Regarding insurance, could the insurance companies decide to cover the drugs for off-label addiction treatment but not other uses?
I'm not sure how the money works out but addiction and related health conditions can be a very expensive thing for an insurance company so they might actually calculate it's a money saver. Or they might calculate that it saves too many lives who might have died cheaply otherwisez
My understanding is that insurance companies can cover whatever they want to, on label or off, but it's rare that they will cover something that's off label and high cost. And frequently they don't cover all medicines that are on label. For example, Zepbound is often not covered for obesity or is more difficult to get coverage for than Wegovy, because it is more expensive.
GLP-1 agonists are no longer “off-label” for the treatment of obesity; that’s been the case for several years now. Tirzepatide and semaglutide are both labeled for the treatment of obesity.
I believe the economic case for Federal subsidies to insurers to cover effective weight loss drugs will become obvious - most of the harmful consequences of obesity typically kick in around the age you’d go on Medicare.
I agree! Would be great to see more long-term economic analysis on this. Also, I think there will be tremendous local, state, and federal cost savings from reductions in drinking and other drug use. Lower crime, incarceration, etc.
Why would people microdose rather than take a full dose? That seems particularly implausible for addiction treatment. Who says: I need help controlling my cravings and I'm willing to take medication but I wouldn't want to take a full dose and instead hope the effect from a tiny dose I go to trouble to take isn't zero.
I'm not sure how common micro-dosing will be for addiction, my prediction was for overall GLP-1 micro-dosing. But I suspect that there are and will be people who are experiencing moderately elevated cravings for alcohol or other substances and find that their cravings respond to very low doses of GLP-1s. They won't want to take more than they need to.
I assumed they would want to take more than they need. If you are quitting opiates, meth or even nicotine it's hard to avoid gaining weight so I figured the weight-loss would be a bonus.
Yes, I think the weight loss is definitely attractive to people, which is great for adoption and adherence in a field where patients are reluctant to adopt and usually discontinue treatment quickly. It will definitely depend on the person and how they respond-- most will take full doses. You can read about some people's experiences here: https://www.reddit.com/r/dryzempic/
Those experiences seem to all be at least the .25 loading dose but maybe that's what you mean by microdosing.
But whether it works against placebo or not it's probably important to be available for the same reasons methadone maintenance will bring you down to red water for awhile.
“Just Say No” disappeared in the late 90’s and in 2012 highly profitable recreational marijuana was legal in CO & WA state - and more importantly the “small business” farmer’s & dispensaries - began making huge profits from recreational weed. Our morality is very easily superseded by $.
The US change to High Fructose Corn Syrup (originally developed to fatten cattle) made huge profits for Coke and ushered in the age of endemic obesity. Now the drug companies making GLP-1’s are making huge profits “curing” obesity and diabetes. If you’re poor/unable to afford GLP-1’s then you will suffer for years with pain, inflammation, GI issues, memory issues, and addiction (death, jails, & institutions). If you have health insurance you probably won’t be covered for weight loss medications in 2025 so now we have Discord & Telegram forums providing info about the burgeoning grey market.
It doesn’t have to be this way but yet it is because that’s the design. Will shooting healthcare CEO’s change anything? No - Penn State churns out a new crop every year. We are all crabs in the pot.
But is there any indication that "just say no" had any benefits? And marijuana can be grown. What makes it " highly profitable?"
For that matter, was "just say no" actually an example of morality? Or was it part of justifying incarceration for huge numbers of Americans for mostly victimless crimes?
Money is another kind of blood. It is always present in human activity. We recognize that flow of cash selectively according to our biases. Cops and jails made money off of the war on drugs.
The success of GLP-1’s in treating the desire for alcohol/drugs is further evidence that this and obesity may be a result of dis-regulation in the hypothalamus. What causes the dis-regulation is up for debate the ability to use GLP-‘s to silence food/sugar/alcohol cravings is not. https://www.nature.com/articles/s41598-023-48267-2
The use of GLP-1’s to silence the cravings and the use of AA’s 12 Steps to help people sort through the wreckage of the past to build a sober future will become the new standard.
Okay, I'll buy that. But does that fit the thesis that "Our morality is very easily superseded by $?" It seems like you're saying here that the older "morality" was flawed and was replaced by a model that was more effective at addressing social problems? And... isn't that a good thing?
Like the Tetlock-ian forecasting!
Regarding insurance, could the insurance companies decide to cover the drugs for off-label addiction treatment but not other uses?
I'm not sure how the money works out but addiction and related health conditions can be a very expensive thing for an insurance company so they might actually calculate it's a money saver. Or they might calculate that it saves too many lives who might have died cheaply otherwisez
My understanding is that insurance companies can cover whatever they want to, on label or off, but it's rare that they will cover something that's off label and high cost. And frequently they don't cover all medicines that are on label. For example, Zepbound is often not covered for obesity or is more difficult to get coverage for than Wegovy, because it is more expensive.
GLP-1 agonists are no longer “off-label” for the treatment of obesity; that’s been the case for several years now. Tirzepatide and semaglutide are both labeled for the treatment of obesity.
Yes, on label but not necessarily covered.
I believe the economic case for Federal subsidies to insurers to cover effective weight loss drugs will become obvious - most of the harmful consequences of obesity typically kick in around the age you’d go on Medicare.
I agree! Would be great to see more long-term economic analysis on this. Also, I think there will be tremendous local, state, and federal cost savings from reductions in drinking and other drug use. Lower crime, incarceration, etc.
Why would people microdose rather than take a full dose? That seems particularly implausible for addiction treatment. Who says: I need help controlling my cravings and I'm willing to take medication but I wouldn't want to take a full dose and instead hope the effect from a tiny dose I go to trouble to take isn't zero.
I'm not sure how common micro-dosing will be for addiction, my prediction was for overall GLP-1 micro-dosing. But I suspect that there are and will be people who are experiencing moderately elevated cravings for alcohol or other substances and find that their cravings respond to very low doses of GLP-1s. They won't want to take more than they need to.
I assumed they would want to take more than they need. If you are quitting opiates, meth or even nicotine it's hard to avoid gaining weight so I figured the weight-loss would be a bonus.
Yes, I think the weight loss is definitely attractive to people, which is great for adoption and adherence in a field where patients are reluctant to adopt and usually discontinue treatment quickly. It will definitely depend on the person and how they respond-- most will take full doses. You can read about some people's experiences here: https://www.reddit.com/r/dryzempic/
Those experiences seem to all be at least the .25 loading dose but maybe that's what you mean by microdosing.
But whether it works against placebo or not it's probably important to be available for the same reasons methadone maintenance will bring you down to red water for awhile.
Things will only change if it is profitable!
“Just Say No” disappeared in the late 90’s and in 2012 highly profitable recreational marijuana was legal in CO & WA state - and more importantly the “small business” farmer’s & dispensaries - began making huge profits from recreational weed. Our morality is very easily superseded by $.
The US change to High Fructose Corn Syrup (originally developed to fatten cattle) made huge profits for Coke and ushered in the age of endemic obesity. Now the drug companies making GLP-1’s are making huge profits “curing” obesity and diabetes. If you’re poor/unable to afford GLP-1’s then you will suffer for years with pain, inflammation, GI issues, memory issues, and addiction (death, jails, & institutions). If you have health insurance you probably won’t be covered for weight loss medications in 2025 so now we have Discord & Telegram forums providing info about the burgeoning grey market.
It doesn’t have to be this way but yet it is because that’s the design. Will shooting healthcare CEO’s change anything? No - Penn State churns out a new crop every year. We are all crabs in the pot.
But is there any indication that "just say no" had any benefits? And marijuana can be grown. What makes it " highly profitable?"
For that matter, was "just say no" actually an example of morality? Or was it part of justifying incarceration for huge numbers of Americans for mostly victimless crimes?
Money is another kind of blood. It is always present in human activity. We recognize that flow of cash selectively according to our biases. Cops and jails made money off of the war on drugs.
Addiction as moral failing has been thoroughly disproved and “Just Say No” didn’t work.
https://www.scientificamerican.com/article/why-just-say-no-doesnt-work/#:~:text=A%20meta%2Danalysis%20(mathematical%20review,those%20who%20received%20no%20intervention.
AA and other sobriety programs are successful but at a rate of 5% to 50% depending upon a number of factors.
https://www.recoveryanswers.org/research-post/update-evidence-alcoholics-anonymous-participation/
The success of GLP-1’s in treating the desire for alcohol/drugs is further evidence that this and obesity may be a result of dis-regulation in the hypothalamus. What causes the dis-regulation is up for debate the ability to use GLP-‘s to silence food/sugar/alcohol cravings is not. https://www.nature.com/articles/s41598-023-48267-2
The use of GLP-1’s to silence the cravings and the use of AA’s 12 Steps to help people sort through the wreckage of the past to build a sober future will become the new standard.
*edited for grammar
Okay, I'll buy that. But does that fit the thesis that "Our morality is very easily superseded by $?" It seems like you're saying here that the older "morality" was flawed and was replaced by a model that was more effective at addressing social problems? And... isn't that a good thing?