people should take them, that was a mistake on my part. I’m just really not what you’d think of as a model candidate for them, so I’m not quite ready to commit to my first and only, not exactly free, rest of my life pharmaceutical dependence. That may not seem perfectly rational to some… but ya’know… I’m the one who has to live with my brain.
arjie 2mo ago
Interesting. Part of the reason I was eager to use retatrutide was the reversibility. Fantastic drug and entirely reversible. I self-tested and the effects I had on it were reversed entirely in its absence. Similar to caffeine or amphetamine at the doses I have tried (which are not high), removing the intervention resulted in a return to a prior state over a fairly short period. I'd say that, in general, some of the good properties essential to an intervention for a non-debilitating condition are: * uniform dose-response: easy to increase effect by changing dose * reversibility: automatic reversion to pre-intervention in a short-term is gold standard - allows for regret escape * low-cost GLP-1 drugs have these properties which I like. I'm surprised to hear that someone would prefer the alternative, but I must imagine that cost and the dosing structure (sub-q injection is annoying) must dominate decision making here.
- Balooga 2mo ago
  The side effect of drastic muscle loss isn't quickly reversible though. Because muscle is about 3x as expensive to maintain as fat, unless you are on some major strength training to maintain, muscle is the very first thing that your body gets rid of when losing weight. So now you are off the GLP-1. But you also have to eat fewer calories to maintain a calorie deficit because you no longer have all that calorie burning muscle. * And depending on when you start your GLP-1 journey, men when they hit 40 naturally lose between 5% and 8% of their total muscle mass ++a year++ a decade (women, probably earlier). In addition to the muscle loss due to weight loss. * And it takes approximately 3 times longer in your 50s to create a pound of muscle that it does in your 20s. * And you can't train like you did in your 20s or you will hurt yourself. * And as you age, your body can't absorb the protein it needs to build muscle as efficiently as it did when you are young. So you need to eat even more food to compensate. Ok. This is now more of a rant about getting older than it is about GLP-1s. -- Edited to reflect that muscle loss % is decade, per the corrections in replies.
  - tonyedgecombe 2mo ago
    If I lost 5% of my muscle mass every year since I was forty I would only have 32% of my muscle mass left. At 8% I’d be down to 16% left.
rayiner 2mo ago
GLP-1s aren’t “forever drugs.” They’re eliminated so fast from your system you need to keep taking them to keep the effect. That’s the opposite of a forever drug. If you go off them, you just return to the way you were.
- cassianoleal 2mo ago
  Which means if you want to maintain their effect, you need to keep taking them forever. So maybe GP used the wrong term but I suspect they meant exactly this. In any case, we just don't know what kind of long-term effects these drugs have. No one knows what happens if you come out of them 30 years after you started.
  - dd8601fn 2mo ago
    You’re right, I did say that wrong, I suppose.
- SAI_Peregrinus 2mo ago
  I think they mean they're drugs you have to keep taking forever (for the rest of your life) to keep the effects.
  - rayiner 2mo ago
    Interesting. That usage is the opposite of “forever chemicals” though. Isn’t it a good thing GLP-1s don’t permanently change your body?
    - SAI_Peregrinus 2mo ago
      It certainly can be a good thing! But it can also be considered a bad thing that you have to keep taking them, and have to keep paying for them forever. A one-time fix (a cure) can be more desirable than a lifelong treatment regimen.
      - tancop 2mo ago

Do you have the same concerns about water or food? Why does it matter that it stops benefitting you if you stop taking it?

dd8601fn 2mo ago
Oh god… if only I could quit food, too.
- estearum 2mo ago
  No but like... why is it a concern? Money? The health problems that GLPs produce help people avoid are way more costly than the drugs will ever be. Especially now that the market is so competitive and will only get moreso.
  - treis 2mo ago
    For me, historically drugs like this for ADHD or depression or gastric bypass or whatever tend to lose effectiveness over time as the body adjusts. Not for everyone but for enough where you've got a short term gain that ultimately compounds the original problem. Medication can be a slippery slope into side effects and rotating dosages/medicines. Especially for behavioral medicines.
    - astrange 2mo ago
      ADHD medications do not lose effectiveness over time. That's magnesium deficiency.
      - disgruntledphd2 2mo ago
        > ADHD medications do not lose effectiveness over time. I mean, they're mostly stimulants, which definitely lose effectiveness over time. It would be really weird if they didn't as that's basically how our bodies work in general. Note: I have been prescribed said medication, but have not started taking them yet so I might be entirely wrong in the practicalities (and how would one disentangle the psychological impact of medication from the physiological impact?).
        estearum 2mo ago
        I had the same intuition as you but I looked it up in light of GP's comment and it actually seems not so clear that's how it works. Apparently the physiological effects of prescription ADHD meds will tend to still be ~same intensity for years and years. Patients often report weakened cognitive/psychological effectiveness, but obviously that's very hard to compare...
        disgruntledphd2 2mo ago
        > Apparently the physiological effects of prescription ADHD meds will tend to still be ~same intensity for years and years. I'm not sure how one would even measure this. Like, back in the halcyon days of my youth I took a bunch of stimulants, and experentially there was definitely less impact over time (habituation is a thing). And given that ADHD is predominantly a psychological issue, then the only measure that matters is that of the patients themselves. Do you have some of the sources you mentioned available, I'd be interested to understand the details?
        astrange 2mo ago
        > Like, back in the halcyon days of my youth I took a bunch of stimulants, and experentially there was definitely less impact over time (habituation is a thing). That's magnesium deficiency. Promise. (Or side effects from getting worse sleep.)
        disgruntledphd2 2mo ago
  - dd8601fn 2mo ago
    Yeah, money, and just signing up to regularly inject a thing forever. Anything that’s “starting tomorrow and until the day you die” just seems like a thing I shouldn’t take lightly. Also I’m not badly, badly overweight. So it’s not like “it’s this or cardiac arrest in a year or two”, for me. I should probably be dealing with my issues the old timey way. The stakes look very different for other people, obviously.
logicchains 2mo ago
Water and food have a milder risk profile. The FDA (https://glp-1.health/blog/glp1-obesity-eligibility-bmi-chart/ https://glp-1.health/blog/glp1-obesity-eligibility-bmi-chart...) recommends "GLP-1 weight loss medications (Wegovy, Zepbound) if your BMI is 30 or higher, or if your BMI is 27 or higher with at least one weight-related health condition such as high blood pressure, type 2 diabetes, or sleep apnea". This is because there are side effects such that GLP-1 meds have not been shown to produce a net positive benefit-to-risk ratio for people who are only mildly overweight.
- estearum 2mo ago
  > This is because there are side effects such that GLP-1 meds have not been shown to produce a net positive benefit-to-risk ratio for people who are only mildly overweight. Importantly, this is different from "GLP-1 meds have been shown not to produce a net positive benefit-to-risk ratio" Anyway nearly all of the side effects for these drugs are just discomfort. Not even really obvious they should be called "risks." Meanwhile, the vast majority of Americans who are not already diabetic or have HTN will soon, and it would be quite a surprise to learn these drugs don't have protective effect.
jollyllama 2mo ago
It's possible to secure those independently in a wide variety of scenarios. It's harder to DIY your own GLPs.

dnautics 2mo ago

uniquely among maintenance drugs some people report saving money on GLP-1s, they spend less on food than the drugs cost... But think of the farmers!

Analemma_ 2mo ago

Bariatric surgery has most of the same upsides as GLP-1s and is a one-time cost. But I agree with the other commenters that "forever drug" is mostly fretting without an actual reason. The Hunger that engineered foods are deliberately designed to induce is a forever thing too, now there's a counterweapon.

dd8601fn 2mo ago
If it sounded like I don’t think other people should take them, that was a mistake on my part. I’m just really not what you’d think of as a model candidate for them, so I’m not quite ready to commit to my first and only, not exactly free, rest of my life pharmaceutical dependence. That may not seem perfectly rational to some… but ya’know… I’m the one who has to live with my brain.

arjie 2mo ago

Interesting. Part of the reason I was eager to use retatrutide was the reversibility. Fantastic drug and entirely reversible. I self-tested and the effects I had on it were reversed entirely in its absence. Similar to caffeine or amphetamine at the doses I have tried (which are not high), removing the intervention resulted in a return to a prior state over a fairly short period. I'd say that, in general, some of the good properties essential to an intervention for a non-debilitating condition are: * uniform dose-response: easy to increase effect by changing dose * reversibility: automatic reversion to pre-intervention in a short-term is gold standard - allows for regret escape * low-cost GLP-1 drugs have these properties which I like. I'm surprised to hear that someone would prefer the alternative, but I must imagine that cost and the dosing structure (sub-q injection is annoying) must dominate decision making here.

Balooga 2mo ago
The side effect of drastic muscle loss isn't quickly reversible though. Because muscle is about 3x as expensive to maintain as fat, unless you are on some major strength training to maintain, muscle is the very first thing that your body gets rid of when losing weight. So now you are off the GLP-1. But you also have to eat fewer calories to maintain a calorie deficit because you no longer have all that calorie burning muscle. * And depending on when you start your GLP-1 journey, men when they hit 40 naturally lose between 5% and 8% of their total muscle mass ++a year++ a decade (women, probably earlier). In addition to the muscle loss due to weight loss. * And it takes approximately 3 times longer in your 50s to create a pound of muscle that it does in your 20s. * And you can't train like you did in your 20s or you will hurt yourself. * And as you age, your body can't absorb the protein it needs to build muscle as efficiently as it did when you are young. So you need to eat even more food to compensate. Ok. This is now more of a rant about getting older than it is about GLP-1s. -- Edited to reflect that muscle loss % is decade, per the corrections in replies.
- tonyedgecombe 2mo ago
  If I lost 5% of my muscle mass every year since I was forty I would only have 32% of my muscle mass left. At 8% I’d be down to 16% left.

rayiner 2mo ago

GLP-1s aren’t “forever drugs.” They’re eliminated so fast from your system you need to keep taking them to keep the effect. That’s the opposite of a forever drug. If you go off them, you just return to the way you were.

cassianoleal 2mo ago
Which means if you want to maintain their effect, you need to keep taking them forever. So maybe GP used the wrong term but I suspect they meant exactly this. In any case, we just don't know what kind of long-term effects these drugs have. No one knows what happens if you come out of them 30 years after you started.
- dd8601fn 2mo ago
  You’re right, I did say that wrong, I suppose.
SAI_Peregrinus 2mo ago
I think they mean they're drugs you have to keep taking forever (for the rest of your life) to keep the effects.
- rayiner 2mo ago
  Interesting. That usage is the opposite of “forever chemicals” though. Isn’t it a good thing GLP-1s don’t permanently change your body?
  - SAI_Peregrinus 2mo ago
    It certainly can be a good thing! But it can also be considered a bad thing that you have to keep taking them, and have to keep paying for them forever. A one-time fix (a cure) can be more desirable than a lifelong treatment regimen.
    - tancop 2mo ago