[mbivert]

Sure, there may be honest and enthusiastic people. But their input would be essentially that of an ad: a product with 100% gain and 0% loss? That's never been observed, never; there's always a trade-off.

A less emotionally grounded, more balanced and nuanced description would be more accurate, honest. But it'd sell way less.

[fshbbdssbbgdd]

I see a lot of the recommendations expressing anxiety about what will happen when they discontinue - which calls into question the validity of the official treatment plan they are under and isn’t normally something you’d bring up in an ad.

[mbivert]

Perhaps I must emphasize that my point is subtly different from the parent's: whether those people are genuine or not fundamentally is irrelevant: a miracle drug with essentially no drawbacks is a fairy tale. It's almost certainly a lie.

(That's why the parent think they could be ads, unless he's deeply cross-referencing South Park…).

The loudness of that lie ITT might also drag people down an unhealthy path: it's irresponsible not to speak up about it.

[cthalupa]

We know obesity is one of the absolute worst things you can do to yourself as a human.

We know that being prescribed diet and exercise has not helped hundreds of millions of people in the world stop being obese.

We do not catch every long term concern when developing a medicine - but we do catch a decent amount! We know specific mechanisms to be concerned for, e.g. angiogenesis and the likelihood of accelerating tumor growth, lots of others. We do not see any mechanisms that would point towards health risks anywhere near the level of obesity.

So the realm of concern lies around possible long term side effects that we're not aware of.

If you find yourself in a room that is on fire, and you see a door but you're not sure what's on the other side of it, are you going to refuse to open it because there might be something worse on the other side?

"Too good to be true" is also just an aphorism, not a law of nature. It's certainly possible that are negative long term impacts from GLP1 medications, but should all of the people that have been unable to remove one of the single biggest health risk factors in human history via diet or exercise not pursue an option that we know is highly effective at removing that risk factor just because there might maybe be something worse years down the line? We're not talking about acne or hair loss here, man.

[mbivert]

> If you find yourself in a room that is on fire,

The immediacy of the danger makes things incomparable.

> "Too good to be true" is also just an aphorism, not a law of nature.

It's not "too good to be true". It's "no free lunch" (unfortunate pun), or "conservation of energy": the more one wins without apparent loss, the more one should be suspicious.

There are furthermore great reasons to be highly skeptical of pharmaceutical compagnies: consider the ongoing opioid crisis in the US, in great part caused by the sale of opioid-based medication (OxyContin) whose addictiveness was purposefully downplayed. Not to say that things will be as scandalous, merely that pharmaceutical compagnies cannot be trusted.

> We're not talking about acne or hair loss here,

Yes, and the people suffering from eating disorders are often psychologically weakened as a result (and/or cause), thus vulnerable to further abuse. Of course such people want to hear about a miracle way to solve this pesky, long-standing issue, of course.

And that's exactly what they're being sold; it's disheartening.

[cthalupa]

> The immediacy of the danger makes things incomparable.

Being obese is an immediate danger. It is an increase in risk for all cause mortality. Being obese today is making you more likely to develop cancer. It's making your more vulnerable to hear attack or stroke. It is one of the highest comorbidities with covid and plenty of other diseases.

It also is taking decades off your lifespan in the long term, of course. Some of that can be reversed by reversing your obesity, but for some the damage is cumulative over time. Maybe we'll get gene therapy or some other advanced medicine and be able to fully reverse, but maybe not.

> It's not "too good to be true". It's "no free lunch" (unfortunate pun), or "conservation of energy":

No free lunch is another aphorism. Conservation of energy is largely true, though some quantum effects, dark energy, etc. mean it might not be on the largest and smallest scales, but at a human size reference frame, is. But... no one is suggesting any physics boggling mechanism of action for these GLP-1 meds. We spend energy manufacturing a chemical that agonizes receptors that have the effects we're looking for.

> the more one wins without apparent loss, the more one should be suspicious.

There's fairly significant economic loss right now, but I know that's not the point you're going for. But iodine in salt has been basically 100% positive. Well studied over decades, it's one of the largest public health wins in human history. Caffeine, consumed in reasonable quantities, is basically universally a health win. You can have contraindications, certainly, but those also exists for GLP-1s - no one suggests they don't. But for the vast majority of people, ingesting caffeine is basically all health benefits - even if we remove the energy/wakefulness portion, we have mountains of research on how moderate amounts of caffeine a day reduce all of the major CVD outcomes, etc. We've been using caffeine for thousands of years - should I be suspicious of another shoe dropping?

> There are furthermore great reasons to be highly skeptical of pharmaceutical compagnies: consider the ongoing opioid crisis in the US, in great part caused by the sale of opioid-based medication (OxyContin) whose addictiveness was purposefully d

To be clear, I'm not a fan of big pharma - despite being generally incredibly pro-capitalism, public health is one of those areas where I think a government that serves the people should be stepping in and handling things. The power imbalance is too high for the market to be free, and profit motives generally lie in treatment vs. cures. If I could wave a magic wand, we'd have socialized medicine and pharma research would be funded by people where the motive is curing disease first and foremost.

But that doesn't mean that I'm going to shun modern medical science. And yeah, stuff like OxyContin is horrific. But for every oxycontin there's a hundred drugs that weren't handled nearly as recklessly.

> Yes, and the people suffering from eating disorders are often psychologically weakened as a result (and/or cause), thus vulnerable to further abuse. Of course such people want to hear about a miracle way to solve this pesky, long-standing issue, of course.

I mean, what's the alternative here? We should just... not use a drug that is succeeding in getting people out of obesity and being overweight? Because something might maybe happen later that will be bad?

We know obesity is one of the absolute worst things you can do to your health. It is 100% an immediate and clear danger to the health of every obese person. I'm not going to say they have to take a GLP-1 drug - that's their own choice. But we know the overwhelming majority of obese people do not succeed in getting the weight off to begin with, much less keep it off, despite being "prescribed" diet and exercise. So what's your proposed solution? Have hundreds of millions of people stay fat for a couple of decades while we wait and see if there might be long term risks that are worse than what is already one of the single most significant risks factors to health and longevity?

I do not believe that is a rational take.

[mbivert]

> So what's your proposed solution?

To take the time to study the root causes of obesity more closely, and treat the genuine causes, instead of slapping medicine on top of it, for an undetermined period of time to millions of people. It's insane.

Obesity at that scale is a recent issue[0], I'm sure we're clever enough to figure it out.

Think about it: as far as we know, the human body has evolved slowly over many thousands of years; how can drafty-patching it at scale over a few decades works? When something as inconspicuous as switching from stale bread to softer bread has had a drastic impact on dental issues[1]?

It's like a junior dev undertaking a major rewrite on his first day of work.

I'm reluctant to argue much further, I doubt it'll change much for either of us.

[0]: https://www.ncbi.nlm.nih.gov/books/NBK44656/

[1]: https://www.youtube.com/watch?v=3wWg9Jx-Byw (French, English papers in the description if you want to dig)