Wegovy = Magic

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mehrlicht said:
This amplifies my concern that these will not be marketed to people not who are unable to lose weight through any other means, but as those who want to look good while not giving up unhealthy lifestyles.
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In the nicest way possible....no one appointed you, or anyone, as the gatekeeper for these medications.

This reminds me of the hand wringing around the Gardasil ("it will encourage teenagers to have sex!"), PrEP ("it will encourage gay men to have sex!") and Suboxone/Narcan ("it will encourage people to just keep using drugs!") I do find it interesting that there is no similar hand wringing around Viagra/Cialis/Levitra, all of which had similarly sensationalist advertising, and all of which are clinically riskier medications than the GLP-1s. ED is often caused by diseases related to obesity (it is often referred to as peripheral vascular disease of the genitals, after all), and Viagra can cause significant hypotension, among other things. But it is still very readily available, is often covered by insurance, and you can even get it through a simple website with minimal interaction with a healthcare professional.

The meds are available because they're safe and they serve a purpose. There will be people who will irresponsibly prescribe them, just like there are people who irresponsibly prescribe Viagra or people who irresponsibly recommend proton therapy to everyone. But that doesn't mean that they're bad drugs.
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smq123 said:
In the nicest way possible....no one appointed you, or anyone, as the gatekeeper for these medications.

This reminds me of the hand wringing around the Gardasil ("it will encourage teenagers to have sex!"), PrEP ("it will encourage gay men to have sex!") and Suboxone/Narcan ("it will encourage people to just keep using drugs!") I do find it interesting that there is no similar hand wringing around Viagra/Cialis/Levitra, all of which had similarly sensationalist advertising, and all of which are clinically riskier medications than the GLP-1s. ED is often caused by diseases related to obesity (it is often referred to as peripheral vascular disease of the genitals, after all), and it can cause significant hypotension, among other things. But it is still very readily available, is often covered by insurance, and you can even get it through a simple website with minimal interaction with a healthcare professional.

The meds are available because they're safe and they serve a purpose. There will be people who will irresponsibly prescribe them, just like there are people who irresponsibly prescribe Viagra or people who irresponsibly recommend proton therapy to everyone. But that doesn't mean that they're bad drugs.
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Shazam.
 
smq123 said:
In the nicest way possible....no one appointed you, or anyone, as the gatekeeper for these medications.

This reminds me of the hand wringing around the Gardasil ("it will encourage teenagers to have sex!"), PrEP ("it will encourage gay men to have sex!") and Suboxone/Narcan ("it will encourage people to just keep using drugs!") I do find it interesting that there is no similar hand wringing around Viagra/Cialis/Levitra, all of which had similarly sensationalist advertising, and all of which are clinically riskier medications than the GLP-1s. ED is often caused by diseases related to obesity (it is often referred to as peripheral vascular disease of the genitals, after all), and Viagra can cause significant hypotension, among other things. But it is still very readily available, is often covered by insurance, and you can even get it through a simple website with minimal interaction with a healthcare professional.

The meds are available because they're safe and they serve a purpose. There will be people who will irresponsibly prescribe them, just like there are people who irresponsibly prescribe Viagra or people who irresponsibly recommend proton therapy to everyone. But that doesn't mean that they're bad drugs.
Click to expand...

That's a lot of strawmen to unpack. I could pick apart each of them one by one the same way I disabused the (very firm) claim that these drugs don't cause unusually high relative amounts of lean mass loss. But I will not. I could also get deep into the C*vid data since that was brought up -- that I do know off the top of my head, in pretty good detail. But it's clear that is not allowed even though there was a personal swipe at me by a moderator on that topic.

I'm not sure where your angst is coming from on this, and I couldn't even begin to guess. I think it is safe to say that we disagree on probably just about everything.

Gatekeeper? Where did I claim that I want to be the P2P reviewer for all these prescriptions. I did not. I simply stated my opinion about my concerns, which besides the obvious jokes about "melted" whatever, were not personally directed at anyone. "In the nicest way possible" -- I am aware what that is a euphemism for.

So, as this is clearly not a good use of my time, I will check out of here. However, since an unrelated topic was again brought up out of nowhere... I will leave you all with this flaming piece of trash to ponder...

journals.lww.com

A paradigm shift away from condoms: Focusing STI prevention ... : JAAPA

An abstract is unavailable.
journals.lww.com journals.lww.com

You can check the comments on Doximity if you think I might be in the minority opinion on this one. As Dr. Phil says (great man btw), you shouldn't do things that reward bad behavior. I never said they are "bad" drugs, in fact quite the opposite if you go back and read my awe at how dramatic the results are. Are they dangerous for certain populations? I'm pretty sure they are. If you think that easy access to these weight loss drugs is not going to cause a lot of problems, you've got another thing coming.
 
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mehrlicht said:
I'm sure Peter Attia is FOS too. He's done a few very good podcasts on this topic:

peterattiamd.com

Lean mass loss on GLP-1 receptor agonists: a downside of the “miracle drugs”

Clinical trials have generated impressive data on the effects of GLP-1 agonists on body weight and BMI, but how do these drugs perform in terms of body composition?
peterattiamd.com peterattiamd.com

In 2021’s STEP 1 trial – the first trial demonstrating the efficacy of semaglutide as a treatment for adult obesity – a subset of 140 patients underwent DEXA scans for body composition analysis. Among these patients, lean mass accounted for approximately 39% of total weight loss – substantially higher than ideal. In a substudy of 178 patients from the SUSTAIN 8 trial on semaglutide as a diabetes treatment, the average proportion of lean mass loss was nearly identical at 40%, despite lower doses and less total weight loss than in the STEP 1 trial.
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I’m reading his book right now. It was recommended to me by a patient.

The book starts with an airing of grievances about the culture of medicine. Of course, I’m like “f yea” I love this guy!
 
mehrlicht said:
This one is in the lay press today under headlines of weight-loss wonder pill, "eat whatever you want", burn belly fat without dieting, etc.


This amplifies my concern that these will not be marketed to people not who are unable to lose weight through any other means, but as those who want to look good while not giving up unhealthy lifestyles.

Google "CPACC drug" and you will see the headlines I am talking about. "What your patients are reading..."
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You CAN eat what you want to eat… you just don’t want to eat as much.
 
mehrlicht said:
I'm not sure where your angst is coming from on this
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Well, I'll tell you where my angst is coming from; I can't speak for others. There are two parts.

1. The message that obesity is itself not part of a disease process but is a failure of will...and the corollary that treating a patient who has not demonstrated sufficient will is somehow bad.

This line of thinking can be applied to alcoholism, drug abuse, sex addiction, gambling addiction, hoarding, obsessive behaviors (like perseverating on certain topics), anxiety and tobacco abuse.

I don't think it's a helpful paradigm. While you may personally be a shining manifestation of "will to power", imbued with the kindness, wisdom and strength that permeates your posts, most people are not.

In my opinion, it is necessary to live as though you and others have free will, while acknowledging actionable targets in the real world (be they environmental or biological or other) that are shown to impact outcomes. Actually, this is what most good PCPs do. They are aware that a healthy lifestyle is extremely important and promote healthy behaviors, while also using pharmaceutical measures when they think the circumstances dictate and evidence supports.

In this thread, the original post is regarding a yet to be published study demonstrating a heart disease benefit for a drug heretofore used for other indications. It is exciting, and if it bears out, we should all be happy about this. That this is met with skepticism is fine. That it is met with perhaps philosophical opposition is concerning.

Would you never give this type of drug, even if the evidence pans out that it prevents cardiovascular events, on the basis of failure of will?

2. The tendency (in myself and on this board) to gravitate towards "enviable contrarian wisdom". The oppositional, anti-establishment opinion that is by definition more appealing to a certain audience (ours). The type of wisdom that goes against convention and makes supporting arguments seem so much smarter and more meaningful than those supporting an established position. This type of wisdom is almost always wrong.*

*Still looking for outstanding supporting arguments regarding expansion of protons BTW. Perhaps I have succumbed to the "enviable contrarian wisdom" trap.
 
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communitydoc13 said:
Well, I'll tell you where my angst is coming from; I can't speak for others. There are two parts.

1. The message that obesity is itself not part of a disease process but is a failure of will...and the corollary that treating a patient who has demonstrated sufficient will is somehow bad.

This line of thinking can be applied to alcoholism, drug abuse, sex addiction, gambling addiction, hoarding, obsessive behaviors (like perseverating on certain topics), anxiety and tobacco abuse.

I don't think it's a helpful paradigm. While you may personally be a shining manifestation of "will to power", imbued with the kindness, wisdom and strength that permeates your posts, most people are not.

In my opinion, it is necessary to live as though you and others have free will, while acknowledging actionable targets in the real world (be they environmental or biological or other) that are shown to impact outcomes. Actually, this is what most good PCPs do. They are aware that a healthy lifestyle is extremely important and promote healthy behaviors, while also using pharmaceutical measures when they think the circumstances dictate and evidence supports.

In this thread, the original post is regarding a yet to be published study demonstrating a heart disease benefit for a drug heretofore used for other indications. It is exciting, and if it bears out, we should all be happy about this. That this is met with skepticism is fine. That it is met with perhaps philosophical opposition is concerning.

Would you never give this type of drug, even if the evidence pans out that it prevents cardiovascular events, on the basis of failure of will?

2. The tendency (in myself and on this board) to gravitate towards "enviable contrarian wisdom". The oppositional, anti-establishment opinion that is by definition more appealing to a certain audience (ours). The type of wisdom that goes against convention and makes supporting arguments seem so much smarter and more meaningful than those supporting an established position. This type of wisdom is almost always wrong.*

*Still looking for outstanding supporting arguments regarding expansion of protons BTW. Perhaps I have succumbed to the "enviable contrarian wisdom" trap.
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Most Americans are probably overweight and insulin resistant. Lifestyle changes fail 99% of the time over the long run. It is also very possible that the cardiovascular benefits are not just from weight loss. Glp receptors are all over the myocytes and vasculature and a lot of preclinical evidence that these agents have beneficial cardiovascular effects.
 
RealSimulD said:
So, uh, what kind of effect you think it will have on cancer?
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Anything that suppresses growth signaling: insulin-igf mtor pathway could lower rates of cancer. I doubt it’s would have much of an impact on clinical cancer.

Rapamycin/rapalog (affinitor) - much more potent-has limited activity in kidney and breast, but in animal models has a huge effect on lowering rates of cancer development in healthy animals. I think there was a Metformin arm in the STAMPEDE prostate trial that failed. If you are interested in this follow the ITP program of the NIH/NIA. It trials drugs (mostly diabetic agents) for longevity in mice. The primary cause of death in lab mice is cancer.

peterattiamd.com

#148 - Richard Miller, M.D., Ph.D.: The gold standard for testing longevity drugs: the Interventions Testing Program - Peter Attia

“I don't really care what causes aging. What I care about is: What is the process that can postpone all the different aspects of aging?” — Rich Miller
peterattiamd.com peterattiamd.com

pubmed.ncbi.nlm.nih.gov

Repurposing Metformin as Therapy for Prostate Cancer within the STAMPEDE Trial Platform - PubMed

Metformin is a safe, well-tolerated, inexpensive treatment that can be given in addition to current standard-of-care therapies for prostate cancer. Its use might mitigate the deleterious side effects of castration and exert an additional anticancer effect. It will be incorporated in the STAMPEDE...
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov
 
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RealSimulD said:
So, uh, what kind of effect you think it will have on cancer?
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Here's a thought...
Decreased obesity, diabetes, cardiac events --> patients live longer and develop cancer due to decreased competing risks.

Would probably shift the profile of cancer types away from the obesity related ones. But cancer incidence is stochastic. If people live longer odds are that eventually a cancer will pop up.
 
CaesarRO said:
Here's a thought...
Decreased obesity, diabetes, cardiac events --> patients live longer and develop cancer due to decreased competing risks.

Would probably shift the profile of cancer types away from the obesity related ones. But cancer incidence is stochastic. If people live longer odds are that eventually a cancer will pop up.
Click to expand...

Ooohhh... don't say that out-loud! Don't want to give anyone ideas about supply/demand...
 
CaesarRO said:
Here's a thought...
Decreased obesity, diabetes, cardiac events --> patients live longer and develop cancer due to decreased competing risks.

Would probably shift the profile of cancer types away from the obesity related ones. But cancer incidence is stochastic. If people live longer odds are that eventually a cancer will pop up.
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Obesity is probably the number one cause of cancer. Decreased obesity is going to decrease cancer along with cvd. How about this speculation: radoncs are in better health and less likely to retire, working well into their 80’s and 90’s?
The biggest risk for cancer is aging. Cancer, cardiovascular disease, neurodegeneraritive diseases are symptoms of aging. Obesity/diabetes/insulin resistance like smoking is going to impact all of them. (There is an ongoing phase 3 trial of ozempic in Alzheimer’s )
 
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From the above threads:

Dr. Phil is a great man... uh, no. I really hope you just forgot to add the /s.

As for my patients reading X today.. many of mine don't even have teeth, I'm not sure how many can actually read.
 
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sirspamalot said:
From the above threads:

Dr. Phil is a great man... uh, no. I really hope you just forgot to add the /s.

As for my patients reading X today.. many of mine don't even have teeth, I'm not sure how many can actually read.
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They probably don’t have to worry abt weight loss? #methlife
 
SneakyBooger said:
I bet psilocybin is better for weight loss...

Chronic Treatment With Psilocybin Decreases Changes in Body Weight in a Rodent Model of Obesity - PMC

There are currently relatively few effective pharmacological treatments for obesity, and existing ones may be associated with limiting side-effects. In the search for novel anti-obesity agents, drugs that modify central serotonergic systems have ...
www.ncbi.nlm.nih.gov www.ncbi.nlm.nih.gov
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It might be very effective with just a few treatments in some patients (if the issue is compulsive addictive eating). The issue i see happening is there is a lot more money to be made with a lifelong drug rather than a few treatments so I could see less companies being interested in producing the pill and “shortages” like we see with tons of generic drugs these days.
 
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thecarbonionangle said:
It might be very effective with just a few treatments in some patients (if the issue is compulsive addictive eating). The issue i see happening is there is a lot more money to be made with a lifelong drug rather than a few treatments so I could see less companies being interested in producing the pill and “shortages” like we see with tons of generic drugs these days.
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This is going to be a huge problem.
 
Thierry Vugler said:
Hi,
You bring up a valid point.
It's important to recognize that everyone's situation is unique, and what works for one person may not work for another. While medications like Viagra, Cialis, and Levitra have been beneficial for many individuals, it's crucial to approach their use with caution and under the guidance of a healthcare professional. As with any medication, there are potential risks and side effects to consider, and it's essential to weigh these against the potential benefits.

Ultimately, the decision to use medication should be made in consultation with a healthcare provider who can provide personalized advice based on an individual's medical history and needs. It's essential to prioritize safety and responsible use when considering any medication, including those for erectile dysfunction.
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Thanks chatgpt
Bad bot
 
Welcome back to another episode of "Dead Internet Theory".

Here's what I want to know: how is this programmed? Is someone manually searching for pharmaceutical names across the web and then posting/commenting with copypasta?

Or is it truly a bot?

Obviously I'm a doctor, not a programmer, so perhaps this is stupid simple and it's just not my thing, but I've dabbled in web scrapers and stuff and it's very hard (for me) to setup a bot on dynamic places like message boards.

Even a non-programmer like me and easily create a bot that spews messages but it's GETTING the bot to the right place...that perplexes me.
 
You think that AI would have figured out that it is very easy to identify bots by the way they use a few key phrases and structure their sentences.

"while..."
"It is essential that"
"ultimately"
"It's important to realize"

This is not how real humans write, especially on internet forums. The turing test is not passed. How soon will we be at the point where we are unsure if any of us are real or not? I've thought a lot about this and have concluded that, while AI offers great promise to facilitate information exchange among healthcare providers, ultimately, it will be imperative for us as individuals to become familiar with the advancements in AI and to understand the risks of communicating online.
 
MidwestRadOnc said:
You think that AI would have figured out that it is very easy to identify bots by the way they use a few key phrases and structure their sentences.

"while..."
"It is essential that"
"ultimately"
"It's important to realize"

This is not how real humans write, especially on internet forums. The turing test is not passed. How soon will we be at the point where we are unsure if any of us are real or not? I've thought a lot about this and have concluded that, while AI offers great promise to facilitate information exchange among healthcare providers, ultimately, it will be imperative for us as individuals to become familiar with the advancements in AI and to understand the risks of communicating online.
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Do androids dream of electric 🐏 ?
 
There’s only two humans on this forum, the rest of the posters are bots I swear /s
 
taserlaser said:
There’s only two humans on this forum, the rest of the posters are bots I swear /s
Click to expand...
1713299326608.png
 
MidwestRadOnc said:
You think that AI would have figured out that it is very easy to identify bots by the way they use a few key phrases and structure their sentences.

"while..."
"It is essential that"
"ultimately"
"It's important to realize"

This is not how real humans write, especially on internet forums. The turing test is not passed. How soon will we be at the point where we are unsure if any of us are real or not? I've thought a lot about this and have concluded that, while AI offers great promise to facilitate information exchange among healthcare providers, ultimately, it will be imperative for us as individuals to become familiar with the advancements in AI and to understand the risks of communicating online.
Click to expand...
In a very meta way this post gives the distinct aura of having been written with chatgpt

Maybe i’m paranoid or maybe it really is chatgpt
 
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