You've got a crowd of people raised in a Calvinist society who think nothing good comes without suffering, you've got people who feel this is a cheat where discipline should win out, and you have a bunch of people who are used to all easy solutions coming with either a bad lottery ticket or externalities on other people/the environment.
They can all agree that they're waiting for the other shoe to drop.
That said, we are at a point where people are overweight enough that getting exercise has its own risks, and taking a medication that allows you to be more active is likely to cancel out some of those downsides. As long as you do both I have no problem with people taking ozempic, mounjaro, etc.
I would prefer if we figured out what other than cultural changes is making everyone have symptoms of inflammatory dysfunctions. There is more than one thing going on. Processed foods, contamination, some microbe that doesn't culture in agar. And it's spreading to more of the world.
> Calvinist society who think nothing good comes without suffering
Or, some of us older folks have been around long enough to understand that we are, in an uncontroversial and factual way, the long term medical trial, and long term effects found in that trial, along with the eventual market withdrawal, may not show up until 10 to 20 years later, creating a healthy distrust in the money/corporations behind the, sometimes outright crafted [1], early medical trials.
How many times has a drug had negative effects that only showed up after 10-20 years? Out of all the drugs that have been widely prescribed in, say, the last 100 years? And it’s not even actually a new drug class - Liraglutide was approved in 2010! Should we wait until the clinical trial participants all die of old age until we put a drug on the market?
Most the nonpharmaceuticals I could list from memory, I had to google the medication
Nonpharmaceuticals
- microplastics
- bisphenol A
- asbestos
- nicotine
- DDT
- fungicides like HCB
- PFAS
Pharmaceutical
- benzodiazepines
- Terfenadine
- Benfluorex
Of the 528 new drugs approved over the period of interest, a total of 22 (4.2%) were eventually withdrawn. Between 3.9% and 4.4% of the drugs approved in each 5-year period were eventually withdrawn (χ2 = 0.04, p = 0.99 for difference among 5-year periods). The median time between approval and withdrawal was 1271 days (interquartile range 706–2876).[0]
By some estimates 7% of US have used semaglutides. That is 24.5M people. That could be 24.5M people who have benefitted but if it turns out that there are long term consequences, that's a lot of people who are now all in that ship together when at least some of those users could have chosen lifestyle intervention rather than chemical intervention. If we take the 4.2% recall rate that gives an EV of 980k people in the US who will suffer adverse effects from semaglutides
I wasn’t talking about non-pharmaceuticals, and neither were you. Non-pharmaceuticals don’t go through clinical trials, and they mostly don’t require any pre-approval. So that’s clearly just trying to pad your list.
Benzodiazepines do not have effects that only suddenly show up after 10-20 years of use. The serious side effects/withdrawal show up with a few months of heavy use, sometimes sooner. They’re also actively prescribed (with some appropriate caution), so a really weird one to lead with.
There are actually quite a few drugs still widely prescribed today that cause similar QT prolongation to terfenadine (e.g. quetiapine). The difference is they are for more serious conditions where the other options have similarly serious side effects, and terfenadine has to compete with Benadryl. No reason to have to get periodic EKGs just to keep your sinuses decongested in allergy season.
> Of the 528 new drugs approved over the period of interest, a total of 22 (4.2%) were eventually withdrawn. Between 3.9% and 4.4% of the drugs approved in each 5-year period were eventually withdrawn (χ2 = 0.04, p = 0.99 for difference among 5-year periods). The median time between approval and withdrawal was 1271 days (interquartile range 706–2876).[0]
I’ll give you the benefit of the doubt, and assume that you just didn’t care to read the paper once you assumed it agreed with you and did not selectively quote on purpose. From the same paper:
> Of the 22 drugs withdrawn, 11 first had a serious safety warning and 11 did not (Table 2). The median time between the Notice of Compliance and withdrawal was 1271 days (interquartile range 706–2876).
So, the percentage you quoted was double what we were actually talking about here. On top of that, I don’t think you finished reading what you did quote; the median time to withdrawal was < 5 years, and if you actually look at the table only two drugs with serious safety issues actually hit the 10-20 year range you mentioned.
> those users could have chosen lifestyle intervention
We’ve been trying all kinds of “lifestyle interventions” for a long time, from doctors telling people to exercise to semi-organized campaigns of body shaming. It hasn’t worked for the vast majority of people in practice. So unless you have some actually novel idea here, you’re essentially trying to get people to switch from a drug that works to the power of positive thinking. Good luck with that.
It took us 10-20 years to find out about tardive dyskinesia due to antipsychotic medications and the long term dependency and withdrawal effects of benzodiazepines. Two entire classes of drugs that are now in common use, so it’s not unheard of.
I’m not saying we should take Ozempic off the market but don’t be fooled into thinking that we’re immune to unintended consequences just because we did a few studies (almost all of which were on diabetics with controlled diets).
At no point did I say we were immune to unintended consequences. Just that demanding every drug be used for 30+ years before you’ll touch it is not actually making an analysis of the tradeoffs involved.
Also, the drug classes you listed are not great examples. Benzodiazepines don’t fit what we’re talking about at all: it’s common to develop tolerance and get serious withdrawal symptoms from a few months of heavy use. You definitely don’t need to take them for 10-20 years (or even the 8 years since Ozempic was approved) to notice the serious side effects. If Ozempic killed you if you quit it cold turkey, we would already know. Psychiatrists were not unaware of what happened when you took too much Valium back in the 60s when it was first introduced. It’s just that they (and society in general) had an attitude toward risks that is totally alien to modern sensibilities (and to be clear, I think it was bad).
First-generation antipsychotic’s incidence of TD was strongly correlated with dose, which was strongly correlated with having schizophrenia and other mental illnesses involving psychosis specifically (as opposed to other indications like bipolar without psychotic features or major depression). Getting TD later in life but being able to live outside of an asylum (they were still around when first-generation antipsychotics were commonly prescribed) is probably a tradeoff many of these people would have taken, even if they knew about it.
> Just that demanding every drug be used for 30+ years before you’ll touch it is not actually making an analysis of the tradeoffs involved.
Your replies are unnecessarily aggressive, and you’re not reading comments in a charitable way, or keeping track of the usernames writing them. Nobody is saying this.
I also never said we were “immune to unintended consequences”. How charitable was putting those words in my mouth?
Also not sure where your quip about me not keeping track of usernames came from - I responded to specific examples given in each individual comment. They just both happened to bring up benzodiazepines.
> I would prefer if we figured out what other than cultural changes is making everyone have symptoms of inflammatory dysfunctions.
I personally hope it's just cultural and sugar/hfcs. Because some alternatives might be grim to reckon with just from a humanistic/grief perspective: https://pubmed.ncbi.nlm.nih.gov/34484127/
You've also got the crowd who would argue that there's nothing wrong with being fat in the first place and that are scared of society pressing on this matter again after years of pushback.
As someone who was 100 pounds overweight for a long time, and now isn't, that mindset is really dangerous and preventing a lot of people from living life to its fullest.
There is never any reason to be cruel or unkind to people who are overweight, but pretending that it doesn't have negative consequences or is even "healthy for me" or whatever is really harmful.
I think there is a large chance that this crowd referenced arguing for "this" is even smaller than than the population of (25? 50?) trans ncaaa athletes that all the rubes believed was ruining america. Loudmouths on the internet exist and suck but don't represent everyone.
> That said, we are at a point where people are overweight enough that getting exercise has its own risks, and taking a medication that allows you to be more active is likely to cancel out some of those downsides.
And yet we rarely ask or say "maybe I should just eat fewer calories?" Unless you have some other disorder that prevents normal bodily function, that does work (and would be viable I'd imagine for the majority of people being prescribed).
But it requires patience and discipline which are basically non-existent for the majority of the population.
As someone who has been fat and not-fat throughout my life, I think literally everyone knows that it is simple to lose weight by eating fewer calories. That does not mean it is easy. If you are already fat, which can happen almost without you noticing by eating 200-300 calories too much a day over a year say, or as a result of some brain malfunction (both have happened to me), then eating the calorie deficit require to lose weight is mentally very hard to to.
As a thought experiment, imagine what you eat per day. Now halve it. Would you be having a good time?
I've been fat/not-fat my whole life too. I'm fat right now (working too much and not watching diet).
> That does not mean it is easy. If you are already fat, which can happen almost without you noticing by eating 200-300 calories too much a day over a year say, or as a result of some brain malfunction (both have happened to me), then eating the calorie deficit require to lose weight is mentally very hard to to.
You install an app. You honestly track what you eat. Set a goal for how many calories per day. Done.
I've intentionally set my calories at 1,300 per day. Low, yes, but I allow myself to eat over that to satiation. The end result is that I'm still in a deficit relative to my actual caloric needs (e.g., maybe I eat 300-500 extra calories and my daily total rounds out around 1600-1800), so I lose weight.
I've started eating less and tracking calories and I'm losing weight (I'm not even exercising—I sit most of the day programming). Nothing extreme, just a simple mental hack.
I've done this before to the tune of losing 70-80 pounds. Literally just tracking calories and not even really exercising beyond walking. I wasted years on different workouts and diets all just to come back to realizing "yeah if you just eat less calories (and increase your intake of whole foods, not boxed slop), you lose weight."
Much better choice than shooting up with pharma syrup that has god knows what in it that's a ticking time bomb.
They can all agree that they're waiting for the other shoe to drop.
That said, we are at a point where people are overweight enough that getting exercise has its own risks, and taking a medication that allows you to be more active is likely to cancel out some of those downsides. As long as you do both I have no problem with people taking ozempic, mounjaro, etc.
I would prefer if we figured out what other than cultural changes is making everyone have symptoms of inflammatory dysfunctions. There is more than one thing going on. Processed foods, contamination, some microbe that doesn't culture in agar. And it's spreading to more of the world.