The prescription hurdle is absolutely necessary -- these are not drugs that anyone can safely take without guidance. It's the price that needs to be fixed.
Unless that risk is egregious, informed adults should be able to accept it if they so choose.
What we might not agree with is specifically what "informed" or "egregious" might mean.
FWIW I do not think that most people agree with this.
I can tell you that the conversations I've had with people who take these drugs from telehealths or from med spas -- they generally don't understand how these drugs work, what the risk profiles, are or how dosing should be managed. There's a lot of misinformation going around about all these drugs.
"immiment" is a different word than "egregious" isn't it? Malnutrition, cancer, and death are pretty egregious as well, even if they occur maybe months or years in the future, aren't they?
Literally, enough people are fucking this stuff up that we have pop culture references to it: "ozempic face". Losing weight this rapidly is unsafe. Sure, a lot of people might consent to the idea of rapidly losing weight, but there's nothing "informed" about it.
Sure. I don't think that that implies we have the right system currently or that we can't come up with good definitions. And again, "informed" is almost definitely already an understood term in medicine since "informed consent" is already understood.
> they generally don't understand how these drugs work, what the risk profiles, are or how dosing should be managed.
That's fine. I don't think they have to understand how they work. They have to have the risks conveyed appropriately to them. They might make a call that's ultimately harmful. Adults can do that, they should be allowed to do that.
> "immiment" is a different word than "egregious" isn't it?
Well, yes. If I had defined "egregious" as the same word, that wouldn't be very helpful.
> Malnutrition, cancer, and death are pretty egregious as well, even if they occur maybe months or years in the future, aren't they?
Not really. Things that take years to happen are a lot less serious, especially as they can be monitored for. But again, this can all be explained to the patient. I'd say the bar for "egregious" should be very, very high. When in doubt, give patients the power to choose.
> Literally, enough people are fucking this stuff up that we have pop culture references to it: "ozempic face". Losing weight this rapidly is unsafe.
That isn't compelling. How many of those people are getting ozempic from a nurse practitioner at one of these compound pharmacies? If anything, I'd bet that doctors taking the time to ensure patients are informed would lead to a reduction here.
You take a dose every two weeks. And if you accidentally double dose because you misread 1U to mean 1 dose, it just gives you some nausea.
Are we going to pretend it's hard to take this drug now too? Or that the doctor has some magical insight into your getting-on? Remember to eat. That's it. I guess a few people might need the doctor to go "you're eating, right?" but I don't believe in infantilizing everyone over that.
Additionally, getting the correct dose is not straightforward for a layperson as it is for other OTC drugs with standard doses.
I do think GLP-1s are just about right. It is appropriate to take them under personalized professional guidance.
Certainly you can abuse a GLP1 and get yourself very sick, or not abuse it and still end up with pancreatitis. But smoking and alcohol presumably cause way more cases of pancreatitis, and you don't need a script for a handle of Popov.
Indeed. In fact, I think just recently there were updated studies for at least one of the popular GLP1s that disclaimed entirely a link to pancreatitis.
Apparently we have forgotten people who died from eating disorders (previously called anorexia nervosa)?
There is a VAST difference between someone who weighs 300lbs asking for GLP-1 to combat morbidity and someone who is barely 100lbs asking for a GLP-1 to take off weight for bikini season. That's what needing to ask a doctor for a prescription is for.
Weekly, if you are following guidelines correctly. The half-life of most GLP1 peptides is 5-6 days.
I otherwise agree with your point entirely. Though anecdotally, I may have given my brother-in-law a single small vial of tirzepatide at his request so that he could experience it, and the results were ... not good. Turns out he's an idiot, thought that 'more is better', 'drinking enough water is for weenies', and 'I am not an alcoholic even though I get plowed most evenings.' All against my very specific advice on how to give it a try. Whoops.
My fault, yes, I should have realized he was too stupid to do it without adult supervision. He made himself so sick he almost went to the ER. Nothing really dangerous, of course, tirzepatide is pretty safe stuff, but overdosing on it can make you feel very shitty for a few days until the blood concentration drops.
It's that your health care system the doctor is in builds a few extra hurdles. I've talked to my (non-tele) doctor about GLP-1. I've tried losing weight before, with her, there's a long history.
To get approval, between the hospital my doc is in and the insurance, I need to:
1) Have a BMI of >30. Since it's only 29.5, I get to stuff my face if I want to lose weight.
2) Have six sessions with a nutritionist. Which are massively useless, their advice is roughly equivalent to reading Cosmopolitan. I know because I had prior conversations, and they're documented. But still, gotta do it again.
3) Do six months on Weight Watchers. Which is one massive scam leading you right to disordered eating. Also, I've tried for years to lose weight via diet changes, documented and talked through with my doc.
4) Before I can get tirzepatide, I have to get semaglutide for three months to see if it works. Never mind there's study over study over study showing it's slightly less effective and has massively more side effects.
Or I can just cough up the cash directly and buy from Eli Lilly, if somebody signs that receipt.
I'm fortunate enough I could afford that, so I did. (After a second consultation with my family's doctor back home - both they and my doctor agreed it was appropriate, so it's not just a case of "wanting is enough")
And after six months, my weight was in a much better region, lipid panels were much improved, other related biomarkers looked better as well - exactly as numerous studies and my doctors said one could expect.
So, as long as I cough up enough money, sure, I can bypass all the hoops. My health didn't enter the equation, just screw the poors (whose treatment for worse outcomes because they couldn't get access will cost a whole lot more than GLP-1 would've cost).
So, fuck the "prescription hurdle" and the medical system in the US with a hot white glowing iron rod right up the ass.
As for "these are not drugs that anyone can safely take without guidance", that's not really true either.
They're neither hard to take - "inject one vial once a week into the flabby part" isn't rocket science - nor does it cause massive health risks by itself. (And the hazard ratios for diabetes 2 and cardio events are so spectacularly low that they dwarf the other risks)
Yes, talking to a doc is a good idea. No, the current gatekeeping is in no way necessary.
The diagnostic criteria is simply (BMI > 30) OR (BMI > 27 + a weight related comorbidity like high blood pressure or high cholesterol)
> They're neither hard to take - "inject one vial once a week into the flabby part" isn't rocket science
It's not that they're difficult to administer, it's that dosage needs to be managed appropriately.
You're totally missing the point thought. The prescription hurdle effectively does not exist. It's just a paywall.
You pay your $100, get a 3 minute call with a NP/PA/whomever, and basically the robot writes you a prescription for whatever you want. The point is you pay and you get the prescription. Patient safety has nothing to do with anything.
The advantage to a telehealth is not getting the prescription written -- it's that they'll fill it for cheap through a tiny compounding pharmacy that is making it, technically illegally, but are small enough to be off the FDAs enforcement radar for the moment.
It's slightly cheaper for me to use telehealth vs. billing through my insurance. The downside is it doesn't go towards my deductible of course.
The stuff you are describing are entire supply chains of a sort where you want a GLP-1 or perhaps a few other things like TRT. Those you are signing up for the drug itself, which happens to include the prescription part with it.
Telehealth can be used for any old medication you want. It removes the permission slip part of the process and replaces it with a payment gateway. If you have $75-150 you can just click some buttons and have a prescription for nearly anything you want at most a day later. This includes antibiotics, ADHD meds (getting harder on these), certain benzos, etc.
HIMS/HERS/etc. and their smaller ilk are super popular, but they are the tip of the iceberg.
Telehealth providers can certainly work with compounding pharmacies but not necessarily. If you are looking to get a prescription for Diazapam you are going to be getting that sent to your local Walgreens or whatnot.
How? Usually PCP visit are cheap and everyone gets one for free.
> HIMS/HERS/etc. and their smaller ilk are super popular, but they are the tip of the iceberg. > Telehealth providers can certainly work with compounding pharmacies but not necessarily.
Yeah I’m aware there are a whole host of services telehealths provide but the primary reason people use them for GLP1s is to avoid the name brand cost.