Actress Mayim Bialik shares her ‘nightmare’ experience with a GLP-1

RocksInMyHead said:

You posted the link you're referring to two days after saying that. You're not going to blame people for not reading your mind, are you? And it's still unnecessarily pejorative.

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What would be the nice way to say it?

"Some young people want to lose 15 lbs so they look better, but don't want to diet or exercise" isn't exactly flattering either. There are certain things that there's just no "super happy" way of saying.

RocksInMyHead said:

Why does it need to be said in the first place? Whether or not you think someone needs a weight loss drug is irrelevant to a discussion of lax prescription patterns. The issue isn't that "undeserving" people are getting access, but rather that some doctors are potentially not properly evaluating patients (or communicating risks) before giving them prescriptions.

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In a world where there are active initiatives aimed at building a system where all of us to chip in on healthcare costs for the collective (even more than we already do), then discussions about whether meds are needed or not (vs. if there's a better way) are reasonable and on the table for debate.

I'm receptive to the notion of universal single payer healthcare, but it comes with the stipulation that people need to at least put a half-[bless and do not curse][bless and do not curse][bless and do not curse][bless and do not curse][bless and do not curse] effort toward participating in their own health.

...same reason I wouldn't want to be in the same insurance pool as someone who says "Yeah, I'll start a bonfire in my basement...who cares, if the house burns down, State Farm will pay for it"

RocksInMyHead said:

By people with the knowledge to speak fluently on the subject, perhaps. But you're no more capable of judging my medical needs than I am of yours. It's one thing to say "Hey, I think it's a bit odd that I can get [drug] after a five minute video call with a doctor I've never talked to before" and another thing entirely to say "I don't think this person should get [drug] because I think there are other things they should be doing to treat their condition."

The first of those is an observation of a deviation from expected behavior - most of us are accustomed to needing to go to a doctor in-person, and perhaps develop a relationship with them before they start suggesting prescriptions. The second is a nuanced medical decision that requires detailed knowledge of the patient's medical history as well as a background in biology, chemistry, and pharmacology.

Democratizing technical fields is the stuff of communism parodies.

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But what you're describing there is a form of credentialism (and a form that allows certain entrenched financial interests to carve what they want out of the system).

Where the people who do have the more in-depth knowledge (thereby, seen as the only ones qualified to "make the judgement call") are influenced to press down a specific path at the behest of other entities. In lay terms, if a certain group of people are deemed to be "the only ones who can make the call", and those are the same people who are perhaps getting some "perks" from the drug companies, then one has to wonder "do they really think this is the best approach?...or do they want to keep getting invited to those conferences at the resort?"


And I'd suggest there's a spectrum with regards to whether or not a person has to be deeply familiar with a subject to speak on absolutely all parts of it. There's levels to it. If it was subject about the nitty gritty of how electrical impulses control heart rhythm, then yeah, that's best left to a cardiologist. However, not every subject involving human health and nutrition is that complex and in-depth.

In same way that, yes, my mechanic knows a lot more about cars than I do, but I don't need to have the same level of prowess to accurately assess certain car problems, and to know that if after his meeting with the STP sales rep, he starts recommending expensive brake system flushes every 3,000 miles, that it sounds fishy.


Regarding diet/exercise/nutrition, it's one of the simpler concepts that's very approachable. So simple in fact, that they're able to teach it to school children (or at least they used to when I was in school, not sure what they're doing nowadays)


With regards to the concept of overprescribing, certain concepts can't be detached. In a world where commercials are blasting people with ads (with celebrity Cameos), and you walking into the waiting room that's littered with brochures for "if you think this sounds right for you, ask your doctor about <insert brand name drug here>", those are basically fostering an environment where we're not "deferring to the experts". The people with the power of the pen are being pressured in a certain direction.

"This is a decision between me and my doctor, he's the expert, so this was his call"... I'd call shenanigans on that, because that's not what's happening all the time, patients are specifically asking doctors for specific drugs that they heard about elsewhere (that they otherwise wouldn't have even known the name of).

The proof is in the pudding. Drug companies are spending billions and billions of dollars in advertising, telling patients which drugs to ask their doctors for before they even go in for the visit. And that spending has been steadily increasing over time. They wouldn't keep sinking that kind of money into advertising if they weren't getting a return on their investment.

In those scenarios, it's not actually a doctor's assessment in the true sense, it's a self-assessment with a compliant physician who's willing to grant the request.


Honest question, if there were no ads for GLP1 meds on TV/Facebook/Etc prompting people to go ask their doctor for it... Do you think the prescribing rate on those would have increased the way it has?

RocksInMyHead said:

That's certainly a reasonable thing to point out, and I generally agree that there are issues with the amount of drug advertising we see in the US, but again, following that thread down to the individual goes beyond the capability of laypersons to evaluate.

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But that's the thing, I'm not taking it down to the individual level for every single case. As I said in one of my very first posts in this thread, there are certainly people out there for whom, the pros of GLP-1s outweigh the cons.

The fact that we've seen a huge spike in prescriptions being handed out for it, and we've seen overprescribing trends for a wide variety of drugs over the past 30 years is evidence that it's happening, but I'm not suggesting that I know for certain which people are in those categories, just that we know it's happening.

If I said "Steve Shmedley living at 123 main street from Tacoma Washington definitely doesn't need them" that would be one thing, but I'm speaking more broadly.


...but it's impossible to have the discussion about the reality that "there's some people getting them prescribed to them who don't need them and would be better off modifying their diet", if people who are currently on them are going to take it way too personally. What logical conclusion does that lead to? We just let 100% of the population have them on-demand because anything less would be "gatekeeping weightloss" and evoke a "how dare you" response?


If, amid the opioid pandemic, someone pointed out "there's too many people getting prescriptions for those who don't need them, and would be better off trying other means like physical therapy" (which was 100% true speaking broadly), I got all hot and bothered and said "When my dad had stage 4 cancer, those drugs were the only thing that gave him relief at the end, so how dare you tell other people what they do and don't need, you're not a doctor!!!"

Would that have been a productive approach?