I just listened to an excellent episode of Elise Loehnen's podcast with Johann Hari about his book on Ozempic--I though it was a great factual deep dive to into the bigger picture, and a really nuanced discussion.
A few things I wish we talked about more in this context:
-Big Pharma loves and has always loved to market "magic bullet" drugs--see SSRIs, ketamine, Mother's Little Helper-type benzos, Adderall, past iterations of diet drugs, etc. It's worth remembering that pharmaceutical marketing to patients/consumers is illegal in every country except the US and New Zealand, so what's normal for us in terms of all this messaging is not actually normal globally.
-The FDA gives drug approval based on clinical trial data provided by the pharma companies, and there's a major David & Goliath dynamic here. The FDA is a government agency with all the staffing and funding shortcomings of government agencies in the post-Trump era, and pharma companies have ungodly amounts of money. All of which is to say, we don't yet know the long-term effects and risks of this drug and we're not well set up to study them. And there's a long history of the FDA approving drugs that we later learn are very unsafe. See, um, the opioid crisis. Read Empire of Pain if you haven't yet.
-All the above being said, I see/read a lot of knee-jerk Ozempic shaming online, without an acknowledgement that for people with obesity and other medical conditions, it can be a lifesaving /life-changing drug. So many people think weight loss is a question of willpower, and I think that's a privileged position you're only able to hold if you've never experienced what it's like to take drugs that change your metabolism, including many SSRIs.
--Big Ag and our food system have contributed so much to the obesity epidemic--when are we going to hold them more accountable? Address food desserts, lower quality food sources, all the ways this is a race and class issue? In some ways, focusing on the wealthy is a distraction from systemic issues of injustice that have led us here, and it's being made worse when people who "know a guy" are commandeering the supply, not to mention the fact that Big Pharma is allowed to set Ozempic prices so high.
-NIH is currently studying whether SSRIs may have also contributed to the obesity epidemic--they certainly had that effect on me. So I am frustrated and tired of conversations that talk about Ozempic as a transhumanist drug for the era of AI, as if we were previously so pure. Our bodies have always been infiltrated by pharma, agriculture, etc. Ozempic is not new in this regard. It might be helpful to see it as a palliative--addressing issues agriculture and pharma created--but certainly not a long term solution to a public health crisis.
Love, your resident Big Pharma critic reader who yearns for more nuance in these convos!
The SSRI-as-magic-bullet comparison is so real. One was prescribed to me in five minutes as a low risk medication, such an easy decision, "you'll just feel better!" And I had a really bad experience with a lot of side effects. There's no such thing as a risk-free drug.
Yes! I’ve had similar experiences. The marketing of opioids was not an anomaly—they may have the worst side effect/addiction profile but in terms of hype and ignoring warning signs/cherry picking data/both patients and doctors not having access to a full and unbiased picture of risks and rewards, that’s the case for basically every drug out there.
SSRIs have all either made me feel instantly suicidal or so nauseated that I was getting sick constantly and needed Dramamine. Plus the serious and sometimes permanent sexual side effects are routinely underplayed. It’s insane to me how they’re just given out like candy. Also thank you for bringing up big ag and food deserts.
There are two (conflicting) dynamics here that really stand out to me - both feel true.
First, semiglutides are somewhat of a miracle drug for the populations they were designed for. Zooming out, some 42% of Americans (as of 2020) are obese. I think it’s amazing that there are drugs that regulate insulin and reduce appetite (largely) without severe side effects. Our culture’s puritan inclination towards both self-refusal and collective shaming have always felt particularly cruel in light of just how many of us are obese, especially given research suggesting that obesity is actually a form of malnourishment that leads to more not fewer hunger cues. The idea that someone could take a drug to lose weight and actually think about food and their bodies *less*, and have the whole process be less shame-based is great.
Second, the complete about face on body positivity is sickening. There are so many parts of our culture that seem to be giving up feminism as if it was a passing fad - where everyone is flirting with sugarbabydom, idolizing trad wives, and making waist-to-waist videos - taking GLP1 drugs to wither away feels like an extension of all of that. There’s something horrific about watching the collective acknowledgment that asses and bellies and soft bodies are sexy slip away before our eyes.
Completely unrelated, there are some really interesting stories about semiglutide impact on a range of other diseases including cardiovascular disease, kidney health and its anti-inflammatory properties dramatically improving arthritis and osteoporosis symptoms… so to make a bold prediction seems like we might be headed to a future where everyone is on a low does of semiglutides all the time…
I think a huge part of the conversation is being left out when discussing this, which is that there is an abysmally low amount of research done on hormones in women
People like to spew that losing weight is calories in calories out, which it is I mean I’m not gonna argue that if you eat less than you expend you lose weight. However, women have hormonal weight gain and loss that has absolutely nothing to do with how much they eat. I mean how many times have we heard of friends or moms or other women who say they’re only eating ___ amount of insanely low calories and can’t lose weight, sometimes gaining even more. Women have a completely different make up then men I mean we have estrogen in our brains for god sakes. As we continue to expand our life spans further and further past our child bearing years, there is simply not enough research being done on the hormonal changes that occur to women in perimenopause and beyond, and the research that is you have to have the time and education to seek out and apply to yourself. Weight is SO different for women, and while GLP1 does suppress appetite, it also helps with inflammation which is a major side effect of hormonal imbalances. I’m not an expert and I have no idea how we can discuss and view GLP1 through a hormonal lens, but I do believe it’s been such a craze because a lot of women have been struggling with their weight from hormone imbalance for a long time that has gone unaddressed and unnoticed by doctors because no one really cared about women’s health lol.
Yes. Wait til perimenopause hits - the body composition changes and ability to lose weight are staggering. Many of my friends put on 10-15 lbs within a year, with visceral fat. These are women of all shapes, habits and health histories.
And even reading the response to my comment, I wasn’t even thinking about it in terms of undetermined damage it could do, I was viewing it from how it could actually help! Which just goes to show again how we literally have no baseline for hormonal health!
This is the biggest reason I wouldn't go on it. As someone who's spent a year and thousands of dollars on fertility treatments, it's not worth the uncertainty about how it affects your fertility, hormones, and health of future children. It might be fine, but no one knows right now – which is a big dice to roll, unless prioritizing children is far in the future or past for you. This is the dominant reason I hear from other friends my age (32-35) why they won't go on it for a while. They're doing the first research studies on long term impacts on fertility, hormones, and post-Ozempic babies now, but the first wave of results don't come out until 2026.
I’ve been on Mounjaro for about two years (with a few months break for insurance issues) and I’ve lost a hundred pounds and boy! Do I have THOUGHTS about this whole thing as a sociocultural topic. I’m going to try to corral them into some sort of order and then write a hopefully coherent follow up to this comment.
Ok I am going to break this up into I think some general talking points because there's my personal Mounjaro Journey (vomit, I hate describing weight loss as A Journey but it's an easy shorthand) and then my experiences as a fat person seeing the impact it's had culturally.
1) in October 2021 I hit my all time highest weight, I felt like shit, I felt like my mobility was at risk, and I was just so tired. I have gained and lost large amounts of weight in the past mostly through grueling efforts at giving up entire categories of food (I once didn't eat bread for two years) but none of my old tricks were working. I have had disordered eating issues since I was a preteen and have been in therapy and on meds for them for a long time. I decided to stop worry about diet and just focus on activity so I got a personal trainer 3 days a week. I also finally got diagnosed with sleep apnea and got on a cpap machine and honestly that was the single most impactful thing I have ever done for myself. So between improved mobility and finally getting restorative sleep things were looking a little less grimdark for me and I thought well maybe I will investigate these drugs I have heard about. One of my friend's husbands was on Mounjaro and had lost a lot of weight.
2)I didn't want to deal with any doctors locally so I went through a telemed service called Alpha, which was one of the services people on r/Mounjaro were using. It was about $75 a month and I felt like the screening process was pretty thorough, but on the other hand...what's to keep you from lying? They required a monthly check in and a monthly full body photo but I don't know if that was anything but a CYA move on their part. When I started on Mounjaro in March-ish 2022 I was paying out of pocket using the original Mounjaro $25 coupon. There was a ton of turmoil about the coupons, because depending on when you downloaded your coupon there were different rules and a bunch of people got cut off from their coupons every few months causing much turmoil on the subreddit.
3)For someone who has always suffered from a brain that basically has a fork stuck in a garbage disposal in it at all times, the sudden and blessed silence was shocking. It was like someone hit the mute button on all the thoughts in my brain about food. About what I was going to eat, what I should eat, what I shouldn't eat, all of it. And satiety! I had never truly understood satiety as a concept. I had two modes: eat until I was sick, or eat a controlled portion and then feel resentful and angry that I couldn't eat the rest of it. Suddenly I have this little voice in my brain saying "you're getting pretty full! Let's take a break! you can always eat more later!". WILD.
4)I have never had many side effects. The worst ones I get are the sulfur burps and some GI distress if I eat food that's too high in fat too close to taking my injection. When I have gone up a dose I have also had some fatigue and achiness the day after my injection but that has gone away by the second or third dose. I have a theory that a lot of the terrible side effects people report are because there are so many people taking these drugs who do not have the underlying issues they're meant to deal with. I have PCOS, Hashi's, and generally bad insulin resistance and have at times had numbers that flirted with pre-diabetes. If you are just a healthy person who wants to lose 25 pounds I think using a GLP-1 is like using a bazooka to take out a roach. Your body doesn't know how to deal with it so you get the full spectrum of side effects - constipation, diarrhea, gastroparesis, nausea, aches, fatigue, etc.
5)I do not tell people I am on Mounjaro. I didn't tell my family. My very very closest friends now and obviously my doctors know. But I found at the beginning that people are weird and fucking judgmental about these drugs and I just don't want to deal with it. I have had people tell me almost gleefully that I'm going to get cancer one day. I have had people tell me I shouldn't be "taking shortcuts" or I should have gotten gastric bypass (i looked into that at one point, one of my friends had it done, it's its own black hole of issues to get into and I took a pass) and I have had people tell me I'll have to be on it forever which...I don't think is the own they think it is because I'm going to have to be on Synthroid forever and nobody is telling me to stop taking that, you know?
6)Hunger. I have spent two years really confused about the people who do not eat on these drugs because I still get hungry! How much I eat has changed a lot, and what I eat has changed a lot, but with the exception of the day or two after I first go up a dose, I have not had the experience a lot of people talk about with being utterly unable to eat, barely being able to eat 900 calories a day, etc. I used to think I was broken and it's hard, sometimes, not to look at the speed of weight loss in those people and think man if it "worked" better for me I could have lost a hundred pounds in one year and not two! But that leads me to my next point which is....
7)Ozempic face/ozempic body/insert term here. Uh, not to be vain but I look great. I have a lot more weight to lose but I am actually fairly happy with my appearance right now. I haven't lost any hair, my skin looks amazing, I had someone ask me if it was my 30th birthday and I just turned 42....I chalk this up to NOT having lost a hundred pounds in a year, eating enough protein, lifting weights with my trainer, blah blah blah. Losing so much weight so quickly is what gives you the sunken "ozempic" face and you'd get it no matter how you lost the weight if you lose it rapidly and without doing things to support your body during the process. A friend of mine lost about sixty pounds of baby weight on compound very quickly and had to go get Sculptra to replace the lost volume in her cheeks, for example. I've made the decision to avoid any interventions beyond the small amount of botox I get in my forehead twice a year until I am close to my goal weight because I just don't know what I will end up looking like.
8) I had to go off Mounjaro for about four or five months at the end of 2023 because the coupon ran out. I gained back about five pounds but otherwise, I stayed pretty stable. Some of the food noise came back and I certainly did not lose more weight but it wasn't the catastrophe I had worried about or people had taunted me with.
9)I do not have type 2 diabetes but my otherwise shitty insurance covers my Mounjaro - it's a $50 copay and with the current coupon I pay $25. How did I pull off this miracle? By being a big fucking nerd. I had heard rumors on the subreddit that my insurance company had some underwriting guidelines about approving GLP-1s that aren't the weight loss branded ones (which they absolutely will not cover on my crappy exchange policy, as I am self-employed) IF the patient had Metformin in their medical history. So me being me... I tracked down and read this internal underwriting guideline and told my doctor about it - by this point I had stopped using Alpha and had started seeing my endocrinologist again because she was covered by my new health insurance - and had her prescribe me Metformin for a month (which I tried taking and HAAAAATED, I had ten times the side effects versus Mounjaro) and then put in a script for Mounjaro and It WORKED. Every month that I pick up my meds and it's $25 I feel like I am committing a bank heist.
I could yap about this topic for another ten thousand words but I am going to stop now. What do I think about the people who are taking these meds to lose 20 pounds, or to give themselves the boost to make their anorexic behaviors stick? I can't help them or do anything about them. I think it's dumb, obviously. I wish that people didn't treat GLP-1s like a joke or like it's cheating or it's just for rich skinny people. But I can't do anything about it except not talk about it and keep losing weight.
Thank you for this! I can relate to a lot of what you wrote. It's an interesting time. People's reactions to this drug are wild and seem to have -not all- but some to do with our inherent weird moral issues around weight. Like you can kind of feel people being curious but also very much expecting a horrible, deadly side effect to emerge. Also yeah I think Ozempic face is much more from crash diet results on these drugs, my weight loss has been slow, I look fine?
It's very schizophrenic feeling. The messaging to me has always been "hey fattie, lose some weight" and then this thing comes along that makes losing weight not easy per se but much more doable and now the message is "hey fattie, you're doing it wrong". It's just fatphobia. And because it DOES work, there has to be a catch, right? Because fat people can't have a clean win. It can't just be "here's something that works well, that has some caveats but overall is a good thing." There has to be a moral component. It's in all the talk about how fat people are stealing GLP-1s from the "deserving diabetics" but you know these people would say awful things about diabetics and how they did it to themselves.
To me what’s more concerning is now all the brands coming out and co opting the term to Joe’s point above. The fact that people are loosely using names like “Ozempic dupe” on advertising (Sugarless does) or how Supergut went from the prebiotic trend to now saying it’s “Natures Ozempic” —Arrae coming out with its own “MB-1” which stands for “metabolic burn”
It all feels so gimmicky and predatory
That being said I am curious to hear from anyone who has taken the pill versions of GLP-1 or tirzepatide? Wondering if they are just as efficient.
Re: the "easy" way: My working theory is that being naturally thin or even naturally straight sized is like having a trust fund. It doesn't mean you don't work hard, you just have a (sometimes very big) advantage that hard work alone often can't get you to in terms of outcomes. Thinking about it in those terms has killed that mindset for me. If "you can never be too rich or too thin," it makes sense that people who don't technically need it for health reasons would choose to take it. Would you turn down more money because you didn't work hard enough for it? (Obviously this is all problematic.)
This is all so horrible. Also, I myself got a doctor over the phone to prescribe my Ozempic. I am embarrassingly thin and fit, but sometimes old habits die hard and we consider trends when we are losing weight for a wedding. Plz don't attack me lol. But anyway, the doctor easily have it to me over a phone call. I told him I'm 125 lbs, weight train 3x a week, eat healthy, and he was like "you'll look super lean it's great for you! I'm giving you a small dose, I just sent you the invoice." It's pretty scary. It took me 10 minutes. The doctor was in LA.
Nobody here is allowed to attack you. That was the rule.
Thank you for sharing, and I think a LOT of people have been through the same exact situation as you. Was it your regular doctor? Did you think differently about the health system in the US?
The harm is more about who takes it. When a girl who is healthy, works out, early 30s and a size 4 goes on ozempic - and the suddenly looks sick and like she needs professional help, and can't stop (due to body dysmorphia or developing an ED) that's when its harmful. I think if you're the right person for it, it's an incredibly helpful tool!
It tipped a friend of mine from "eating disordered in the usual millennial female way" to " residential anorexia treatment". She lost the weight she wanted to lose, came off the drug, and then just kept losing weight until it became a crisis.
I am on a compounded semaglutide due to a mix of insurance issues, accessibility and frankly the modern medical system.
Many GLP1 meds and compounding providers can be pay to play. You CAN lie about almost anything and get the medications in your hands. You most time have to pay to even talk to a provider to see if you qualify. On most online compounding retailers (Ro, Henry Meds, etc.) don’t always know where the medication comes from until it arrives at your door. Most also use 503b pharmacies at best.
Additionally- most everything about the Lemme or Arrae supplements claiming natural Ozempic is bananas. Ro advertising quick and easy ozempic access is also false advertising.
The real issue is: most people can access GLP1 medication, cost prohibitive, no matter what.
Abuse is rampant and misinformation is all over the place. Everyone thinks they’re a doctor on every social platform.
Event with my own decision to use this medication, people in my personal life have shared false or harmful info. Not to mention straight up ignorance.
Everyone has something to say. Hence why the comments are open haha.
However I will say lastly- GLP-1 medication (when used correctly!!!!!) has brought thousands of people freedom that could not even be imagined if you’ve never genuinely experienced obesity issues.
I think your last point is the most important one -- my friends who are doctors have been amazed by how HEALTHY Americans are able to get with this drug. Thank you so much for sharing.
Totally agree. This drug is such a godsend for people who've truly struggled with weight for their whole lives, and it's really nice to see our culture and medical capabilities evolve beyond shame and body morality.
I'm tiring of the repetitive conversations surrounding GLP1s (not in FeedMe, but in general), but also recognize that this isn't a fad but an inflection point. I think we will look back on the introduction of GLPs the same way we think about the launch of Facebook. There was life before, and life after. As the resident pharmacist here I want to point out some news from the past week that flew under the radar.
In the below article from a few days ago: "Later this year, Novo is expected to report data from a Phase 3 study of CagriSema, a combination therapy of the GLP-1 drug semaglutide, the active ingredient in Ozempic and Wegovy, and cagrilintide, a treatment that activates amylin and calcitonin receptors. (Calcitonin receptors are closely related to amylin receptors and many of the amylin drugs in development activate both types of receptors.)
Investors have high hopes for this readout. In a Phase 2 trial of people with diabetes, the combination treatment showed an average 15.6% weight loss over 32 weeks, compared to 5.1% for people who were taking semaglutide alone and 8.1% with cagrilintide alone."
That's a 3x increase in weight loss vs Ozempic!! The GLPs we have now are just the tip of the iceberg. STAT News has an obesity drug tracker that follows every drug in development and at the moment there are 133 drugs in clinical trials targeting obesity. In the next few years we will see new and improved oral versions of these medications that improve results and reduce side effects. We've only just begun.
"133 drugs in clinical trials targeting obesity" blows my mind and makes me think about the grander issue being the problems we as a society created within the food system, agriculture, and gaps in health education and now are making large profits off of medical solutions. I wish the same urgency and funds were put into health education and regulating our food system.
This is the issue with pharma in the US! We’re really good at medicating symptoms (weight gain, anxiety) and really really bad at addressing root causes that are more diffuse/political/economic. In some ways the above is good news and in others it’s really sad… Japan has only 4% obesity in part because their food system and diet are so different. This is a really American issue.
I have type 1 diabetes and have spent much of my adult life underweight due to high blood sugar. There have been experimental treatments done on type 1 and glp1, so My endocrinologist prescribed me ozempic in hopes that better glycemic control might help with my diabetes management.
It pains me in unspeakable ways to see how the masses have commodified this medication. I feel that glucose monitors are becoming a trendy wellness accessory. As a college student, there have been months that my diabetes medications will cost thousands of dollars, a burden that many diabetics cannot afford and die from annually.
The glibness to which people approach these medications speaks volumes. I am all for the accessibility of weight loss drugs, but this creates a market that prioritizes profit over patient safety. When diabetics cannot access their medications, I have to wonder what our country has come to.
My husband who is type 1 has been taking Zepbound and it has been very good for his blood sugars and it's also cut down on the amount of thinking and calculating and mental toll of managing diabetes because it's like 120 more decisions a day with T1D versus not. And because the drugs are not "officially" for type 1 yet he has been THROUGH IT with insurance regarding getting it and staying on it.
I’m so glad your husband has seen positive results! It’s allowed me to cut my bolus probably by 2/3rds so definitely a game changer. The insurance thing is such a hassle. I had to pay out of pocket before my prior auth went through and it was definitely infuriating…
I’m pretty sure being diagnosed with diabetes at 6 is why my husband went into (kind, low profit) lawyering and generally dealing with bureaucracy professionally. The amount of bureaucracy that you have to deal with regarding a chronic illness in America is a real robbery of time and brilliance imo, on top of the base level of the mental toll. It’s a lot! I can see why things like Silicon Valley deciding glucose monitors are trendy is just gross, dystopian decadence.
As a fat person I can't help but think about how all this plays into the dwindling plus-sized options in major retailers (Corinne Fay has a great piece on Madewell cutting back on plus-sized clothing in a recent newsletter). Even Old Navy stopped carrying many plus sizes in-store. As GLP-1's become more common, what does it mean for those of us who can't take them, don't want to take them, can't afford them? Despite being the majority of the population, fat people are being pushed more than ever to the margins.
The anecdotal stories about their use impacting addiction, too, are very compelling to me. Another massive public health crisis, potentially treatable.
Even if I'd never lost a pound, I'd still be taking them because the lack of food noise is so incredible. It finally reduces food to the size it's supposed to be in your life. I felt bewildered after about a month on Mounjaro, wondering "is this how normal people live?" I had an event with a buffet and instead of spending the entire time anxiously waiting for the buffet to open, trying to bargain with myself about what I would get, obsessing over being not the FIRST person in line bc that's weird but also being not too far back in the line - I socialized and chatted and did not even notice that the buffet had opened and in fact opened for a while. It was wild.
Listen, Emily you were with me when we were hiking and I had to stop and throw up because Ozempic. I have PCOS and it’s been a good solve for a lot of my issues, but it’s not an easy breezy drug. The side effects are very real. I think ALL health conversations are personal an nuanced and anyone who is casting judgment on someone else for ANY medical treatment they’re seeking, whether they think it’s needed or not, should zip it.
I was prescribed Wegovy by my doctor back in April because of lifelong struggles with my weight. I couldn't fill the prescription until June when I got my first 4 doses (.25mg). In that month I lost 5lbs and was encouraged. But then I couldn't get the next dose (you step up slowly to the full 2.4mg dose). It's now September and am still unable to fill my prescription. The pharmacies just don't have any. I have since gained back those 5lbs and added another 5 on the rebound - all without major lifestyle changes. Still no Wegovy. I've tried other pharmacies and just switched to my 5th to see if an online pharmacy will have better luck. We will see. But I suspect all the supply for those who need it are getting snorted up by those who most definitely don't. It's frustrating.
I come from a family where severe levels of addiction run in every direction in my family. My mom and my Grandma both struggle with compulsive eating, my Grandma was medically obese as a result, and my Mom has definitely struggled with heavy weight gain. My whole life I always KNOWN I wanted to eat as much as they did and never stop, but I've seen the impact it had on their lives, and I've superficially guarded against indulging ... but doing that has been exhausting, anxiety-inducing, etc etc. All the things. Reading people in the comments talking about "fighting the food noise" in their heads is enormously gratifying and validating, I didn't even know I need to hear from other people about this.
I had this issue my whole life and then (for totally unrelated reasons) I underwent EMDR in my early 30s. I have no idea if this is "real" or not - but after I finished treatment, I noticed the food noise was gone. It's never come back. There's not a day goes by that I'm not just... I-could-cry levels of grateful for that, even still.
Anyway, all that's to say.. the shaming/judgement around people who want weight management options... ugh. Fuck off.
Anyway, congrats to having one of the only great comment sections on the internet, Emily!
I like that you drew a parallel with ADD meds and id like to draw another parallel to opiates and specifically how the science was changed to accommodate the over prescription of these meds (e.g. pain being the fifth vital sign, doctors being trained in med school that they couldn't address their patients concerns while they were still in pain, massive kickbacks). The medical community had LOADS of evidence these drugs were harmful, but the science changed to accommodate the market. Long conversations with your doctor became short ones. Harms were undersold. Money was made: by doctors, hospitals, pharmacies, and pharmaceutical companies.
We also had a large moral reaction to these drugs being limited. There was talk about how it "wasn't right" that people "truly in pain" couldn't get relief because of "addicts." Stigma and morality entered the conversation. They have not left.
It only took WIDESPREAD death for the public to take notice. I see a similar trend happening with ozempic. My husband is a doctor and noted that, as an anesthesiologist, he cannot perform surgery on patients with full or partially full stomachs due to issues with placing the breathing tube. Yet, he frequently has to turn patients away for surgeries and emergency surgeries because their stomachs are unsafely full. Some of these people have stopped taking the meds for to a week pre-procedure but it's not always enough. A lot of these patients weren't aware rhat ozempic could cause issues if they were to need emergency surgery.
It seems, as was the case with opiates, conversations are being skipped. There is A LOT of money being made off the drugs and after my own experiences with opiate addiction, I have a healthy mistrust of new drugs being marketed as safe when there simply isn't the long term (10+ years) research to back it up.
This is America, and today's solution is always tomorrow's problem.
I just listened to an excellent episode of Elise Loehnen's podcast with Johann Hari about his book on Ozempic--I though it was a great factual deep dive to into the bigger picture, and a really nuanced discussion.
A few things I wish we talked about more in this context:
-Big Pharma loves and has always loved to market "magic bullet" drugs--see SSRIs, ketamine, Mother's Little Helper-type benzos, Adderall, past iterations of diet drugs, etc. It's worth remembering that pharmaceutical marketing to patients/consumers is illegal in every country except the US and New Zealand, so what's normal for us in terms of all this messaging is not actually normal globally.
-The FDA gives drug approval based on clinical trial data provided by the pharma companies, and there's a major David & Goliath dynamic here. The FDA is a government agency with all the staffing and funding shortcomings of government agencies in the post-Trump era, and pharma companies have ungodly amounts of money. All of which is to say, we don't yet know the long-term effects and risks of this drug and we're not well set up to study them. And there's a long history of the FDA approving drugs that we later learn are very unsafe. See, um, the opioid crisis. Read Empire of Pain if you haven't yet.
-All the above being said, I see/read a lot of knee-jerk Ozempic shaming online, without an acknowledgement that for people with obesity and other medical conditions, it can be a lifesaving /life-changing drug. So many people think weight loss is a question of willpower, and I think that's a privileged position you're only able to hold if you've never experienced what it's like to take drugs that change your metabolism, including many SSRIs.
--Big Ag and our food system have contributed so much to the obesity epidemic--when are we going to hold them more accountable? Address food desserts, lower quality food sources, all the ways this is a race and class issue? In some ways, focusing on the wealthy is a distraction from systemic issues of injustice that have led us here, and it's being made worse when people who "know a guy" are commandeering the supply, not to mention the fact that Big Pharma is allowed to set Ozempic prices so high.
-NIH is currently studying whether SSRIs may have also contributed to the obesity epidemic--they certainly had that effect on me. So I am frustrated and tired of conversations that talk about Ozempic as a transhumanist drug for the era of AI, as if we were previously so pure. Our bodies have always been infiltrated by pharma, agriculture, etc. Ozempic is not new in this regard. It might be helpful to see it as a palliative--addressing issues agriculture and pharma created--but certainly not a long term solution to a public health crisis.
Love, your resident Big Pharma critic reader who yearns for more nuance in these convos!
The SSRI-as-magic-bullet comparison is so real. One was prescribed to me in five minutes as a low risk medication, such an easy decision, "you'll just feel better!" And I had a really bad experience with a lot of side effects. There's no such thing as a risk-free drug.
Yes! I’ve had similar experiences. The marketing of opioids was not an anomaly—they may have the worst side effect/addiction profile but in terms of hype and ignoring warning signs/cherry picking data/both patients and doctors not having access to a full and unbiased picture of risks and rewards, that’s the case for basically every drug out there.
SSRIs have all either made me feel instantly suicidal or so nauseated that I was getting sick constantly and needed Dramamine. Plus the serious and sometimes permanent sexual side effects are routinely underplayed. It’s insane to me how they’re just given out like candy. Also thank you for bringing up big ag and food deserts.
👏 yes!
There are two (conflicting) dynamics here that really stand out to me - both feel true.
First, semiglutides are somewhat of a miracle drug for the populations they were designed for. Zooming out, some 42% of Americans (as of 2020) are obese. I think it’s amazing that there are drugs that regulate insulin and reduce appetite (largely) without severe side effects. Our culture’s puritan inclination towards both self-refusal and collective shaming have always felt particularly cruel in light of just how many of us are obese, especially given research suggesting that obesity is actually a form of malnourishment that leads to more not fewer hunger cues. The idea that someone could take a drug to lose weight and actually think about food and their bodies *less*, and have the whole process be less shame-based is great.
Second, the complete about face on body positivity is sickening. There are so many parts of our culture that seem to be giving up feminism as if it was a passing fad - where everyone is flirting with sugarbabydom, idolizing trad wives, and making waist-to-waist videos - taking GLP1 drugs to wither away feels like an extension of all of that. There’s something horrific about watching the collective acknowledgment that asses and bellies and soft bodies are sexy slip away before our eyes.
Completely unrelated, there are some really interesting stories about semiglutide impact on a range of other diseases including cardiovascular disease, kidney health and its anti-inflammatory properties dramatically improving arthritis and osteoporosis symptoms… so to make a bold prediction seems like we might be headed to a future where everyone is on a low does of semiglutides all the time…
Great articulation of the tension I also feel about semiglutides.
I think a huge part of the conversation is being left out when discussing this, which is that there is an abysmally low amount of research done on hormones in women
listening…
People like to spew that losing weight is calories in calories out, which it is I mean I’m not gonna argue that if you eat less than you expend you lose weight. However, women have hormonal weight gain and loss that has absolutely nothing to do with how much they eat. I mean how many times have we heard of friends or moms or other women who say they’re only eating ___ amount of insanely low calories and can’t lose weight, sometimes gaining even more. Women have a completely different make up then men I mean we have estrogen in our brains for god sakes. As we continue to expand our life spans further and further past our child bearing years, there is simply not enough research being done on the hormonal changes that occur to women in perimenopause and beyond, and the research that is you have to have the time and education to seek out and apply to yourself. Weight is SO different for women, and while GLP1 does suppress appetite, it also helps with inflammation which is a major side effect of hormonal imbalances. I’m not an expert and I have no idea how we can discuss and view GLP1 through a hormonal lens, but I do believe it’s been such a craze because a lot of women have been struggling with their weight from hormone imbalance for a long time that has gone unaddressed and unnoticed by doctors because no one really cared about women’s health lol.
Yes. Wait til perimenopause hits - the body composition changes and ability to lose weight are staggering. Many of my friends put on 10-15 lbs within a year, with visceral fat. These are women of all shapes, habits and health histories.
And even reading the response to my comment, I wasn’t even thinking about it in terms of undetermined damage it could do, I was viewing it from how it could actually help! Which just goes to show again how we literally have no baseline for hormonal health!
This is the biggest reason I wouldn't go on it. As someone who's spent a year and thousands of dollars on fertility treatments, it's not worth the uncertainty about how it affects your fertility, hormones, and health of future children. It might be fine, but no one knows right now – which is a big dice to roll, unless prioritizing children is far in the future or past for you. This is the dominant reason I hear from other friends my age (32-35) why they won't go on it for a while. They're doing the first research studies on long term impacts on fertility, hormones, and post-Ozempic babies now, but the first wave of results don't come out until 2026.
100%
I’ve been on Mounjaro for about two years (with a few months break for insurance issues) and I’ve lost a hundred pounds and boy! Do I have THOUGHTS about this whole thing as a sociocultural topic. I’m going to try to corral them into some sort of order and then write a hopefully coherent follow up to this comment.
Ok I am going to break this up into I think some general talking points because there's my personal Mounjaro Journey (vomit, I hate describing weight loss as A Journey but it's an easy shorthand) and then my experiences as a fat person seeing the impact it's had culturally.
1) in October 2021 I hit my all time highest weight, I felt like shit, I felt like my mobility was at risk, and I was just so tired. I have gained and lost large amounts of weight in the past mostly through grueling efforts at giving up entire categories of food (I once didn't eat bread for two years) but none of my old tricks were working. I have had disordered eating issues since I was a preteen and have been in therapy and on meds for them for a long time. I decided to stop worry about diet and just focus on activity so I got a personal trainer 3 days a week. I also finally got diagnosed with sleep apnea and got on a cpap machine and honestly that was the single most impactful thing I have ever done for myself. So between improved mobility and finally getting restorative sleep things were looking a little less grimdark for me and I thought well maybe I will investigate these drugs I have heard about. One of my friend's husbands was on Mounjaro and had lost a lot of weight.
2)I didn't want to deal with any doctors locally so I went through a telemed service called Alpha, which was one of the services people on r/Mounjaro were using. It was about $75 a month and I felt like the screening process was pretty thorough, but on the other hand...what's to keep you from lying? They required a monthly check in and a monthly full body photo but I don't know if that was anything but a CYA move on their part. When I started on Mounjaro in March-ish 2022 I was paying out of pocket using the original Mounjaro $25 coupon. There was a ton of turmoil about the coupons, because depending on when you downloaded your coupon there were different rules and a bunch of people got cut off from their coupons every few months causing much turmoil on the subreddit.
3)For someone who has always suffered from a brain that basically has a fork stuck in a garbage disposal in it at all times, the sudden and blessed silence was shocking. It was like someone hit the mute button on all the thoughts in my brain about food. About what I was going to eat, what I should eat, what I shouldn't eat, all of it. And satiety! I had never truly understood satiety as a concept. I had two modes: eat until I was sick, or eat a controlled portion and then feel resentful and angry that I couldn't eat the rest of it. Suddenly I have this little voice in my brain saying "you're getting pretty full! Let's take a break! you can always eat more later!". WILD.
4)I have never had many side effects. The worst ones I get are the sulfur burps and some GI distress if I eat food that's too high in fat too close to taking my injection. When I have gone up a dose I have also had some fatigue and achiness the day after my injection but that has gone away by the second or third dose. I have a theory that a lot of the terrible side effects people report are because there are so many people taking these drugs who do not have the underlying issues they're meant to deal with. I have PCOS, Hashi's, and generally bad insulin resistance and have at times had numbers that flirted with pre-diabetes. If you are just a healthy person who wants to lose 25 pounds I think using a GLP-1 is like using a bazooka to take out a roach. Your body doesn't know how to deal with it so you get the full spectrum of side effects - constipation, diarrhea, gastroparesis, nausea, aches, fatigue, etc.
5)I do not tell people I am on Mounjaro. I didn't tell my family. My very very closest friends now and obviously my doctors know. But I found at the beginning that people are weird and fucking judgmental about these drugs and I just don't want to deal with it. I have had people tell me almost gleefully that I'm going to get cancer one day. I have had people tell me I shouldn't be "taking shortcuts" or I should have gotten gastric bypass (i looked into that at one point, one of my friends had it done, it's its own black hole of issues to get into and I took a pass) and I have had people tell me I'll have to be on it forever which...I don't think is the own they think it is because I'm going to have to be on Synthroid forever and nobody is telling me to stop taking that, you know?
6)Hunger. I have spent two years really confused about the people who do not eat on these drugs because I still get hungry! How much I eat has changed a lot, and what I eat has changed a lot, but with the exception of the day or two after I first go up a dose, I have not had the experience a lot of people talk about with being utterly unable to eat, barely being able to eat 900 calories a day, etc. I used to think I was broken and it's hard, sometimes, not to look at the speed of weight loss in those people and think man if it "worked" better for me I could have lost a hundred pounds in one year and not two! But that leads me to my next point which is....
7)Ozempic face/ozempic body/insert term here. Uh, not to be vain but I look great. I have a lot more weight to lose but I am actually fairly happy with my appearance right now. I haven't lost any hair, my skin looks amazing, I had someone ask me if it was my 30th birthday and I just turned 42....I chalk this up to NOT having lost a hundred pounds in a year, eating enough protein, lifting weights with my trainer, blah blah blah. Losing so much weight so quickly is what gives you the sunken "ozempic" face and you'd get it no matter how you lost the weight if you lose it rapidly and without doing things to support your body during the process. A friend of mine lost about sixty pounds of baby weight on compound very quickly and had to go get Sculptra to replace the lost volume in her cheeks, for example. I've made the decision to avoid any interventions beyond the small amount of botox I get in my forehead twice a year until I am close to my goal weight because I just don't know what I will end up looking like.
8) I had to go off Mounjaro for about four or five months at the end of 2023 because the coupon ran out. I gained back about five pounds but otherwise, I stayed pretty stable. Some of the food noise came back and I certainly did not lose more weight but it wasn't the catastrophe I had worried about or people had taunted me with.
9)I do not have type 2 diabetes but my otherwise shitty insurance covers my Mounjaro - it's a $50 copay and with the current coupon I pay $25. How did I pull off this miracle? By being a big fucking nerd. I had heard rumors on the subreddit that my insurance company had some underwriting guidelines about approving GLP-1s that aren't the weight loss branded ones (which they absolutely will not cover on my crappy exchange policy, as I am self-employed) IF the patient had Metformin in their medical history. So me being me... I tracked down and read this internal underwriting guideline and told my doctor about it - by this point I had stopped using Alpha and had started seeing my endocrinologist again because she was covered by my new health insurance - and had her prescribe me Metformin for a month (which I tried taking and HAAAAATED, I had ten times the side effects versus Mounjaro) and then put in a script for Mounjaro and It WORKED. Every month that I pick up my meds and it's $25 I feel like I am committing a bank heist.
I could yap about this topic for another ten thousand words but I am going to stop now. What do I think about the people who are taking these meds to lose 20 pounds, or to give themselves the boost to make their anorexic behaviors stick? I can't help them or do anything about them. I think it's dumb, obviously. I wish that people didn't treat GLP-1s like a joke or like it's cheating or it's just for rich skinny people. But I can't do anything about it except not talk about it and keep losing weight.
Thank you for this! I can relate to a lot of what you wrote. It's an interesting time. People's reactions to this drug are wild and seem to have -not all- but some to do with our inherent weird moral issues around weight. Like you can kind of feel people being curious but also very much expecting a horrible, deadly side effect to emerge. Also yeah I think Ozempic face is much more from crash diet results on these drugs, my weight loss has been slow, I look fine?
It's very schizophrenic feeling. The messaging to me has always been "hey fattie, lose some weight" and then this thing comes along that makes losing weight not easy per se but much more doable and now the message is "hey fattie, you're doing it wrong". It's just fatphobia. And because it DOES work, there has to be a catch, right? Because fat people can't have a clean win. It can't just be "here's something that works well, that has some caveats but overall is a good thing." There has to be a moral component. It's in all the talk about how fat people are stealing GLP-1s from the "deserving diabetics" but you know these people would say awful things about diabetics and how they did it to themselves.
This is...so similar to my exact experience. The Alpha to actual doctor pipeline. Wow. Thank you for sharing!
Wow, this is so illuminating, thank you for sharing!
Thank you for taking the time to share your experience - quite illuminating!
Thank you for sharing! Looking forward to hearing your thoughts...
To me what’s more concerning is now all the brands coming out and co opting the term to Joe’s point above. The fact that people are loosely using names like “Ozempic dupe” on advertising (Sugarless does) or how Supergut went from the prebiotic trend to now saying it’s “Natures Ozempic” —Arrae coming out with its own “MB-1” which stands for “metabolic burn”
It all feels so gimmicky and predatory
That being said I am curious to hear from anyone who has taken the pill versions of GLP-1 or tirzepatide? Wondering if they are just as efficient.
Re: the "easy" way: My working theory is that being naturally thin or even naturally straight sized is like having a trust fund. It doesn't mean you don't work hard, you just have a (sometimes very big) advantage that hard work alone often can't get you to in terms of outcomes. Thinking about it in those terms has killed that mindset for me. If "you can never be too rich or too thin," it makes sense that people who don't technically need it for health reasons would choose to take it. Would you turn down more money because you didn't work hard enough for it? (Obviously this is all problematic.)
Great comparison
This is all so horrible. Also, I myself got a doctor over the phone to prescribe my Ozempic. I am embarrassingly thin and fit, but sometimes old habits die hard and we consider trends when we are losing weight for a wedding. Plz don't attack me lol. But anyway, the doctor easily have it to me over a phone call. I told him I'm 125 lbs, weight train 3x a week, eat healthy, and he was like "you'll look super lean it's great for you! I'm giving you a small dose, I just sent you the invoice." It's pretty scary. It took me 10 minutes. The doctor was in LA.
Nobody here is allowed to attack you. That was the rule.
Thank you for sharing, and I think a LOT of people have been through the same exact situation as you. Was it your regular doctor? Did you think differently about the health system in the US?
Telehealth for GLP1 and no, I was not really surprised. It's the same healthcare system that gives out adderall like candy!
Note: I eventually decided not to do it after seeing how this harmed one of my peers.
What was the harm? I'm curious. The few articles I've read seem to be 100% rah-rah.
The harm is more about who takes it. When a girl who is healthy, works out, early 30s and a size 4 goes on ozempic - and the suddenly looks sick and like she needs professional help, and can't stop (due to body dysmorphia or developing an ED) that's when its harmful. I think if you're the right person for it, it's an incredibly helpful tool!
Thanks Julia. That makes a lot of sense.
It tipped a friend of mine from "eating disordered in the usual millennial female way" to " residential anorexia treatment". She lost the weight she wanted to lose, came off the drug, and then just kept losing weight until it became a crisis.
Wow. It makes a lot of sense honestly. It's very sad.
I am on a compounded semaglutide due to a mix of insurance issues, accessibility and frankly the modern medical system.
Many GLP1 meds and compounding providers can be pay to play. You CAN lie about almost anything and get the medications in your hands. You most time have to pay to even talk to a provider to see if you qualify. On most online compounding retailers (Ro, Henry Meds, etc.) don’t always know where the medication comes from until it arrives at your door. Most also use 503b pharmacies at best.
Additionally- most everything about the Lemme or Arrae supplements claiming natural Ozempic is bananas. Ro advertising quick and easy ozempic access is also false advertising.
The real issue is: most people can access GLP1 medication, cost prohibitive, no matter what.
Abuse is rampant and misinformation is all over the place. Everyone thinks they’re a doctor on every social platform.
Event with my own decision to use this medication, people in my personal life have shared false or harmful info. Not to mention straight up ignorance.
Everyone has something to say. Hence why the comments are open haha.
However I will say lastly- GLP-1 medication (when used correctly!!!!!) has brought thousands of people freedom that could not even be imagined if you’ve never genuinely experienced obesity issues.
I think your last point is the most important one -- my friends who are doctors have been amazed by how HEALTHY Americans are able to get with this drug. Thank you so much for sharing.
Totally agree. This drug is such a godsend for people who've truly struggled with weight for their whole lives, and it's really nice to see our culture and medical capabilities evolve beyond shame and body morality.
I'm tiring of the repetitive conversations surrounding GLP1s (not in FeedMe, but in general), but also recognize that this isn't a fad but an inflection point. I think we will look back on the introduction of GLPs the same way we think about the launch of Facebook. There was life before, and life after. As the resident pharmacist here I want to point out some news from the past week that flew under the radar.
In the below article from a few days ago: "Later this year, Novo is expected to report data from a Phase 3 study of CagriSema, a combination therapy of the GLP-1 drug semaglutide, the active ingredient in Ozempic and Wegovy, and cagrilintide, a treatment that activates amylin and calcitonin receptors. (Calcitonin receptors are closely related to amylin receptors and many of the amylin drugs in development activate both types of receptors.)
Investors have high hopes for this readout. In a Phase 2 trial of people with diabetes, the combination treatment showed an average 15.6% weight loss over 32 weeks, compared to 5.1% for people who were taking semaglutide alone and 8.1% with cagrilintide alone."
That's a 3x increase in weight loss vs Ozempic!! The GLPs we have now are just the tip of the iceberg. STAT News has an obesity drug tracker that follows every drug in development and at the moment there are 133 drugs in clinical trials targeting obesity. In the next few years we will see new and improved oral versions of these medications that improve results and reduce side effects. We've only just begun.
https://www.statnews.com/2024/09/05/obesity-drug-tracker-amylin-weight-loss-drugs-novo-nordisk-eli-lilly-zealand-pharma/
https://www.statnews.com/2023/09/12/new-weight-loss-drug-tracker-novo-nordisk-eli-lilly/
Pharmacist in the comments 🚨
"133 drugs in clinical trials targeting obesity" blows my mind and makes me think about the grander issue being the problems we as a society created within the food system, agriculture, and gaps in health education and now are making large profits off of medical solutions. I wish the same urgency and funds were put into health education and regulating our food system.
Wait so we're looking at the effects of Ozempic and saying, "faster, faster!" from a health and caregiving perspective? Yikes
This is the issue with pharma in the US! We’re really good at medicating symptoms (weight gain, anxiety) and really really bad at addressing root causes that are more diffuse/political/economic. In some ways the above is good news and in others it’s really sad… Japan has only 4% obesity in part because their food system and diet are so different. This is a really American issue.
I have type 1 diabetes and have spent much of my adult life underweight due to high blood sugar. There have been experimental treatments done on type 1 and glp1, so My endocrinologist prescribed me ozempic in hopes that better glycemic control might help with my diabetes management.
It pains me in unspeakable ways to see how the masses have commodified this medication. I feel that glucose monitors are becoming a trendy wellness accessory. As a college student, there have been months that my diabetes medications will cost thousands of dollars, a burden that many diabetics cannot afford and die from annually.
The glibness to which people approach these medications speaks volumes. I am all for the accessibility of weight loss drugs, but this creates a market that prioritizes profit over patient safety. When diabetics cannot access their medications, I have to wonder what our country has come to.
My husband who is type 1 has been taking Zepbound and it has been very good for his blood sugars and it's also cut down on the amount of thinking and calculating and mental toll of managing diabetes because it's like 120 more decisions a day with T1D versus not. And because the drugs are not "officially" for type 1 yet he has been THROUGH IT with insurance regarding getting it and staying on it.
I’m so glad your husband has seen positive results! It’s allowed me to cut my bolus probably by 2/3rds so definitely a game changer. The insurance thing is such a hassle. I had to pay out of pocket before my prior auth went through and it was definitely infuriating…
I’m pretty sure being diagnosed with diabetes at 6 is why my husband went into (kind, low profit) lawyering and generally dealing with bureaucracy professionally. The amount of bureaucracy that you have to deal with regarding a chronic illness in America is a real robbery of time and brilliance imo, on top of the base level of the mental toll. It’s a lot! I can see why things like Silicon Valley deciding glucose monitors are trendy is just gross, dystopian decadence.
As a fat person I can't help but think about how all this plays into the dwindling plus-sized options in major retailers (Corinne Fay has a great piece on Madewell cutting back on plus-sized clothing in a recent newsletter). Even Old Navy stopped carrying many plus sizes in-store. As GLP-1's become more common, what does it mean for those of us who can't take them, don't want to take them, can't afford them? Despite being the majority of the population, fat people are being pushed more than ever to the margins.
As someone who white knuckles it through the "food noise" every damn day of my life, I've found the sound of these drugs very compelling.
The anecdotal stories about their use impacting addiction, too, are very compelling to me. Another massive public health crisis, potentially treatable.
Their possible application for alcohol use disorder is exciting!
Even if I'd never lost a pound, I'd still be taking them because the lack of food noise is so incredible. It finally reduces food to the size it's supposed to be in your life. I felt bewildered after about a month on Mounjaro, wondering "is this how normal people live?" I had an event with a buffet and instead of spending the entire time anxiously waiting for the buffet to open, trying to bargain with myself about what I would get, obsessing over being not the FIRST person in line bc that's weird but also being not too far back in the line - I socialized and chatted and did not even notice that the buffet had opened and in fact opened for a while. It was wild.
Listen, Emily you were with me when we were hiking and I had to stop and throw up because Ozempic. I have PCOS and it’s been a good solve for a lot of my issues, but it’s not an easy breezy drug. The side effects are very real. I think ALL health conversations are personal an nuanced and anyone who is casting judgment on someone else for ANY medical treatment they’re seeking, whether they think it’s needed or not, should zip it.
You've had very good takes this week. Adore you!
I was prescribed Wegovy by my doctor back in April because of lifelong struggles with my weight. I couldn't fill the prescription until June when I got my first 4 doses (.25mg). In that month I lost 5lbs and was encouraged. But then I couldn't get the next dose (you step up slowly to the full 2.4mg dose). It's now September and am still unable to fill my prescription. The pharmacies just don't have any. I have since gained back those 5lbs and added another 5 on the rebound - all without major lifestyle changes. Still no Wegovy. I've tried other pharmacies and just switched to my 5th to see if an online pharmacy will have better luck. We will see. But I suspect all the supply for those who need it are getting snorted up by those who most definitely don't. It's frustrating.
Wow, I'm so sorry that's happened – that's a deeply frustrating thing to hear.
I come from a family where severe levels of addiction run in every direction in my family. My mom and my Grandma both struggle with compulsive eating, my Grandma was medically obese as a result, and my Mom has definitely struggled with heavy weight gain. My whole life I always KNOWN I wanted to eat as much as they did and never stop, but I've seen the impact it had on their lives, and I've superficially guarded against indulging ... but doing that has been exhausting, anxiety-inducing, etc etc. All the things. Reading people in the comments talking about "fighting the food noise" in their heads is enormously gratifying and validating, I didn't even know I need to hear from other people about this.
I had this issue my whole life and then (for totally unrelated reasons) I underwent EMDR in my early 30s. I have no idea if this is "real" or not - but after I finished treatment, I noticed the food noise was gone. It's never come back. There's not a day goes by that I'm not just... I-could-cry levels of grateful for that, even still.
Anyway, all that's to say.. the shaming/judgement around people who want weight management options... ugh. Fuck off.
Anyway, congrats to having one of the only great comment sections on the internet, Emily!
LOL pls ignore my bad grammar and typos, was doing this fast
I like that you drew a parallel with ADD meds and id like to draw another parallel to opiates and specifically how the science was changed to accommodate the over prescription of these meds (e.g. pain being the fifth vital sign, doctors being trained in med school that they couldn't address their patients concerns while they were still in pain, massive kickbacks). The medical community had LOADS of evidence these drugs were harmful, but the science changed to accommodate the market. Long conversations with your doctor became short ones. Harms were undersold. Money was made: by doctors, hospitals, pharmacies, and pharmaceutical companies.
We also had a large moral reaction to these drugs being limited. There was talk about how it "wasn't right" that people "truly in pain" couldn't get relief because of "addicts." Stigma and morality entered the conversation. They have not left.
It only took WIDESPREAD death for the public to take notice. I see a similar trend happening with ozempic. My husband is a doctor and noted that, as an anesthesiologist, he cannot perform surgery on patients with full or partially full stomachs due to issues with placing the breathing tube. Yet, he frequently has to turn patients away for surgeries and emergency surgeries because their stomachs are unsafely full. Some of these people have stopped taking the meds for to a week pre-procedure but it's not always enough. A lot of these patients weren't aware rhat ozempic could cause issues if they were to need emergency surgery.
It seems, as was the case with opiates, conversations are being skipped. There is A LOT of money being made off the drugs and after my own experiences with opiate addiction, I have a healthy mistrust of new drugs being marketed as safe when there simply isn't the long term (10+ years) research to back it up.
This is America, and today's solution is always tomorrow's problem.