Hunger and satiety have complex underlying physiological processes, as already noted. While we know some stuff about GLP-1 receptors (the thingies that are activated by drugs like ozempic), we have only scratched the surface on understanding their role and mechanisms. We do know that it’s complicated.
I mention this because I’m currently at a conference where cutting-edge research is being presented on GLP-1 stuff (among many other things). Some of the findings about GLP-1 activity include: it attenuates drug seeking in cocaine and opioid-dependent animals; its natural role is complicated and broadly regulates energy homeostasis; it seems to produce preemptive satiation when food is available but eating hasn’t even started yet (this is my favorite finding!)
Do I think these should be called a miracle drugs? No. Do I think they will prove to be quite important in providing therapeutic treatment for at least some stuff? Absolutely. Time will tell what we can find out about the biological actions of GLP, and also what can be done using pharmacological agents that influence its pathways.
I don’t know how to feel about the widespread use of this drug for weight loss. I’m not a physician. While I wish it was cheaper and not at a shortage, I’m upset that it’s available from compounding pharmacies and I hope that loophole is somehow closed because it’s not operating as the FDA intended. I don’t judge anyone who takes it. I really don’t know what to expect 5 years from now with these drugs. I’m sure it will prove to be interesting, regardless.
The loophole will technically close when there are no more shortages. Recently, a lawsuit seeking to stop compounders from making their versions of the injectables has been tossed… I’m sure there will be an appeal, but for now, this Wild West will continue, likely, until someone gets harmed. I’m not a fan of the FDA loophole either.
Not all compounders are created equal. I did not say I did not like them. They are wonderful when a need arises for a more palatable formation of a med (chicken flavored antibiotics for a sick kitten, anyone?). It is the questionable “compounders” that bug me. The GLP-1 drug some of them are formulating is NOT the same as the version approved by the FDA but a salt. While it all sounds benign, for biologics (which this is technically is) it can make a difference. That, and the fact that such compounders are willing to sell it to some charlatans is what is worrisome.
There are plenty of unethical doctors, and complicit regular pharmacies-see, the recent opiate crisis. Not sure why one would think compounding pharmacies are necessarily worse in this regard. Of course, patients wouldn’t need to seek out compounding pharmacies if there were reasonable drug costs to begin with, like in other countries.
I don’t have a problem with compounding pharmacies in general either. They serve a vital function. But in this case, the loophole is being exploited for a drug that a lot of people want to take. Combine the compounding loophole with unethical folks who will prescribe it to anyone over the internet and you could end up with some bad results.
Perhaps. Of course those people may already be facing very bad results from having obesity and related problems and being unable to afford treatment at retail prices.
Hyped-up demand? 40% of American adults are obese. Another 30% are overweight. Seems to me no one needs to hype the demand; the need for these drugs is enormous.
Perhaps the US obesity rate being double that of France greatly increases demand in the US and allows the makers of these drugs to set higher prices in the US even beyond the customary higher prices for anything health care in the US.
I don’t think demand has much to do with medical prices in the US vs Europe.
Despite spending nearly twice as much on healthcare per capita, utilization rates in the United States do not differ significantly from other wealthy OECD countries. Prices, therefore, appear to be the main driver of the cost difference between the United States and other wealthy countries. In fact, prices in the United States tend to be higher regardless of utilization rates. For example, the Peterson-Kaiser Health System Tracker notes that the United States has shorter hospital stays, fewer angioplasty surgeries, and more knee replacements than comparable countries, yet the prices for each are higher in the United States.
Hyped-up demand - I see why people think that; all the celebs and TikToks. But it’s not hype in reality. They’ve just “discovered” it. Hype implies an unrealistic result buried in false advertising and that’s not what’s going on here. (The demand itself is not hyped either; it’s quite real.)
The cost of the drug is exponentially lower in other countries. In general, pharma argues that it needs to recoup its R&D expenses, which is why a drug is expensive here. I call BS on that, but since the pharma lobby can make legislators dance on a string, I don’t see that changing any time soon.
Just getting the ability for Medicare to negotiate some drug pricing was a huge lift for Biden (he deserves more credit on this, imho).
If anyone is interested in real people’s experiences with Mounjaro, unfiltered from media reports, check out the /Mounjaro sub on Reddit. Granted, it’s “The Internet,” and so you take everything with a grain of salt, but wow, the before and after pix, and the really soul-baring/emotional narratives … when you realize that for most people, they are kind of forging a new path with zero guidance, as their doctors know as little as they do, it’s eye-opening.
These systems are fascinatingly complex and interwoven, aren’t they? I remember years ago when it was discovered that Polycystic Ovarian Syndrome was tied into some of the same genetics that caused insulin resistance. I mean, wow, infertility and DM2 linked in some way! (My med school friend even showed it. She had PCOS despite being very thin and her dad had DM2 despite also being thin.) And then Leptin and adiposity. But also puberty. And lordosis! Holy buckets.
I am also fascinated by the gene variants for muscle mass (although they seem less complex.) I remember the story that came out a few years ago (although now I can’t seem to find it) about the little boy conceived in the Olympic Village. Organizers stock the Olympic Village with a vast number of free condoms, but apparently they aren’t always used. In any case, this child was the product of 2 Olympic athletes, and was heavily muscled even as a newborn. Through genetic analysis it was determined he was homozygous for the Double Muscle gene variant and that each of his parents was heterozygous. This exact gene mutation is that same one that beef cattle, and meat goats, and meat sheep lines all have.
Okay…maybe this is why, after decades of working out…I still can’t do a pushup. The arm muscle mass was/is just not there. On the good side of this…if you have skinny arms you don’t get floppy ‘wings’ when you age. there’s nothing to flop.
Yeah, and possibly reducing addiction, and cholesterol, and PCOS and diabetes and on and on and on – and still insurance companies will call it a vanity drug. Sigh.
I still find it very judgmental for people to insist that eat less move more is the only answer to weight loss.
I dieted for 3 years and went to the gym 4 x week and have a very active job, I routinely hiked 15 + miles and have a very lean husband. With 3 years of hard work I only losses 20 pounds. I started mounjaro and lost 80 pounds in 5 months. My diet and exercise didn’t change much from when I was trying so hard to lose weight.
Mounjaro affects many organs that can affect weight control
I don’t see people on here saying that at all. I see people saying this drug is great for those who qualify for it. But the truth is that 40% of Americans aren’t obese because of medical issues. A true try at changing diet and exercise should be the first path. Some people are obese because they eat horrible and have a sedentary lifestyle. Obviously, medication shouldn’t be the first choice.
In the UK Wegovy has just been approved for weight loss on the NHS but before it’s prescribed people have to complete and fail a 6 month nutritional program. This sounds good but their is a long wait list to enter the program.
