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> I'm always immediately skeptical as to what drugs pharmacies are pushing out

Major nitpick here. Pharmacies aren't pushing anything. Pharmaceutical companies are pushing these drugs.

Worse yet, independent pharmacies have only been losing money selling GLP-1 agonists. Insurance companies have begun to collude using pricing networks. They claim that the market value that pharmacies get the drugs for is too high, even though they are still patented and brand-name, so the insurance and pharmaceutical companies together are the ones that set the price. Then they refuse to reconcile the cost minus the deductible. Last I knew, it was about -42$ on a month prescription.

Pharmacies are absolutely pushing stuff, the DOJ has repeatedly investigated and fined pharmacies for things they did during the opioid epidemic. The entire industry is so incestuous that it's almost not even worth distinguishing as if the singleton Mom and Pop drug stores still exist, even if they do in some form these days.

Walmart, Walgreens, and CVS? You mean those small pharmacies--two of which also contain insurance companies, and the other one still has its own clinics?

Pharmacies can only give out what people are prescribed, the only things they can push are OTC products. They can't get and sell scheduled drugs without being explicitly tracked.

But you're right about health care in the US. We need a single-payer system to get prices lower, but that means fairness and cutting out unnecessary costs. The whole health insurance industry would cease to exist, and all the people abusing it don't want that to happen.

Cost Plus Drugs exist because the mega pharmacy chains have been colluding to keep prices of both patented and generic prescriptions artificially high. They're not pushing medications (that would require a physician's approval), but they are extracting money from patients once their doctor has done that.

Another problem with OTC is that it leads to healthcare discrimination based on income and insurance quality since these are often not covered.

The US desperately needs to do away with for-profit health insurance and mega hospital corporations, severely limit the patenting and absurd profiteering in pharma, and replace Medicaid and Medicare with better single-payer, universal healthcare like the rest of the world does more cheaply and with better outcomes.

It needs to -- but never will.

Take a look at the Fortune 500 and see how many top 20 are healthcare companies.

Then take a look at Global F500 and see how many of those are there.

They'll tank the US economy before they let for-profit healthcare die

"Ask your doctor about <insert drug here>" is "pushing" the drug. "Pushing" is advertising, "selling" happens later.

> Pharmacies can only give out what people are prescribed, the only things they can push are OTC products. They can't get and sell scheduled drugs without being explicitly tracked.

I think they can - specifically, the pharmacies that mix drugs locally can mix and sell a drug that's declared in shortage. IIRC Ozempic was in that situation recently.

You mean compounding? They are allowed to dilute to create a specific strength or combine constituents, but they can't actually create stuff from scratch on site any more than you or I can. That would be a laboratory. It's not like you can just buy semaglutide or the derivatives anywhere. It would have to come from the pharmaceutical company.

I looked it up, and I believe what you've heard about ended up just being people offering fake Ozempic.

You're right, I was thinking about compounding pharmacies.

> It's not like you can just buy semaglutide or the derivatives anywhere. It would have to come from the pharmaceutical company.

Pharmaceutical companies don't make those on their own either, they're contracting it off to drug manufacturing plants. The thing I read the other day said that compounding pharmacies order the same stuff from the same factories directly.

EDIT: found the article I read: https://www.astralcodexten.com/p/the-compounding-loophole.

Of course this is what I meant, and I'll update the original post. Thanks

We actually have a lot of data on Ozempic and GLP-1s generally, going back to the first GLP-1 FDA approval in 2005:

• Exenatide - FDA approved in 2005

• Liraglutide / Saxenda - FDA approved in 2010

• Dulaglutide / Trulicity - FDA approved in 2014

• Semaglutide / Ozempic/Wegovy - FDA approved in 2017

• Tirzepatide / Mounjaro - FDA approved in 2022

Ozempic / Semaglutide was FDA approved in 2017, but clinical trials started in 2008. That was 16 years ago. Obviously it's always possible there are even longer term side effects we're unaware of, but generally if this class of drug caused large scale problems for kidneys, liver, etc, we'd likely know by now.

>of course, that isn't to say these things aren't useful - to have a methadone/suboxone dependency is way preferable to heroin addiction.

Heroin will cause you to be sick.

Suboxone will make you go into a blind rage so manic you will never find yourself without it.

For those who actually "need" Suboxone, it is a magnitude easier to taper off of than the reasons for needing it - unfortunately a medical system with perverted incentives shrowd how (read: trivially, comfortably) easy it is to start and taper off of Suboxone, even from literally incredulous depths of synthetic opiate addiction - sometimes without even as much as a single iota of withdrawal.

It is literally easier to start and taper with Suboxone without Big Pharma - with no paper work inhibiting your and jeopardizing your future in perpetuity, as a nice perk.

Recreational suboxone use makes fentanyl look like a child's game.

Methadone, however well-intentioned, or altruistic in its creators' motives, is a resignment to the inevitable life-long dependency. Chemical handcuffs.

> Methadone, however well-intentioned, or altruistic in its creators' motives, is a resignment to the inevitable life-long dependency. Chemical handcuffs.

It’s of course less common these days but back from what I remember 20 or so years ago they did not inform patients very well to this reality. My experience was not for addiction, but was prescribed 10mg methadone daily for severe chronic pain, took it for a few years - that’s a relatively small dose and I cannot tell in plain English words how awful it was getting off of it. Tapering does not really work, the smallest reduction in dose will send you into just as severe withdrawal symptoms as if you cold turkey’d. I ended up buffering the withdrawal with tramadol, which was the only other thing I could take, but the entire process lasted about 6 months til I felt entirely normal again and the first month was 24/7 full blown acute withdrawals.

I’ve since quit smoking cigarettes and laughed at how easy it was in comparison.

They are a 2nd-best alternative to just doing the work to change your behavior.

If you are overweight, eat less/eat better and exercise.

If you are addicted to alcohol or drugs, quit.

Those are the ideals. If you can do those things it's better than depending on chemicals that for-profit pharmaceutical companies would love to see you buying for the rest of your life.

But if you can't do those things, it's probably better than continuing the status quo. Better to pay Reckitt Benckiser than support some criminal fentanyl dealers. I feel that many people have never really tried, or tried but did not appreciate that it would be really hard, and gave up.

I have health issues, a hormone inbalance which caused havoc on my body. One of the symptoms was extreme craving to the point that I drank half a pint of diluted orange juice (one part juice, three parts water) with phyllium husk and hydrolised guar gum every hour to create goop to fill my stomach. I couldn't stand the craving. I ate lots of fried mushrooms, too (not deep fried, just a little bit of butter).

Then I asked my doctor to give me a different medicament, because I suspected a variation of a deficiency. Her answer was: I don't have experience with that medicament, but after four months she relented. One week later my craving was much, much less.

This experience astounded me extremely deeply.

I have come to the conclusion that there are some body processes, let's say instincts, that can go astray.

Compare this to drowning. Even if people know that there's only water, they try breathe. It's just too strong an instinct.

Having experienced this, I now respect obese people. They just have the bad luck that their instinct of eating derailed. Now they not only lost body fitness but also respect.

> One of the symptoms was extreme craving to the point that

I have a kidney disorder that causes me to waste potassium. Without a supplement, I can't get enough in my natural diet without eating like 10-20 avocados a day, or 6 cups of spinach.

A fun side effect of hypokalemia is that your muscles get really sore, like you just did a full body workout. So, you can literally feel when your potassium is low.

The low salt coincides with some of the most intense food cravings I've ever experienced. I don't crave foods high in potassium, however; just foods with a lot of regular NaCl. So, my body does its best to tell me I need to eat something, triggering a psychological compulsion to get it, but the compulsion is to eat the wrong thing.

I'm just one data point, but I think this might extrapolate out to more people than just me. If you're compelled to overeat, you might be missing some key nutrient that just isn't present in abundance in your current diet. The trick is finding out what it is.

Random related thought - awhile back there was a series of blog posts that got pretty popular (I can't remember the blog's name) trying to investigate the root cause of obesity. They settled on some odd conclusions, but one of the things they noted in their meta-analysis of extant obesity research is that places with lower obesity have more of a particular dissolved mineral (they asserted lithium was the root cause, but I didn't find their conclusions convincing) in their drinking water.

It could be that there are trace elements that, if you don't have mineral-rich drinking water, are otherwise hard to get from a standard diet that drive this craving behavior that I've experienced.

I am not sure but I think my body couldn't generate enough of a specific hormone and then the body's reaction was as if I was starving because that hormone is controlling the metabolism inside the organes. So, probably nothing was missing in my food but because my metabolism was low it was like I was starving but I wasn't.

quick question, do you do any physical activity? or if your hormone imbalance did not allow you to do it, now that you have a different medicament, have you started doing sport? Not just a walk in the evening, like minimum 3 times a week 1 hour of high intensity workout, possibly supervised?

Yes, I started doing a lot of hiking. Today I walked more than 2000 foot up to a hill and back and still felt fine and had a quick stroll along a river the evening. I shoot many pictures of mushrooms, and a friend told me I caught a rare mushroom (lycoperdon echinatum) and Thursday I am going up again with him because he never saw one.

Why?

that's great, but it's not proper training, it's a hike, fantastic activity but (especially growing older) our life is mostly sedentary and it helps a lot to do a proper sport or intense activity at least 3 times a week (i personally workout every day, but sat and sun, for 1 hour with a high intensity sport, not weightlifting). The older you grow the harder it is for the system to process the amount of stuff we eat (especially high calories, highly processed food that is available nowadays) and doing a high intensity activity (heartrate up, muscular stress etcetc) is, in my opinion, fundamental and often ignored by people.

> I feel that many people have never really tried, or tried but did not appreciate that it would be really hard, and gave up.

With all due respect, this is nonsense. This is a very common trope, but I can guarantee you the vast vast vast majority of people who are obese have tried “eating less and moving more,” and that is not new advice to them. Nobody who has been obese for a long time walks into a doctor’s office going “okay I finally think I want that injection that will help me lose weight” as if they just suddenly noticed they’re obese.

There are lots of reasons they might not have been able to deal with it before, and “laziness” is not usually in the top 5. Genetics, means, access to knowledge, living in a food desert, depression, etc. are all far more likely causes.

Being obese sucks. People who are obese are far more aware of that than anyone choosing to judge them from afar.

On the topic of the obesity epidemic, it's worth noting that lab rats with controlled diets are also getting fatter over time. The leading theories are microbiome shifts or environmental contamination (microplastics?,) but afaik no conclusive cause has been found.

When people fail at health, (as when they fail at finance or addiction), a lot of propaganda tells us to blame individuals, with no sympathy or awareness of our failing systems.

SMH at the cruelty....

https://www.scientificamerican.com/article/how-lab-rats-are-...

> SMH at the cruelty....

Many (most?) people have a fundamental need to feel superior to some "other". This need is strong enough to the point where they'd rather be doing poorly themselves so long as there is at least some other group that's doing worse. Were you to give them an opportunity to significantly improve their own lives but in a way that everyone ends up on the same level, they'd balk.

Obesity is one of the few conditions that are socially acceptable to openly mock, and as such, it's like catnip to people who need to feed their inferiority complex.

Re: your first few sentences, I’m not sure how common this is, but I’ve heard that pedophiles in prison are frequently assaulted by the other prisoners for this reason.

(Don’t want to try to find a source for this - consider it as hearsay)

I actually think this is worse in countries with socialized medicine, because now you're not just "openly mockable" but you're also "taxing the system" with your "vice"

Cruel indeed.

Suboxone is far easier to discontinue than methadone, I took it for 18 months and then discontinued use about 10 years ago.

Methadone withdrawals can last for a month (I’d never make it that long) but suboxone physical withdrawals were gone in a few days.

Suboxone also has a dosage ceiling (32mg) where methadone does not.

> To the point where you'd almost be better off just kicking the heroin the "old fashioned" way

You said this and never expanded on it