In the last several months, semaglutide, a drug originally developed to help manage type 2 diabetes, has been in the news for its “breakthrough” weight loss abilities. This video from Vox is a good overview of what the drug does and the interest & controversy around it.
Both Ozempic and Wegovy, Ozempic’s counterpart approved specifically for weight loss by the FDA, are brand names of a drug called semaglutide. Semaglutide is one of several drugs that mimics a crucial digestive hormone called glucagon-like peptide 1, or GLP-1. It amplifies a process our bodies perform naturally.
GLP-1 is released in our intestines when we eat, and there are receptors for the hormone in cells all over the body. In the pancreas, GLP-1 promotes the production of insulin and suppresses the production of glucagon. This helps insulin-resistant bodies, like those with type 2 diabetes or obesity, manage blood sugar levels. In the stomach, GLP-1 slows gastric emptying, extending the feeling of being full. In the brain, GLP-1 suppresses appetite, which also promotes satiety and curbs hunger, so we eat less.
But, as I kept reminding Ozempic-curious friends, these medications were designed for chronic conditions, obesity and diabetes. For people who are dealing with those conditions, Ozempic appears to create a path toward a healthy relationship to food. For those who aren’t, it might function more like an injectable eating disorder. As the side effects make clear, it’s not a casual thing to drastically alter your body’s metabolic process, and there is no large-scale data about the safety of these drugs when taken by people who are mainly interested in treating another chronic condition, the desire to be thin.
I can see my anxiety mirrored in the wave of reactions starting to appear — op-eds, TV segments, people explaining why it’s good, actually, that the vast majority of those using this drug lose a quarter of their body weight. On social media, fat activists are pointing out that our lives were worthy even without this drug. The wave of opinion will not crest for years.
And that’s fair because this is new — not just the drug, but the idea of the drug. There’s no API or software to download, but this is nonetheless a technology that will reorder society. I have been the living embodiment of the deadly sin of gluttony, judged as greedy and weak since I was 10 years old-and now the sin is washed away. Baptism by injection. But I have no more virtue than I did a few months ago. I just prefer broccoli to gloopy chicken. Is this who I am?
Even outside the context of drugs, I find the tension between accepting who you are versus trying to change some behavior you find unappealing is challenging to navigate — it’s something that comes up in therapy a lot. (thx, anil)
There’s a fatal flaw embedded in the basic Covid-19 test, trace, and isolate trifecta used around the world: It doesn’t account for the fact that the coronavirus is not an equal-opportunity pathogen. The people who are most likely to be tested, and to have the easiest time quarantining or isolating, are also the least likely to get sick and die from the virus.
From the United Kingdom to Sweden to Canada, we have evidence that the virus preys on people employed in “essential service” jobs (bus drivers, nurses, factory workers), which don’t allow for telecommuting or paid sick leave; people in low-income neighborhoods; and people in “congregate housing” like shelters, prisons, and retirement homes.
People of color tend to be overrepresented in these groups — but there’s no biological reason they’re more likely to get sick and die from the virus. Simply put: They tend to work jobs that bring them outside the home and into close contact with other people, live in crowded environments ideal for coronavirus contagion, or both.
The state then directed efforts, resources, and money to nursing homes, the unhoused, prisons, and essential workers to make it easier for those folks to stay safe.
I also thought this bit was really interesting:
There’s a simple adage in public health: “Never do a test without offering something in exchange,” said Johns Hopkins’s Stefan Baral. So when a patient gets tested for HIV, for example, they’re offered treatment, support, or contact tracing. “We’re not just doing the testing to get information but also providing a clear service,” Baral added, and potentially preventing that person from spreading the virus any further. “This is basic public health.”
With Covid-19, the US has failed at basic public health. Across the country, people have been asked to get tested without anything offered in exchange.
“If we are asking people to stay home and not work, we have to make sure society is supporting them,” Baral said. “An equitable program would support people to do the right thing.”
“Never do a test without offering something in exchange.” To the extent that federal and state governments have been asking to people to stay home, get tested, and wear a mask, many of those same governments have been unwilling or unable to provide people with much in return for doing so. And so, here we are months into this, paying for that inaction with 250,000 lives.
You can access a free hotel room to safely isolate from your family, which include meals, Rx delivery, free wi-fi, medical staff on site, and transportation to and from hotel and medical appointments.
Antonie van Leeuwenhoek ran a draper’s shop and was a local politician in Delft, Netherlands in the mid-17th century. During this time, he developed an interest in making lenses and hit upon a technique for making lenses with extremely high magnifications for the time, 270x and perhaps even 500x normal magnification. These lenses allowed him to discover that there were tiny organisms living in his mouth.
Ed Yong, Joss Fong, and Julia Belluz discuss van Leeuwenhoek’s achievement and microorganisms in general in the video above and in an interview.
It is undeniable that antibiotics have been a tremendous health good, maybe one of the greatest health goods of all time. They have brought so many infectious diseases to heel and saved so many lives.
But it’s also clear that they have negative effects on our microbiome. So they are indiscriminate weapons. They kill the microbes that we depend upon and that are good for us as well as the ones that are causing disease and causing us harm. They’re like nukes, rather than precision weapons.
So we’re in a difficult situation now, where on the one hand we’re running out of antibiotics, and the rise of antibiotic-resistant bacteria is a huge public health threat. But at the same time we’re aware of the need to preserve the microbiome.
Yong just came out with a book on microbes called I Contain Multitudes. (Perhaps Whitman was speaking literally?)
From juice cleanses to vaccines to gluten to exercise to, uh, vagina steaming, celebrities like Jenny McCarthy and Gwyneth Paltrow are often found making claims that have little or no scientific evidence behind them. Timothy Caulfield recently wrote a book exploring the world of celebrity pseudoscience called Is Gwyneth Paltrow Wrong About Everything?
But while much has been written about the cause of our obsession with the rich and famous, Caulfield argues that not enough has been done to debunk celebrity messages and promises about health, diet, beauty, or the secret to happiness. From the obvious dangers, to body image of super-thin models and actors, or Gwyneth Paltrow’s enthusiastic endorsement of a gluten free-diet for almost everyone, or Jenny McCarthy’s ill-informed claims of the risks associated with vaccines, celebrity opinions have the power to dominate our conversations and outlooks on our lives and ourselves.
JB: So is Gwyneth actually wrong about everything?
TC: It’s incredible how much she is wrong about. Even when she is right about stuff — like telling people to eat more fruits and vegetables — there is always a bit of a tinge of wrongness. She’ll say, “It has to be organic,” for example. She is still distracting us with these untrue details, as opposed to just pushing the honest truth.
Update: I had forgotten about this book, so I was pleased to be reminded of it by this recent interview with Caulfield about celebrity health advice.
Colon cleanse: There is no evidence we need to cleanse our colons or detoxify our bodies. Vagina steaming to detoxify and increase fertility: again, absolutely ridiculous. Getting stung by bees is her latest thing for anti-aging — because, yes, anaphylaxis is so revitalizing. Goop, her website, suggested wearing a bra can cause cancer. This is raising fears, completely science free. I could go on and on and on.
But what’s at the heart of Paltrow’s empire? Is she just a dedicated health-seeker taking us on her path for utmost physical and spiritual well-being? No. Paltrow’s Goop is pure, unadulterated, blood-diamond free, organic-certified, biodynamic, moon-dusted bullshit. And you should avoid it at all costs. Here’s why.
1. Get as much of your nutrition as possible from a variety of completely unprocessed foods. These include fruits and vegetables. But they also include meat, fish, poultry and eggs that haven’t been processed. In other words, try to buy food that hasn’t been cooked, prepared or altered in any way. Brown rice over white rice. Whole grains over refined grains. You’re far better off eating two apples than drinking the same 27 grams of sugar in an eight-ounce glass of apple juice.
What’s more interesting than the guidelines is the admission up front that they’re not supported by rigorous science…and neither is nutrition in general. In the absence of science, “everything in moderation” seems to be the recommended course. (via @jimray)
Update: Julia Belluz recently interviewed Surgeon General1 Vivek Murthy for Vox and within, Murthy shares his four basic rules for health:
One is to eat healthy. I tend to avoid salt, added sugar, and processed foods whenever possible, and try to eat fresh fruits and vegetables as part of all my meals whenever possible.
Second is to stay physically active. That means not just going to gym but incorporating activity into whatever I do, whether that’s taking the stairs or converting sitting meetings to walking meetings whenever possible.
Third is making sure I’m focusing on my emotional and mental well-being. For me, an important part of that is the meditation practice that I do every morning. It’s a chance for me to center myself, a chance for me to remember who I want to be every day.
The fourth thing is I remind myself to stay away from toxic substances like tobacco and drugs.
What an odd antiquated governmental post, Surgeon General of the United States. The US government needs a robust advocate for the health of its citizens, but maybe not a 3-star admiral in the uniformed services you refer to as a surgeon? And while we’re on the topic, sort of, why not a Filmmaker Laureate, Musician Laureate, YouTube Star Laureate, TV Showrunner Laureate, iOS App Programmer Laureate, and Blogger Laureate in addition to Poet Laureate? ↩
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