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Comment by akavi | Hacker News Reader

> We also had initial results from the FLOW trial, suggesting that Ozempic prevents diabetics with kidney disease from needing dialysis.

Between this and the 2nd order decrease in renal disease from the reduction in diabetes and high blood pressure, Ozempic would have to end up having some truly awful long term effects to net out negative in utilitarian terms.

The US spends 130 G$/yr (0.5% of the _entire_ GDP) on dialysis, and that undercounts just how awful being on dialysis is in subjective terms.

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It's so awful that kidney disease is basically one of the conditions that triggers Medicare coverage at any age. It's basically one of the very few ways you can get socialized healthcare in the US.

> Between this and the 2nd order decrease in renal disease from the reduction in diabetes and high blood pressure, Ozempic would have to end up having some truly awful long term effects to net out negative in utilitarian terms.

On a population level, you're absolutely correct. But as an individual, I want to know what I'm getting into for long term effects. I might personally find them objectionable. So I'll wait and see.

Sure, but we already know the long term effects of diabetes and high blood pressure, and they are awful. By waiting to see, you are explicitly choosing to take those long term effects in an attempt to avoid the unknown long term effects of the new drug.

Obviously, it might be that the long term effects are worse, but we shouldn’t act like waiting is a zero cost choice.

I want to point out that this is a hypothetical. I don't have diabetes, and I had in mind more of its still-off-label use as an appetite suppressant for weight loss.

These drugs are not quite as new as often reported. Byetta has been around since 2005 and Victoza since 2010. The difference is that the latest iteration of GLP-1 meds are more effective, and we've discovered they can help with a lot more than just Type 2 Diabetes.

My mom was on Victoza (she has T2D). Ozempic is better for her, and more effective, both at managing her weight and her diabetes. Her A1C has gone down from over 11% (!!!!) to 6.7%.

So yeah, sure, we need more studies on long-term effects. But these aren't drug classes that have only been around since they got popular in 2020. They've been around a lot longer than that.

Moreover: we know well the drawbacks of long-term diabetes and/or obesity. It doesn't end well, on average.

Also if applied early enough may prevent diabetes in the first place.

> 130 G$/yr (0.5% of the _entire_ GDP) on dialysis

Why is dialysis a reasonable endpoint for comparison? How do you know that market functions properly and that prices reflect actual costs of providing service?

> to net out negative in utilitarian terms.

Life long attachments to drugs are universally negative. You only have to ask, "what happens when the supply chain is disrupted?" If you've never been anywhere where alcohol was suddenly hard to get you might not understand how hidden and pernicious these problems can be.

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