There seems to be an explosion of drugs for fat loss. No signs of slowing down.

China disrespects IP and has the fastest growth of anywhere, and has medications

A significant change to IP doesn't necessarily mean the world stops working on things. It just pivots us to a new set of problems.

That's nice. The rest of the world has price caps on what these companies can charge for drugs.

It's one or the other. You can have your ''patents'' and ''intellectual property'' respected...but that requires you not charge an outrageously higher price in certain markets, like the US.

As always, depends on the law. This is a bright line example of companies breaking the law to the direct tangible benefit of not only their customers but the population at large. Letting Novo Nordisk jack the price back up and deprive the vast majority of Americans access to the greatest good to public health in a century meanwhile is… maybe not the example you should be holding as the law working.

The main reason drug development is so enormously expensive because the FDA makes it that way with their paranoid risk averse regulatory process and insanely restrictive requirements on what requires a doctor prescription.

Right I used CPAP as an example because it bypasses all arguments about "novel technology", "drug development" cost, or "need for safety". Even an ASV algorithm could probably be implemented as a ~graduate project since it seems to be a rather basic control algorithm (today with ML you could probably do even fancier things). It's basically a piece of pure technology that could be commoditized, manufactured and sold to people for < $300 in the way smartphones are. If something as "basic" as this can't be accomplished due to the regulatory environment then it's sort of pointless talking about anything more complex like pharma drugs.

Or you pay them directly. Most countries have research funding. Since there's no way to know what you'll find or how long it will take, research doesn't fit well in the capitalist model. Makes much more sense to apply a fixed effort and accept whatever results come out, but only the government can do that — or a rich monopoly like Bell.

> Patent laws exist for a reason

And maybe in this case they are functioning as intended.

Unfortunately, they are also leveraged to provide a moat and profits in situations where no innovation has occurred. (Eg, patents on one click shopping.)

Going to Japan felt like living in the future. I could walk into any glasses store, and for $50 or less buy a pair of frames and lenses. If I didn't know my prescription, included in the price was an automated eye exam machine which'd figure it out in 2 or 3 minutes.

In the US I'm paying $200 just for the exam.

European Respiratory society disagrees on the cancer risk fwiw https://www.ersnet.org/wp-content/uploads/2022/02/Update-on-... but yeah obviously degraded foam isn't good. The foam isn't actually a required part, it's just for sound reduction.

But I think that proves my point, the supposedly "rigorous" FDA review didn't flag concerns about foam in the airpath of something you breathe through, so what exactly is the approval process buying you? Philips issued a voluntary recall but resmed uses foam in their units too, and while they claim it's a different type of foam it seems there are better ways to engineer sound reduction than putting foam in the air channel and potentially breathing in microplastics.

Why is obesity not considered a necessitating condition? It often carries the comorbidities you just mentioned. Should not exclude people just because they haven’t had these specific health problems (yet) but will eventually have them.

I was 347lbs at the time. Wasnt a diabetic (nor pre-diabetic) no heart disease, blood pressure or really anything other than my weight. Prior to then Id had two massive bouts of weight loss at 50-100lbs so I know what it takes. Id tried but this last time without meds was extremely hard. You cant do much in the way of productive exercise when both your shoulders need replacement at 30 and between two knees have an ACL tear and two MCL tears. To top it off I had wildly out of whack hormones.

I think you would be hard-pressed to find any human who has been 100 pounds overweight for any amount of time that doesn't have an obesity-related comorbidity.

Hypertension, sleep apnea, high cholesterol, etc are all common in the general population and exacerbated or even caused by the physical and lifestyle conditions that beget obesity.

People with high blood pressure could just try harder to relax, too.

> Also, on a personal level it rubs me the wrong way to have my insurance premiums go towards something that people could just do themselves, from something they did to themselves. I know many will disagree, of course, and there are other examples (say, lung cancer treatments) that are similar.

Our Obsession With Personal Responsibility Is Making Us Sick - https://jacobin.com/2026/02/health-inequality-individual-res... - February 6th, 2026

> lung cancer treatments

A fairly large portion of lung cancer patients didn't "do it to themselves" (about 20% and rising).

It remains to be seen how vaping impacts lung cancer,

I don't like the idea of finding reasons to penalize people for predicable life decisions that lead to treatment needs. Insurance companies have a lot of resources to make those predictions and if unshackled they aren't afraid of using them. Making construction workers, miners, or truck drivers pay more (or be denied outright) for insurance because their job has negative health effects would be bad for society.

> Also, on a personal level it rubs me the wrong way to have my insurance premiums go towards something that people could just do themselves, from something they did to themselves.

The usual note for this is your insurance premiums were already going towards that, just indirectly by way of paying for heart disease treatments, diabetes management and other secondary effect of obesity.

But I'd also like to propose that "could just do themselves" is carrying a lot of assumptions that may not hold for any individual. A few years back now I started a medication with the side effect of appetite suppression, and I learned something about myself. To the best of my ability to recall, I had never before starting that medication not been hungry. "Full" to me was a physical sensation of being unable to fit more food physically in my stomach, but even when I was "full" I was hungry. Luckily for myself as a teen and young adult I had an incredibly high metabolism. I could eat 3 meals a day, 3-4 bowls of cereal and milk as an "afternoon snack" after school and some late evening snacks while watching TV and I still was in the "almost underweight" category. It was in this context, a time when I could go to a fast food restaurant and order two meals just for myself and stay well inside a healthy weight range that I learned to eat as an adult. Eventually though, the metabolism slowed down, and I started packing on weight but the hunger never subsided. Oh sure, as I got older the idea of and ability to eat an entire pizza by myself slowly went away, but hungry was always there, so I was still always eating and always eating more than I should have.

And I did manage to lose weight on my own many times. Through extremely strict self control and portion control, multiple times I managed to lose 25, 30 even 50lbs, one painstaking week at a time. Every day was strict tracking and weighing of everything I ate, and many days were hard battles of "I know I'm hungry, but I've already hit my limit for the day, so I can't eat more", and going to bed extremely hungry with the hope that when I woke the next morning that feeling would have subsided a little. And it worked each time, until inevitably something happened to disrupt the routines and habits built over the months. Maybe it was a set of family emergencies that had me eating on the run, unable to properly monitor everything and adding some "stress eating" on top of it. Maybe it was running into "the holidays" where calories are cheap and abundant even if you are still keeping track. And sometimes it was just being unable to sustain the high degree of willpower it required to keep myself on the schedule. And what takes month of carefully losing 1lb a week to do only takes a month or two to almost completely undo.

Hunger is probably the closest thing I've ever experienced to an addiction. I've thankfully never had to battle an addiction for anything else, but when it comes to hunger that eternal gnawing was ever present and the more weight I lost by sheer force of will, ever distracting. If the idea popped into my head after lunch that "I'd like a snack", it was an idea that would not leave my head until either I'd given in and gotten a snack or forced myself to not give in and waited until dinner. But that forcing meant dedicating ever larger parts of my mental energy away from my work and tasks at hand to just convincing myself to not go get the snack. And worse, when the time for dinner finally came, I was already feeling "hungry" on top of my normal hunger state, so often not eating the snack just meant delaying the excess consumption to dinner or having to continue that fight at dinner. If it sounds exhausting, in a lot of ways it was. But of course, like you said I can "just do" this. It's simple CI < CO math. And yet it never stuck, in part because unlike a lot of other unhealthy habits you can pick up in your life, you cant just not eat. Yes you can eat different things, or eat healthier, both of which can help with weight problems, but you can't stop eating. You have to eat, the hunger is always there and the same thing the hunger wants is the same thing you NEED to literally survive.

But that medication with its appetite suppressant effect was a game changer for me. For the first time in over 30 years, I actually felt full. Not physically stuffed, but "done eating". I could eat a small lunch and think to myself "that was good, and I feel satisfied". For the first time, when the idea of an afternoon snack popped into my head, I could remind myself that dinner was in 2 hours and I needed to make sure I had room to eat that so the snack could wait, and that would be the end of it, no fight necessary because the hunger wasn't gnawing at me the whole time. When I first started, I was concerned that the medication was giving me anxiety attacks because about 6PM every day, I'd start getting this feeling of my stomach tying itself in knots, and this sensation of "needing something". And after a week or so it occurred to me that what I was feeling for the first time in my life was the feeling of transitioning from having been full and satiated to being hungry again. I'd never not been hungry before. And I know that sounds insane, because it sounded insane to me then. Before taking the medication if you'd asked me if I know what it felt like to be full or to not be hungry I would tell you that I did. But apparently I didn't, and I didn't know that until I started that medication. And for the first time since the weight started coming on, the weight I've lost is staying lost.

So yes, you can "just" eat better and less and control your portions and not eat so much. But from personal experience, it's a hell of a lot easier to have that will power when your body is giving you the right signals and isn't constantly pushing you over the limits.

I personally think that overeating is an addiction, not a moral failing, and is often the side effect of other mental illnesses.

I don't do this as much as others, but as someone who has suffered from Major Depressive Disorder [1], it can be really easy to eat your feelings away. When I've had really bad depressive episodes, I don't want to cook, I don't want a fucking salad, I mostly just want to feel bad about myself and I end up getting a huge meal at Taco Bell and sadly eating that. Doing that one day isn't that bad. Even doing that two days isn't that bad, but when you have a long extended depressive episode, it can easily become a pattern of weeks where you're getting unhealthy fast food every day.

I know a lot of people act like depression is a moral failing as well [2], but I personally don't think that, and it feels like obesity can be a symptom of major depression. If you ever watch "My 600lb Life", you'll see that a lot of the people on there are really going through serious mental disorders and/or dealing from PTSD from sexual abuse, and the overeating can come as a result from that.

I guess I just feel like it's reductive to say "they did this to themselves". The human brain and human psychology are complicated and irritating.

[1] Fortunately my current set of meds has really helped...medical science is pretty cool sometimes!

[2] Not saying that you said that, to be clear.

If losing the weight is good for them, isn’t it possible that it’s not just the humanitarian thing (which I know is a useless argument to make to the soulless ghouls who run insurance companies anyway) but also the economically right choice for them, to avoid paying for their worse health problems later?

The regulation is pretty clear? We just don't choose to blackhole shady foreign (in this case, Chinese) companies from the American internet as a matter of policy. And cannot effectively screen all imports.

Hard to regulate. A lot of the retatrutide sold today is marketed on Discord & Telegram groups and paid for with crypto. It is infeasible for customs to open every last package entering the US, so this avenue will continue to work. The only gov't that could realistically stop it (for a while at least) is the Chinese. And they do, occasionally, shut down a manufacturer for a while. Though not because they are shipping GLP1s to the states.

It’s regulated quite tightly. But if you can’t shut down the illicit street drug market you aren’t going to be able to shut down the illicit make-your-life-better black market either.

I think what’s happening now is about right. FDA approval process for the vast majority of people, and make those who want to play drug astronaut biohacker find it via underground methods. No reason to crack down super hard on such folks since the societal impact is likely net positive - unlike fentanyl or what have you.

Perhaps there could be better enforcement for the folks being totally blatant about it as it risks going “mainstream” and hitting people who don’t have informed consent, but I imagine that’s coming as law enforcement catches up.

> There has also been cases of compounding pharmacies offering reta and other unapproved peptides

Can you elaborate more on this? I hadn't heard about it.

I don't think this is about paperwork. They are presumably violating patents by not buying these drugs from the patent owners.

Eli Lilly will categorically state it is impossible for the compounders to be using the same API as they are due to being the sole source of manufacturing for it on the planet.

From what I can tell they are technically correct. The FDA approved method of manufacturing the peptide chain is different than the Chinese sources these compounders are sourcing from. It may not make an actual biological difference (and hefty evidence of millions of people on it show there is unlikely to be a material difference) but it’s not the same as a generic medication being approved.

This is about as Wild West as most of us have lived through for the U.S. drug market.

Any idea why they'd change their mind about point 4?

The regulatory agencies were understaffed for the work load even before recent layoffs. Why focus on this, of all the things they could put their effort into?

if it helps people facing terminal illness it doesn't mean it should be OTC. "facing terminal illness" probably needs strong stuff. something required for that can harm the normal guy. it's not like Vit D supplement.

They are adding B12 as a way to say that it’s tailored to individuals and not available.

I’ve used mainly compounded medicine over the last five years and find the fervent dislike that people have for compounders bizarre.

If you look into generic regulation in the US, the standards are already through the floor. I’d rather work with someone who has a more direct financial incentive to not fuck up.

But they still market regardless. They probably constitute 50% of the medical ads I see now

The marketing isn't for the drugs.

They market the service that gives you the drugs with the smallest oversight possible. These services are becoming popular among people who shouldn't be taking GLP-1s (eating disorders, body dysmorphia, people who are too thin but want to lose more weight) because most of their providers are just trying to write prescriptions as fast as possible to collect their payments.

In the UK there's a lot of TV advertising for "weight loss medication" that never refers to any drug by name. But if you look at the small print, it refers to "Orlistat", which is technically available without a prescription. Of course, nobody (or few) actually want Orlistat or end up being prescribed it after the consultation.

Canada's laws around this are...odd.

The law prohibits ads from simultaneously naming a prescription drug and its therapeutic use. So you might see an ad pushing a specific drug, but it will never say what it's used for. Or you might see an ad where people talk about treatments for a condition but never mention the drug, just saying talk to your doctor.

Sometimes they get around this subtly. In one ad a number of overweight actors discuss how much they love a specific drug, but it's never mentioned what it's for but is implied.

And of course when US channels are simulcast in Canada, US ads just run as is.

It is still not legal in Canada. Someone must have been flouting the law.

No… The rest of the first world countries as a counter example.

This is not really the correct way to think about this.

Pharma is ultra R&D heavy so yes, medications are deeply profitable on a per-pill cost to manufacture basis. However, drug companies by and large are not extremely profitable. This is because to produce a single drug (which is high-margin from point of production), they have to sink billions of dollars into literally thousands of other drug candidates to figure out which ones are viable.

This is all "real, legitimate cost," as is reflected in their rather abysmal overall profitability.

As for the disparity between US and foreign markets, it's a basic tenet of commercialization to sell to every buyer at the highest price they'll accept, so long as that price is above your price to produce. All sorts of companies engage in "price discrimination" to achieve this. For example, cereal manufacturers will sell their own brand at $4/box, and sell the exact same product in a store brand box for $3.25/box. A lot of products in your local retail stores do this.

Overall, no one is really hurt by this per se. Every consumer is making a transaction they're willing to make, and the company is making the most money it can in aggregate, which actually gives it room to push the price at every price point lower than it would be able to if it could only sell to a single segment.

This is actually extremely important in the drug context due to the aforementioned abysmal profitability.

Let's take Trump's attempt to force a Most Favored Nation (MFN) clause onto drug manufacturers which guarantees US consumers pay the same price as the lowest price internationally. The intended effect is for US prices to come down to the level paid elsewhere.

But here's Pfizer CEO: "When [we] do the math, shall we reduce the US price to France’s level or stop supplying France? We [will] stop supplying France. So they will stay without new medicines. The system will force us not to be able to accept the lower prices.”

Not only does this obviously not result in lower US prices, but it very possibly results in higher US prices (since now there is less net revenue from lower priced consumers) and, more troubling in the pharma case, there is now even less net revenue coming in to justify new drug development.

It's hard to overstate how asinine this entire endeavor is. US consumers certainly pay too-high prices for drugs, but this intervention does very little to actually address that problem. The much more proximal issue is the incredible degree of intermediation in the US market between payers, providers, PBMs, GPOs, and more.

You had the choice to go the expensive route and you took it. Don't tell other people they can't make their own choices too.

> experienced their shots being less effective

People report this with HPLC tested stuff that is proven to be of the same purity/concentration too, "feels" reports are notoriously unreliable in medicine.

Yes. Drugs are too damn expensive and innovation is too damn slow. Better to allow higher risk options. And if you don't like it, you are always free not to use them.

What do you mean "try them on the general population?" Who is forcing anyone to take any of this?

Lol, a military showdown where a few hundred people are killed might be horrible.

Leave the US with an island it doesn't recognize as its own (because Congress wouldn't) and that isn't recognized as US by most of the rest of the world.

Would economic ties between the US and Europe be broken as a result? Probably, but maybe everybody else decides that this will be resolved peacefully in the UN. And the can is kicked down the road, until Trump kicks the can.

Because ending economic ties between Europe and the US would mean a massive depression on both sides. Massive assets lost and written off. Goodbye pension.

Economic meltdown might be worse than a military showdown in the Arctic. Casualties from an economic conflict would be worse.

The Atlantic did a write-up in December [0] about retatrutide availability and they named at least one well known vendor (who also sells tirzepatide, semaglutide, and all the other usual peptides). Not the cheapest vendor, but well known, does the batch lyophilization in the US, still takes credit cards, and gets pretty solid group test participation due to their popularity. And if you know how their pre-sales work, the price premium isn't too terrible, worth it for the test participation IMO.

If you want to know who else to avoid, join the Discord the vendor links to from their web page and ask around in the general discussion topics, people will share.

[0] https://archive.ph/n0daP

Well that's the choice. Allow drug companies to price discriminate so that poorer people can also buy the drugs or don't allow it and get more new drugs. It's not clear that drug companies are even going to retain low prices in other countries if it means that the US consumers will pay less.

Which drugs that haven't been invented yet do you think we should forego?

Anyone who's buying GLP-1 drugs can choose to give that money to the poor instead. What particular drug do you think shouldn't have been invented?

I think 'MFN' is almost propaganda (not a term that existed before 2016-2020 administration) so let's leave that aside.

Are you claiming that the new website is offering lower prices than patients are paying after their co-pay? That is not the case outside the example I presented; moreover, the way the website is organized, there will be no pressure for prices to remain competitive after the initial media attention dies away.

I agree that a hypothetical case where we were paying lower prices would be better for us—but this remains an unrealized hypothetical. One way for us to pay lower prices would be to allow our government to negotiate prices for Medicare/Medicaid recipients, and that is exactly the thing that has been hampered.

Good to know, and thanks for the info!

Do we really need insurance to cover $100/mo meds? Insurance already doesn’t cover OTC vitamins, right?

Insurance plans are currently allowed to have complete exclusions of all obesity medications, even cheaper therapies

I like the way you're thinking about it, but worth mentioning that the net prices paid are likely in the $200-500 range, similar to the cash pay. List price doesn't mean much

Yes, that's why we see this issue in all of the industrialised world on the rise.

It's always the intellectual bankrupt response to blame individuals for a systemic problem

If only everyone could have your willpower, we’d have no addiction or sport injuries or, well, any misadventure from doing anything more interesting than sitting on a couch (which has its own health problems). Alas, most people have flaws.