Ozempic

Article

Ozempic is a recurring brand in the Astral Codex Ten archive, appearing 11 times across 11 issues between November 24, 2022 and July 01, 2025. The archive places it in contexts such as “It notes that Wegovy (semaglutide for obesity) costs more per prescription than Ozempic (semaglutide for diabetes)”; “two older forms of semaglutide not FDA-approved for weight loss - Ozempic and Rybelsus”; “I haven’t seen any evidence that Ozempic costs less in Canada than it does in the US”. It most often appears alongside FDA, China, Gwern.

Metadata

Category: Brands
Mention count: 11
Issue count: 11
First seen: November 24, 2022
Last seen: July 01, 2025

Appears In

- FDA (8 shared issues)
- China (4 shared issues)
- Gwern (4 shared issues)
- Novo Nordisk (4 shared issues)
- ACX (3 shared issues)
- Adderall (3 shared issues)
- Britain (3 shared issues)
- Canada (3 shared issues)
- ChatGPT (3 shared issues)
- COVID (3 shared issues)
- DEA (3 shared issues)
- GLP-1 (3 shared issues)

External Links

Source Context

Recovered passages from the original issue text. When the raw archive preserved outbound links inside the source passage, they are listed directly under the quote.

Semaglutidonomics

November 24, 2022 · Original source

Semaglutide started off as a diabetes medication. Pharma company Novo Nordisk developed it in the early 2010s, and the FDA approved it under the brand names Ozempic® (for the injectable) and Rybelsus® (for the pill).

I think “Ozempic” sounds like one of those unsinkable ocean liners, and “Rybelsus” sounds like a benevolent mythological blacksmith. Patients reported significant weight loss as a side effect. Semaglutide was a GLP-1 agonist, a type of drug that has good theoretical reasons to affect weight, so Novo Nordisk studied this and found that yes, it definitely caused people to lose a lot of weight. More weight than any safe drug had ever caused people to lose before. In 2021, the FDA approved semaglutide for weight loss under the brand name Wegovy®. “Wegovy” sounds like either a cooperative governance platform, or some kind of obscure medieval sin. Weight loss pills have a bad reputation. But Wegovy is a big step up. It doesn’t work for everybody. But it works for 66-84% of people, depending on your threshold. (Source) Of six major weight loss drugs, only two - Wegovy and Qsymia - have a better than 50-50 chance of helping you lose 10% of your weight. Qsymia works partly by making food taste terrible; it can also cause cognitive issues. Wegovy feels more natural; patients just feel full and satisfied after they’ve eaten a healthy amount of food. You can read the gushing anecdotes here (plus some extra anecdotes in the comments). Wegovy patients also lose more weight on average than Qsymia patients - 15% compared to 10%. It’s just a really impressive drug. Until now, doctors didn’t really use medication to treat obesity; the drugs either didn’t work or had too many side effects. They recommended either diet and exercise (for easier cases) or bariatric surgery (for harder ones). Semaglutide marks the start of a new generation of weight loss drugs that are more clearly worthwhile. Modeling Semaglutide Accessibility 40% of Americans are obese - that’s 140 million people. Most of them would prefer to be less obese. Suppose that a quarter of them want semaglutide. That’s 35 million prescriptions. Semaglutide costs about $15,000 per year, multiply it out, that’s about $500 billion. Americans currently spend $300 billion per year total on prescription drugs. So if a quarter of the obese population got semaglutide, that would cost almost twice as much as all other drug spending combined. It would probably bankrupt half the health care industry. So . . . most people who want semaglutide won’t get it? Unclear. America’s current policy for controlling medical costs is to buy random things at random prices, then send all the bills to an illiterate reindeer-herder named Yagmuk, who burns them for warmth. Anything could happen! Right now, only about 50,000 Americans take semaglutide for obesity. I’m basing this off this report claiming “20,000 weekly US prescriptions” of Wegovy; since it’s taken once per week, maybe this means there are 20,000 users? Or maybe each prescription contains enough Wegovy to last a month and there are 80,000 users? I’m not sure, but it’s somewhere in the mid five digits, which I’m rounding to 50,000. That’s only 0.1% of the potential 35 million. The next few sections of this post are about why so few people are on semaglutide, and whether we should expect that to change. I’ll start by going over my model of what determines semaglutide use, then look at a Morgan Stanley projection of what will happen over the next decade. Step 1: Awareness I model semaglutide use as interest * awareness * prescription accessibility * affordability. I already randomly guessed interest at 25%, so the next step is awareness. How many people are aware of semaglutide? The answer is: a lot more now than when I first started writing this article! Novo Nordisk’s Wegovy Gets Surprise Endorsement From Elon Musk, says the headline. And here’s Google Trends: Semaglutide is now as searched-for on Google as Prozac or Viagra. Even if this is a temporary Musk-related spike, even pre-Musk it was getting a little above half their level. But Google Trends doesn’t exactly track awareness; few people search for Prozac these days precisely because everyone already knows what it is. So all this tells us is that there’s a lot of buzz around semaglutide. Suppose for the sake of argument that 5% of obese people have heard of this drug. Step 2: Prescription Accessibility The FDA says Wegovy is indicated for obesity, defined as BMI ≥ 30, or for people with BMI ≥ 27 and certain medical conditions. Does that mean that if you have that BMI, your doctor will give you a prescription? I think most doctors will want patients to try diet and exercise first. My experience as a doctor is that most obese people have already considered diet and exercise. Sometimes if you have a very compelling reason and a very well-thought out plan you can get them to try again. But usually they are obese because diet and exercise are hard for them, or don’t work for them, or some other reason besides “they never thought of it”. Still, I hear lots of stories about patient-doctor fights here. I assume this will happen with Wegovy too. Every doctor will have their own threshold for what amount of “already tried diet and exercise” is enough to justify a Wegovy prescription, and sometimes patients won’t meet that threshold. The history of medicine includes the following story many times: there’s some condition that doctors recommend lifestyle changes for. Then an exciting new medication comes out that treats the condition effectively. Over a generation or so, doctors go from demanding the lifestyle change, to gesturing at the lifestyle change before prescribing the medication, to mostly just prescribing the medication. We saw this with cholesterol and statins, with hypertension and ACE inhibitors, with depression and SSRIs. You can form your own opinion on whether this is good or bad, but we’re probably in the very beginning of this process with obesity. Opinions will be all over the map for a while before the inevitable pharma company victory makes everyone agree that semaglutide is first-line therapy. …except that this time, Silicon Valley is short-circuiting the process with fly-by-night telemedicine companies that guarantee you’ll get the drugs you want. For example, NextMed charges $138/month ($99 first month only!) for a guaranteed GLP-1 agonist prescription, plus “support and messaging with expert doctors”. The DEA sometimes shuts these groups down when they start playing around with controlled substances (eg addictive drugs like Adderall), but Wegovy isn’t controlled, and the government probably doesn’t care that much here. These services guarantee that people with money will be able to circumvent conservative doctors and access a prescription. Only 75% of Americans have PCPs at all. If we assume half of them will eventually be able to get a Wegovy prescription from their doctor, that’s 37.5%. Step 3: Affordability Semaglutide costs $15,000/year. Well-off people like Elon Musk might be able to pay that out-of-pocket, but most people will probably need insurance coverage. Right now this is spotty. Medicare doesn’t cover obesity drugs. This isn’t a reaction to the threat of semaglutide-related cost explosions - they’re not that smart. I think Medicare laws were just written in the old days when people were less likely to think of obesity as a disease. Is it time for change? Some Congressmen have proposed a very noble-sounding law telling Medicare and Medicaid to start covering weight loss drugs. I‘m sure this is out of deep compassion for America’s obese population and not because it would make pharma companies one billion zillion dollars. One of the Congressmen even has the last name “Kind!” Some pharma lobbyist probably got a bonus for that one. Private insurers mostly have to cover whatever Medicare does, but they can choose whether or not to include extra non-Medicare-covered drugs. Some have chosen to cover semaglutide under some conditions. Others would prefer not to cover it, but can be scared into covering it by the magic words “medical necessity”. Overall I don’t understand the laws here beyond that maybe they’ll cover it and maybe they won’t. Here, too, it might be time for change. The New York Times is publishing articles trying to convince us that private insurances not covering semaglutide is an outrage. Here in the tiny gray text, I want to take a second to complain about this article. It notes that Wegovy (semaglutide for obesity) costs more per prescription than Ozempic (semaglutide for diabetes), and calls this “a gross inequity”, accusing Novo Nordisk of “charg[ing] people more for the same drug because of their obesity”. But the obesity prescription is higher dose than the diabetes prescription! Milligram per milligram, Wegovy costs *less* than Ozempic! A steelmanned version of the NYT might object - don’t most of the costs come from the intellectual property and not the manufacturing, so that dose shouldn’t matter? Yes, but if you made the obesity version cost too much less per milligram than the diabetes version, then diabetics would cheat the system by buying the obesity version and splitting it into smaller doses! Insurances that do cover it may require extra documentation that the patient has tried lots of diet and exercise, maybe including some official diet-and-exercise program like WeightWatchers. They might also want documentation that patients have tried cheaper earlier-generation weight loss drugs without success. Even when insurances do cover semaglutide, copays may be very high. I have a pretty minimal insurance and it looks like if I got semaglutide my copay would be about $500/month until I reach my out of pocket limit. Harsh. People with better insurances might get hit less hard, but I don’t think anyone will be picking this up for cheap. Let’s say only 5% of people who clear all previous hurdles can afford the drug. How Many People Get Semaglutide? 140 million obese Americans * 25% interested * 5% know of semaglutide’s existence * 37.5% can get prescriptions * 5% can afford it = 33,000, which is a pretty good match for the 50,000 estimated prescriptions. I didn’t even fudge the numbers to come out right, it just happened. The Coming Decade As a service to pharma investors, Morgan Stanley modeled the economic future of obesity medications over the next decade. Their headline result: semaglutide and various semaglutide-copycat-drugs will be a $30 billion market by 2030. That’s less than the $500 billion disaster I was afraid of! But still almost 10% of all US drug spending! Here are two core analyses from the report: The first analysis asks “what if doctors medicalized obesity as comprehensively as they’ve medicalized hypertension and high cholesterol?” That is: what if we put in a society-wide effort to get every obese person to a doctor, and after only a little diet and exercise, the doctor puts them on a medication? They find that the US obesity market would multiply by a factor of 25, to about $87 billion/year. The second analysis is a more realistic projection for the next decade. Two things stand out. First, the number of patients on Wegovy or related medications goes from an estimated 46,910 now (pretty close to my 50,000 estimate!) to 11.3 million in 2030. Second, the cost per prescription goes from $15,000/year to about $4,000 year. Let’s look at this second change in more detail. Right now semaglutide is literally in a class of its own for weight loss. But remember, it started as a GLP-1 agonist diabetes drug. And there are other GLP-1 agonists already in use for diabetes. Novo Nordisk’s competitor Eli Lilly owns a closely related molecule, tirzepatide (Mounjaro®). They’ve already done studies showing it also works very well for weight loss - if anything even better than semaglutide - and they’re expected to get FDA approval to market it as a weight loss medication next year. Although capitalism fans might expect the presence of two competing drugs to immediately drive down prices, this is mysteriously not how things work in health care and prices will probably stay the same in the short term. But several other companies are working on semaglutide-like drugs, some will be cheaper to produce than semaglutide, and Morgan Stanley expects that this stronger level of competition will eventually drive costs down to $350/month ($4,000/year) by 2030. “Mounjaro” sounds like the playful animal sidekick in a Disney movie. From a purely economic perspective, semaglutide costs the health system money (because it’s expensive) but also saves the health system money (because we don’t have to pay for obesity consequences like diabetes and heart attacks). Which effect wins out? According to the Institute for Clinical and Economic Review, benefits would outweigh costs if semaglutide cost less than about $8,000/year. Since it costs $15,000 year now, it’s not cost effective. But if Morgan Stanley’s model comes true and it costs $4,000/year in 2030, then it will be cost effective. So at some point, Medicare (and so insurance companies) may start covering it more out of self-interest. I can’t tell whether the model takes this into account or not. (there’s also a third-level effect where it costs the health system money again, because it prevents people from dying of obesity-related complications, and dead people stop needing expensive health care. I think health economists are supposed to ignore this level.) 11.3 million prescriptions at $4,000/year comes to $45 billion, but Morgan Stanley expects that not everyone will fill their prescriptions consistently or stay on the medication the same amount of time, leading to their $31 billion figure. Towards The Glorious Post-Obesity Transhuman Future The Morgan Stanley report shows that even the greediest pharma investors, openly plotting to medicalize obesity, can’t bring themselves to believe in more than 11 million US semaglutide patients by 2030. That’s less than 10% of the US obese population. Isn’t that kind of disappointing? We’ve got > 100 million people dealing with a condition that not only makes them unhealthy, but also causes them psychological distress, and makes lots of people low-grade disappointed in and repulsed by our society. And we’ve got an effective drug that treats the condition. And we’re going to use it on less than 10% of the people involved? In 2032, semaglutide goes off-patent. It will probably take a few years to sort out legal issues and ramp up generic production, but by the mid-2030s, its price will go way down. I don’t think there are technical barriers to getting it down as low as $10 - $100 per month. By then, maybe there will be even more exciting branded weight loss drugs for wealthy people to choose from. But at the very least, semaglutide itself should become much more widely available even to poor or uninsured patients. I’m not sure what will happen. Will there be an inflection point, where so many people use semaglutide that obesity becomes unusual again, and then the remaining obese people start using it just to fit in? Will obesity become an optional fashion statement, like shaving your head or getting a tattoo? Or will semaglutide end up disappointing us in some way, like so many promising drugs have before? I come at semaglutide from a transhumanist perspective. I want to hack genetics and biology until everyone is as tall as they want, as strong as they want, as smart as they want, and whatever gender they want. If you want wings, you should be able to have wings. And yes, part of this vision is everyone having the weight they want. I’m not sure this will happen, but for the first time I can see a clear path to how it might. Postscript 1: Should You Take Semaglutide? I can’t answer this, please ask your doctor. But I do want to add that there are potential side effects I haven’t mentioned in this post, including nausea, gastrointestinal problems, pancreatitis, and kidney problems. Semaglutide has been accused of slightly increasing risk of pancreatic and thyroid cancers. Studies have found trends in this direction, but these conditions are so rare that even over thousands of patients over many years, the increase hasn’t yet reached clear statistical significance. The current consensus position is that it may increase thyroid cancer by a tiny amount not relevant to most patients, and that it probably doesn’t increase pancreatic cancer. I think my father has looked over these data more and is less sure than other people about the lack of pancreatic cancer risk, but he can’t get the resources he needs to prove anything, and I can’t remember his exact argument. More broadly: like all medications, semaglutide has benefits and risks, and you shouldn’t blindly take it after reading one blog article. Postscript 2: Is There A Way To Cheat The System To Get Semaglutide For Lower Cost? Health care is much like airline tickets: everyone pays a different price for everything and there’s usually a secret way to get what you want for much less money. Is this true of semaglutide? Pharma company Novo Nordisk offers a Savings Card that they say brings the price down to as low as $25 per month. I’m a little suspicious of this - pharma company offers are rarely as good as they sound - but I don’t notice any obvious tricks in this one and it should probably be your first bet. This startup claims that they can get insured people semaglutide for a $25/month copay “after their deductible is met” by negotiating with the insurance company very effectively. I can’t imagine how that works or what they have to negotiate with, but they seem pretty convinced, so I would welcome more information. Otherwise, you don’t have many great options. Although there are two older forms of semaglutide not FDA-approved for weight loss - Ozempic and Rybelsus - these are both more expensive, milligram per milligram, than Wegovy itself. Canada is also of no help. The usual Canadian pharmacies don’t seem to carry Wegovy, and charge about the same amount for Ozempic as American pharmacies do. This article in Drug Discovery Trends says that compounding pharmacies have been selling semaglutide for $300/month, less than a quarter of the sticker price. This is a bit confusing: compounding pharmacies are small local operations permitted to dispense unusual medications by mixing existing ones together in nonstandard ways. They’re arguing that they can legally dispense the semaglutide because they’re mixing it with vitamins, which, fine, but how are they getting it in the first place? Everyone else seems as confused as I am: "Nobody knows how [compounding pharmacies are] getting it," said Karl Nadolsky, an endocrinologist at Spectrum Health. "Who's making it? [The pharma company that makes it] Novo [Nordisk]'s not giving it to them. They're the ones with the rights to the molecule, so how is anybody getting semaglutide?" Has nobody asked compounding pharmacists about this? Do they have a conspiracy of silence? Does the FDA sometimes send their goons in to extract the information, but the compounding pharmacists compound sleeping gas / smoke grenades and vanish into the night? Anyway, the usual authorities warn you not to take compounded semaglutide under any circumstances, but they’re the same people who tell you never to buy drugs from a Canadian pharmacy because they might be adulterated. You can decide how much you want to trust them. Postscript 3: What About Europe And The Rest Of The World? Countries that are not the US usually negotiate with pharmaceutical companies over price. Because of some combination of “negotiation works” and “they are free-riding off Americans’ hard work”, they usually get much lower prices. What does semaglutide cost elsewhere? This is hard to find out because government health agencies sometimes keep their prices secret, plus Wegovy mostly isn’t available in other countries yet. The only information I could find was from Britain, which is in the process of making Wegovy available to patients. It looks like NHS will “restrict the expensive drug’s availability to very obese people attending specialist weight-loss clinics”, but that it might be possible to get it from private clinics for £199/month = £2400/year. Wegovy has been approved in the EU but doesn’t seem to have made it there yet. I can’t find any information about any other country. Non-weight-loss-indicated versions of semaglutide are available in many countries, but I wouldn’t expect their health care systems to be flexible about redirecting it for weight. Canadian regulators have approved Wegovy, but it doesn’t seem to be available there yet. I haven’t seen any evidence that Ozempic costs less in Canada than it does in the US, and I’m not sure why. Maybe the pharma companies have figured out that anything that happens in Canada gets imported into the US, and they’re playing hardball this time. I don’t know whether Canadians will be able to get it for cheaper than Americans or not. Postscript 4: Predictions (all predictions are conditional on no singularity or global catastrophe) 10 million Americans on semaglutide (or yet-to-be-approved equally good or superior alternatives) by 2030: 75%

Here in the tiny gray text, I want to take a second to complain about this article. It notes that Wegovy (semaglutide for obesity) costs more per prescription than Ozempic (semaglutide for diabetes), and calls this “a gross inequity”, accusing Novo Nordisk of “charg[ing] people more for the same drug because of their obesity”. But the obesity prescription is higher dose than the diabetes prescription! Milligram per milligram, Wegovy costs *less* than Ozempic! A steelmanned version of the NYT might object - don’t most of the costs come from the intellectual property and not the manufacturing, so that dose shouldn’t matter? Yes, but if you made the obesity version cost too much less per milligram than the diabetes version, then diabetics would cheat the system by buying the obesity version and splitting it into smaller doses! Insurances that do cover it may require extra documentation that the patient has tried lots of diet and exercise, maybe including some official diet-and-exercise program like WeightWatchers. They might also want documentation that patients have tried cheaper earlier-generation weight loss drugs without success. Even when insurances do cover semaglutide, copays may be very high. I have a pretty minimal insurance and it looks like if I got semaglutide my copay would be about $500/month until I reach my out of pocket limit. Harsh. People with better insurances might get hit less hard, but I don’t think anyone will be picking this up for cheap. Let’s say only 5% of people who clear all previous hurdles can afford the drug. How Many People Get Semaglutide? 140 million obese Americans * 25% interested * 5% know of semaglutide’s existence * 37.5% can get prescriptions * 5% can afford it = 33,000, which is a pretty good match for the 50,000 estimated prescriptions. I didn’t even fudge the numbers to come out right, it just happened. The Coming Decade As a service to pharma investors, Morgan Stanley modeled the economic future of obesity medications over the next decade. Their headline result: semaglutide and various semaglutide-copycat-drugs will be a $30 billion market by 2030. That’s less than the $500 billion disaster I was afraid of! But still almost 10% of all US drug spending! Here are two core analyses from the report: The first analysis asks “what if doctors medicalized obesity as comprehensively as they’ve medicalized hypertension and high cholesterol?” That is: what if we put in a society-wide effort to get every obese person to a doctor, and after only a little diet and exercise, the doctor puts them on a medication? They find that the US obesity market would multiply by a factor of 25, to about $87 billion/year. The second analysis is a more realistic projection for the next decade. Two things stand out. First, the number of patients on Wegovy or related medications goes from an estimated 46,910 now (pretty close to my 50,000 estimate!) to 11.3 million in 2030. Second, the cost per prescription goes from $15,000/year to about $4,000 year. Let’s look at this second change in more detail. Right now semaglutide is literally in a class of its own for weight loss. But remember, it started as a GLP-1 agonist diabetes drug. And there are other GLP-1 agonists already in use for diabetes. Novo Nordisk’s competitor Eli Lilly owns a closely related molecule, tirzepatide (Mounjaro®). They’ve already done studies showing it also works very well for weight loss - if anything even better than semaglutide - and they’re expected to get FDA approval to market it as a weight loss medication next year. Although capitalism fans might expect the presence of two competing drugs to immediately drive down prices, this is mysteriously not how things work in health care and prices will probably stay the same in the short term. But several other companies are working on semaglutide-like drugs, some will be cheaper to produce than semaglutide, and Morgan Stanley expects that this stronger level of competition will eventually drive costs down to $350/month ($4,000/year) by 2030. “Mounjaro” sounds like the playful animal sidekick in a Disney movie. From a purely economic perspective, semaglutide costs the health system money (because it’s expensive) but also saves the health system money (because we don’t have to pay for obesity consequences like diabetes and heart attacks). Which effect wins out? According to the Institute for Clinical and Economic Review, benefits would outweigh costs if semaglutide cost less than about $8,000/year. Since it costs $15,000 year now, it’s not cost effective. But if Morgan Stanley’s model comes true and it costs $4,000/year in 2030, then it will be cost effective. So at some point, Medicare (and so insurance companies) may start covering it more out of self-interest. I can’t tell whether the model takes this into account or not. (there’s also a third-level effect where it costs the health system money again, because it prevents people from dying of obesity-related complications, and dead people stop needing expensive health care. I think health economists are supposed to ignore this level.) 11.3 million prescriptions at $4,000/year comes to $45 billion, but Morgan Stanley expects that not everyone will fill their prescriptions consistently or stay on the medication the same amount of time, leading to their $31 billion figure. Towards The Glorious Post-Obesity Transhuman Future The Morgan Stanley report shows that even the greediest pharma investors, openly plotting to medicalize obesity, can’t bring themselves to believe in more than 11 million US semaglutide patients by 2030. That’s less than 10% of the US obese population. Isn’t that kind of disappointing? We’ve got > 100 million people dealing with a condition that not only makes them unhealthy, but also causes them psychological distress, and makes lots of people low-grade disappointed in and repulsed by our society. And we’ve got an effective drug that treats the condition. And we’re going to use it on less than 10% of the people involved? In 2032, semaglutide goes off-patent. It will probably take a few years to sort out legal issues and ramp up generic production, but by the mid-2030s, its price will go way down. I don’t think there are technical barriers to getting it down as low as $10 - $100 per month. By then, maybe there will be even more exciting branded weight loss drugs for wealthy people to choose from. But at the very least, semaglutide itself should become much more widely available even to poor or uninsured patients. I’m not sure what will happen. Will there be an inflection point, where so many people use semaglutide that obesity becomes unusual again, and then the remaining obese people start using it just to fit in? Will obesity become an optional fashion statement, like shaving your head or getting a tattoo? Or will semaglutide end up disappointing us in some way, like so many promising drugs have before? I come at semaglutide from a transhumanist perspective. I want to hack genetics and biology until everyone is as tall as they want, as strong as they want, as smart as they want, and whatever gender they want. If you want wings, you should be able to have wings. And yes, part of this vision is everyone having the weight they want. I’m not sure this will happen, but for the first time I can see a clear path to how it might. Postscript 1: Should You Take Semaglutide? I can’t answer this, please ask your doctor. But I do want to add that there are potential side effects I haven’t mentioned in this post, including nausea, gastrointestinal problems, pancreatitis, and kidney problems. Semaglutide has been accused of slightly increasing risk of pancreatic and thyroid cancers. Studies have found trends in this direction, but these conditions are so rare that even over thousands of patients over many years, the increase hasn’t yet reached clear statistical significance. The current consensus position is that it may increase thyroid cancer by a tiny amount not relevant to most patients, and that it probably doesn’t increase pancreatic cancer. I think my father has looked over these data more and is less sure than other people about the lack of pancreatic cancer risk, but he can’t get the resources he needs to prove anything, and I can’t remember his exact argument. More broadly: like all medications, semaglutide has benefits and risks, and you shouldn’t blindly take it after reading one blog article. Postscript 2: Is There A Way To Cheat The System To Get Semaglutide For Lower Cost? Health care is much like airline tickets: everyone pays a different price for everything and there’s usually a secret way to get what you want for much less money. Is this true of semaglutide? Pharma company Novo Nordisk offers a Savings Card that they say brings the price down to as low as $25 per month. I’m a little suspicious of this - pharma company offers are rarely as good as they sound - but I don’t notice any obvious tricks in this one and it should probably be your first bet. This startup claims that they can get insured people semaglutide for a $25/month copay “after their deductible is met” by negotiating with the insurance company very effectively. I can’t imagine how that works or what they have to negotiate with, but they seem pretty convinced, so I would welcome more information. Otherwise, you don’t have many great options. Although there are two older forms of semaglutide not FDA-approved for weight loss - Ozempic and Rybelsus - these are both more expensive, milligram per milligram, than Wegovy itself. Canada is also of no help. The usual Canadian pharmacies don’t seem to carry Wegovy, and charge about the same amount for Ozempic as American pharmacies do. This article in Drug Discovery Trends says that compounding pharmacies have been selling semaglutide for $300/month, less than a quarter of the sticker price. This is a bit confusing: compounding pharmacies are small local operations permitted to dispense unusual medications by mixing existing ones together in nonstandard ways. They’re arguing that they can legally dispense the semaglutide because they’re mixing it with vitamins, which, fine, but how are they getting it in the first place? Everyone else seems as confused as I am: "Nobody knows how [compounding pharmacies are] getting it," said Karl Nadolsky, an endocrinologist at Spectrum Health. "Who's making it? [The pharma company that makes it] Novo [Nordisk]'s not giving it to them. They're the ones with the rights to the molecule, so how is anybody getting semaglutide?" Has nobody asked compounding pharmacists about this? Do they have a conspiracy of silence? Does the FDA sometimes send their goons in to extract the information, but the compounding pharmacists compound sleeping gas / smoke grenades and vanish into the night? Anyway, the usual authorities warn you not to take compounded semaglutide under any circumstances, but they’re the same people who tell you never to buy drugs from a Canadian pharmacy because they might be adulterated. You can decide how much you want to trust them. Postscript 3: What About Europe And The Rest Of The World? Countries that are not the US usually negotiate with pharmaceutical companies over price. Because of some combination of “negotiation works” and “they are free-riding off Americans’ hard work”, they usually get much lower prices. What does semaglutide cost elsewhere? This is hard to find out because government health agencies sometimes keep their prices secret, plus Wegovy mostly isn’t available in other countries yet. The only information I could find was from Britain, which is in the process of making Wegovy available to patients. It looks like NHS will “restrict the expensive drug’s availability to very obese people attending specialist weight-loss clinics”, but that it might be possible to get it from private clinics for £199/month = £2400/year. Wegovy has been approved in the EU but doesn’t seem to have made it there yet. I can’t find any information about any other country. Non-weight-loss-indicated versions of semaglutide are available in many countries, but I wouldn’t expect their health care systems to be flexible about redirecting it for weight. Canadian regulators have approved Wegovy, but it doesn’t seem to be available there yet. I haven’t seen any evidence that Ozempic costs less in Canada than it does in the US, and I’m not sure why. Maybe the pharma companies have figured out that anything that happens in Canada gets imported into the US, and they’re playing hardball this time. I don’t know whether Canadians will be able to get it for cheaper than Americans or not. Postscript 4: Predictions (all predictions are conditional on no singularity or global catastrophe) 10 million Americans on semaglutide (or yet-to-be-approved equally good or superior alternatives) by 2030: 75%

Inline links: modeled the economic future of obesity medications over the next decade, https://substackcdn.com/image/fetch/$s_!zSOS!,f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fbucketeer-e05bbc84-baa3-437e-9518-adb32be77984.s3.amazonaws.com%2Fpublic%2Fimages%2F0906b28a-1ad4-421d-a055-87ed95db59ce_918x261.png, https://substackcdn.com/image/fetch/$s_!QJj9!,f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fbucketeer-e05bbc84-baa3-437e-9518-adb32be77984.s3.amazonaws.com%2Fpublic%2Fimages%2Fb966f730-6b24-48e1-98b1-e710cda9264c_903x656.png, this is mysteriously not how things work in health care, https://substackcdn.com/image/fetch/$s_!5poy!,f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fbucketeer-e05bbc84-baa3-437e-9518-adb32be77984.s3.amazonaws.com%2Fpublic%2Fimages%2Fc201f05a-7d1f-4738-911f-11d0d051adf9_2880x1562.png, Institute for Clinical and Economic Review, don’t think there are technical barriers, offers a Savings Card, This startup, about the same amount for Ozempic, This article in Drug Discovery Trends, Everyone else seems as confused as I am, NHS will, private clinics

Highlights From The Comments On Semaglutide

November 30, 2022 · Original source

Second, spending on Wegovy might not fully capture use of semaglutide for weight loss, because some people might be taking Ozempic primarily for weight loss benefits. Ozempic sales are huge, and it is a top-20 spending drug in Medicare. After the clinical trial was published showing sustained weight loss benefits from semaglutide, Ozempic sales growth accelerated (though sales were already growing fast). Even though Ozempic is approved for the diabetes indication, it makes sense that people would take it for weight loss, because (1) there is a big overlap between the obese and diabetic population and (2) Ozempic is more likely to be covered by insurance.

Inline links: a top-20 spending drug in Medicare

2) while I can’t speak to the legality of sourcing the active ingredient, preparing the compound is probably legally fine. Wegovy and Ozempic has been in a shortage state for nearly 2 years now. In cases of shortages, I CAN legally compound products, including those protected by a patent or otherwise theoretically available. Patient access comes first- if I can’t source a finished product due to the manufacturer not having adequate supply, I’m good. I have to maintain documentation of my inability to source the patented products or the otherwise available product, but this is accepted practice. See, for example, this week’s FDA GFI re: compounding amoxicillin suspension for kids.

Practical update. I recently found that some varieties of Blue Cross Blue Shield insurance (through the federal employee program, at least) will now cover Wegovy (Ozempic) for weight loss, starting in January 2023. https://www.fepblue.org/open-season/whats-new-2023

Inline links: https://www.fepblue.org/open-season/whats-new-2023

Links For August 2023

August 09, 2023 · Original source

26: Friends of the blog Stuart Ritchie and Tom Chivers have a new podcast, The Studies Show, dedicated to explaining the latest scientific controversies. Highly recommended (on priors; I don’t listen to podcasts so I can’t be sure). Sample episodes on Ozempic safety and psychedelics for mental health.

Inline links: The Studies Show, Ozempic safety, psychedelics for mental health

Contra Hanson On Medical Effectiveness

April 24, 2024 · Original source

Blood pressure They found no effect of insurance on any of the questionnaires, and modest positive effects on vision and blood pressure. How surprising is this? It seems moderately surprising that nobody improved on any of the questionnaires. These seem to measure overall health. Maybe they were bad measures? Maybe 10,000 mostly-healthy people over 8 years doesn’t provide enough power to detect health improvements on questionnaires? I’m not sure. It doesn’t seem surprising to me that nobody improved on smoking, weight, or cholesterol. The 1970s didn’t have any good anti-smoking medication - even the nicotine patch wasn’t invented until after this study was finished. Likewise for weight loss - the 1970s were in the unfortunate interregnum between the fall of methamphetamine and the rise of Ozempic. There were some weak cholesterol medications back then - eg nicotinic acid - but they were rarely used, and doctors weren’t even entirely convinced that cholesterol was bad. For all three of these things, the 1970s state of the art was doctors saying “You should try to stop smoking and eat better.” RAND found that the better insurances led to 1-2 more doctor visits per year. I don’t think that 3 visits to a doctor saying “You should try to stop smoking and eat better” vs. 4 visits to that doctor is going to affect very much. It’s also not surprising that vision improved; the good insurances were more likely to cover glasses, and everyone knows that glasses help your vision. Even Robin admits this is a real effect; he just classifies it as more physics than medicine. Blood pressure is more debatable. The 1970s had some okay blood pressure medications, like the beta-blockers, and doctors weren’t afraid to use them. So it seems possible in theory that better medical care could lead to decreased blood pressure. Still, Robin is skeptical. He says that the improvement in blood pressure found during the study was p = 0.03. In a study with 30 measures, one will be positive at 0.03 by coincidence. The version of the study he’s reading has 30 measures (mine has 5 - 10, depending on how you count the questionnaire). On the other hand, this paper looks into the blood pressure result in more detail. It finds that “plan effects on blood pressure” were three times higher for hypertensives for non-hypertensives; that is, unlike statistical flukes (which we would expect to affect everyone equally), the effect was concentrated in the people we would expect doctors to treat. It also finds that plan effects are higher for poor people; unlike statistical flukes (which would affect everyone equally), the effect was concentrated in the people we would expect insurance to help. And it finds pretty convincing intermediating factors: people with good insurance were 20 percentage points more likely to get hypertension treatment, p < 0.001). So I think it’s a stretch to attribute this one to random noise. This is the study authors’ conclusion as well. They calculate the benefit from this blood pressure improvement and find that: If 1,000 fifty-year-old men at elevated risk were enrolled on a free rather than a cost-sharing plan, then we would anticipate that about 11 of them, who would otherwise have died, would be alive five years later. Still, they describe their study as having a negative result, because: ...these mortality reductions, in and of themselves, are not sufficient to justify free care for all adults. I assume they’re working off of some kind of reasonable cost-effectiveness model for government spending here. Still, if I were a fifty year old adult, I might be willing to personally spend a few hundred extra dollars a year to increase my 5-year-survival-rate by 1%. Certainly I don’t think it’s fair to describe this as “RAND proves medicine doesn’t work.” Robin has a book with more information than I could get from the papers, so I feel bad contradicting him on this one. I’m more confident in my discussion of the next two experiments, which I think are clear enough that we can go back to this one later and apply what we’ve learned. IV. Oregon Health Insurance Experiment In 2008, Oregon had extra money and decided to expand Medicaid, a free insurance program for poor people. Many people applied for the free insurance, the state ran out of money, and they distributed the available Medicaid slots by lottery. This made the expansion a perfect setup for a randomized controlled trial on whether government-provided free insurance helps the poor. Scientists monitored the recipients for two years (why not longer? I think at some point the insurance coverage stopped) and found that the people with Medicaid did in fact use more medical care than the control group. For example, only 69% of the control group described themselves as getting all the medical care they needed, but 93% of the group with insurance did. People with the insurance used more of almost all categories of medication: People who got the free insurance had less medical debt at the end of the study period. They described themselves on questionnaires as having better health (55% vs. 68% at least “good”, p < 0.0001), and were more likely to say their health had improved over the past few months (71% vs. 83%, p < 0.001). They described having better mental health and less depression (25% vs. 33% depressed, p = 0.001). However, Robin notes that many of these subjective changes happened immediately, ie before they even had a chance to use their new insurance. This means they’re more likely to represent mood affiliation (eg “I have insurance now, so I’m optimistic about my health!”). There was no difference on objective health measures, including blood pressure, cholesterol, and HbA1c (a measure of blood sugar / diabetes control). Why not? The authors do the math on diabetes. If you look at the graph above, you see that about 12.5% of controls vs. 17.5% of experimentals took diabetes medications, p < 0.05. Studies find that diabetes medications decrease HbA1c by about one percentage point (normal HbA1c is about 5%, so this is a lot). If 5% of the insurance group took diabetes medications and decreased their HbA1c by 1 pp each, then the HbA1c of the experimental group would decline by 0.05 pp compared to the control group. Their 95% confidence interval of the difference was (-0.1, +0.1 pp), which includes the predicted value. So when they say “insurance didn’t significantly change HbA1c”, what they mean is “the change in HbA1c is completely consistent with the consensus effect of antidiabetic medications”. Could the same be true of the other results, like hypertension? We find that the experimental group was 1.8 percentage points more likely to get a hypertension diagnosis, 0.7 percentage points more likely to get hypertension medications, and had 0.8 points lower blood pressure - but that all of these numbers were nonsignificant. If we take the nonsignificant numbers seriously, 0.7 pp taking antihypertensives caused an 0.8 point blood pressure drop in the full sample, meaning that antihypertensives caused a 100 point blood pressure drop in each user. This definitely isn’t true - a 100 point blood pressure drop kills you - but it means that a plausible pro-medicine result like antihypertensives lowering blood pressure 10 point is well within the study’s confidence interval. Maybe the anti-medicine position is that, for some reason, good insurance doesn’t lead to hypertension diagnosis or antihypertensive medication use? If I understand these numbers right, about 22% of Americans have blood pressure > 140/90, the level at which doctors recommend medication. I expect the marginally-insured poor people in this experiment to be less healthy than average, so let’s say 25 - 30%. In the experiment, about 13.9% of the control group and 14.6% of the experimental group got antihypertension medication. Why so low? This study found that only about 60% of participants in the Oregon study who got the insurance even went to the doctor for non-emergency reasons! Subtract out the ones who refused to take antihypertensives, or who have too many side effects, or whose doctors let this fall through the cracks, and I think the 13 - 15% numbers make sense. This study found that insurance increased hypertension medication use by a central estimate of 0.7 pp, not significant, confidence interval -4.5 to 5.8. Let’s take a convenient central estimate of our likely hypertension rate and say that 28% of our population should have gotten hypertension meds. That means the central estimate increased the percent of people who got recommended hypertension meds from 50% to 53%, and the 95% confidence interval includes up to 71%. So my assessment of the blood pressure results from this study is: At the beginning of the study, about 50% of people who should have been on hypertension meds were. The study had too low power to really figure out how this changed, but the central estimate is +3%, and the 95% CI rules out improvements beyond +21%

Inline links: this paper, and found, used more, https://substackcdn.com/image/fetch/$s_!YvX7!,f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2Ff05b13be-6994-4161-ac81-bed0eac10b4f_1697x790.jpeg, There was no difference on objective health measures, these numbers, This study

Links for May 2024

May 29, 2024 · Original source

2: Recursive Adaptation: The Growing Scientific Case for Using Ozempic and other GLP-1s to Treat Opioid, Alcohol, and Nicotine Addiction. Early studies suggest that new-generation weight loss drugs like Ozempic treat all addictions. The next step is seeing if the government and insurances will cooperate with using them for that indication. As usual, the barrier is cost, but people seem committed enough to doing something about the opioid crisis that they might be willing to act. I think these drugs might boost willpower more generally. There might come a day when they get treated like Adderall - something that many ambitious people want to be on, and look for excuses to take.

Inline links: The Growing Scientific Case for Using Ozempic and other GLP-1s to Treat Opioid, Alcohol, and Nicotine Addiction

Why Does Ozempic Cure All Diseases?

August 13, 2024 · Original source

Fine, the title is an exaggeration. But only a small one. GLP-1 receptor agonist medications like Ozempic are already FDA-approved to treat diabetes and obesity. But an increasing body of research finds they’re also effective against stroke, heart disease, kidney disease, Parkinson’s, Alzheimer’s, alcoholism, and drug addiction.

Inline links: stroke, heart disease, kidney disease, Parkinson’s, Alzheimer’s, alcoholism, drug addiction

There are two plausible places GLP-1 drugs could lower weight: the body or the brain. In the body, they could change stomach contraction rate, hormone production, etc. In the brain, they could control the mental sensation of hunger. To separate these two effects, scientists bred rats that only had GLP-1 receptors in one place or the other. The results were unequivocal: Ozempic and its relatives work in the brain. Although they have some effects in the body, these are short-lived and not really relevant to their mechanism of action for weight loss.

Inline links: The results

This is pretty surprising: the brain is protected by the blood-brain barrier which usually blocks large molecules. Ozempic is a large molecule. Scientists are still figuring out exactly how it gets through. Some of it seems to leak through endothelial cells, and a little more might make it into the cerebrospinal fluid and then sneak in through the ventricles. But this isn’t very much, and it can’t reach most of the brain. Instead, the little bit that reaches the brain activates a part of the brain stem called the nucleus tractus solitarii which acts as a sort of relay station, producing its own GLP-1 as a neurotransmitter which it sends to other parts of the brain.

Inline links: leak through endothelial cells, make it into the cerebrospinal fluid and then sneak in through the ventricles, nucleus tractus solitarii

Open Thread 343

August 19, 2024 · Original source

3: Thanks to everyone who commented on last week’s post Why Does Ozempic Cure All Diseases? I did see a lot of commenters (who apparently hadn’t read it) loudly assume that it said “because obesity causes all diseases”. I want to emphasize that as best I can interpret the existing research, it’s not because obesity directly causes these diseases (see here for more discussion). Other people were a little more sophisticated and suggested it was because starvation / calorie restriction cures all diseases. I’m skeptical of this one too. Even if you’re in fact starving on Ozempic, it works by sending your body its biochemical “I’m full” signal - so your body is in the fullness biochemical state rather than the starving biochemical state. This isn’t a knockdown argument, because your body has lots of different signals and the full vs. starving states are multifaceted, but I would bet against this one too.

Inline links: Why Does Ozempic Cure All Diseases?, see here for more discussion

The Compounding Loophole

August 22, 2024 · Original source

Now that we’ve gone over the pharmacology of the GLP-1 agonists, let’s get back to the economics.

Inline links: the pharmacology of the GLP-1 agonists

The chemicals coming from the same factories is a good start, but might there be problems with the last few steps done at the pharmacy? The usual suspects have written countless articles warning that compounded semaglutide might not be safe; the really ambitious ones have mentioned that adverse events have even been reported to the FDA. But this article gives away the game:

Inline links: might not be safe, adverse events have even been reported to the FDA, this article

The other safety concern is the salt form. FDA-approved semaglutide is the free base2 (ie the semaglutide molecule not attached to anything). Some suppliers sell the salt version (ie semaglutide attached to an ion like sodium). The FDA has issued warnings saying that the salt version isn’t approved, that any supplier caught using the salt will be shut down, and that you should avoid compounding pharmacies because you can never be sure they’re not offering the dreaded salt form. The commentary I’ve read from chemists is that none of this matters because the salt form dissolves into the free base as soon as it’s in water (which it always is before you inject it), although other people point out that maybe there could still be some theoretical concerns about shelf life and stability. Still, the FDA is legally allowed to shut down anyone offering the salt, and all the compounding pharmacies have switched to the free base.

Inline links: 2, issued warnings, The, commentary, other people

Open Thread 345

September 02, 2024 · Original source

1: Followup on Ozempic/GLP-1RAs - Asterisk Magazine has a superforecaster predict How Long Til We’re All On Ozempic?

Inline links: How Long Til We’re All On Ozempic?

Links For January 2025

January 17, 2025 · Original source

I agree with this solution. 3: Ruxandra Teslo and Willy Chertman: The Case For Clinical Trial Abundance 4: This month in nominative determinism: NYT article calculating your chance of winning the lottery, by Victor Mather (h/t Yafah Edelman). 5: Someone is working on a dating site that uses your conversations with Claude to find a match. Link here, although so far it’s just a landing page where you can register interest (h/t @venturetwins) 6: The Lyttle Lytton Contest searches for the worst possible opening line for a novel; it’s been going on since 2001 and this year’s results are in. 7: Gary Marcus and Miles Brundage have made a bet about AI progress. I agree with @tamaybes and others in saying that Miles let Gary off too easily; Gary’s public statements all sound like “modern AI is mostly hype, it doesn’t really do anything like thinking”, but the bet is about things like “will AI make a Nobel Prize caliber scientific discovery by 2027?” and “will AI write Pulitzer-quality books by 2027?” I don’t blame Gary for taking the best terms he could find. But I am worried that if AI makes a Nobel-quality scientific discovery in 2026, but doesn’t quite write the Pulitzer-quality book, then Gary will get to claim victory over the AI optimists, whereas in fact that would be at probably the 95th percentile of fast timelines by most people’s estimate. 8: “The probability that cows (or other non-human animals) are experiencing constant bliss, lack tanha (craving, aversion, and the resulting suffering), or are "enlightened by default" is, by my estimation, very low”. 9: Recursive Adaptation (blog on addiction policy)’s predictions for 2025. 75% of FDA approval of GLP-1 for a substance use disorder by 2029! 10: In my post on the economics of GLP-1 receptor agonists (eg Ozempic), I wrote about how they’re currently widely available because of a loophole suspending patents during a shortage, and predicted there would be a big fight when the shortage was over. Sure enough, the FDA tried to declare that the shortage of tirzepatide (a next-generation Ozempic relative) was over, compounding pharmacies sued, and tirzepatide is still available while the issue goes through the courts (and will the administration have an opinion?) Also, compounding pharmacy access startup Mochi says that they will continue to prescribe even if the shortage is over, using another loophole saying doctors can do this for specific individual patients in cases of medical necessity. This is an extremely fake use of this loophole, but will the government be willing to call their bluff? 11: Jacob Falkovich has a blog on dating advice, which he plans to turn into a book of dating advice. I can’t really comment on the accuracy (my dating strategy tends to look more like waiting for women to send me emails saying “I like your blog, would you like to go on a date?” which probably doesn’t generalize), but I’ve had many good interactions with Jake, and he has a beautiful family which means he must be doing something right. Also, Jake is poly, and I sometimes wonder if poly people are the only ones qualified to give dating advice: if you’re monogamous, you either met your future spouse quickly (in which case you have no experience), dated for years without meeting your spouse (in which case you can’t be very good), or aren’t looking for a committed relationship at all (which is just pickup artistry, and follows very different dynamics). Poly people are the only ones who can break out of this trilemma! 12: Christ And Counterfactuals is a blog on effective altruism from a Christian perspective. Some previous attempts at this have felt kind of forced, but the first post I read here was actually pretty interesting. Richard Swinburne (apparently “the world’s best Christian philosopher”), thinks that: “[One] reason why it is good that the human race should sometimes be in an initial situation of considerable ignorance about the causes and effects of our actions, is this. If God abolished the need for rational inquiry and gave us from childhood strong true beliefs about the causes of things, that would make it too easy for us to make moral decisions. As things are in the actual world, most moral decisions are decisions taken in uncertainty about the consequences of our actions. I do not know for certain that if I smoke, I will get cancer; or that if I do not give money to some charity, people will starve. So we have to make our moral decisions on the basis of how probable it is that our actions will have various outcomes—how probable it is that I will get cancer if I continue to smoke (when I would not otherwise get cancer), or that someone will starve if I do not give. Since probabilities are so hard to assess, it is all too easy to persuade yourself that it is worth taking the chance that no harm will result from the less demanding decision (the decision which you have a strong desire to make). And even if you face up to a correct assessment of the probabilities, true dedication to the good is shown by doing the act which, although it is probably the best action, may have no good consequences at all.” (Could a Good God Permit so Much Suffering? A Debate, pp. 52-53.) This is pretty galaxy-brained, but something galaxy-brained must be going on for God to tolerate the existence of evil at all, and this is a surprisingly natural extension of some common premises on the subject. 13: Swedish study: diagnosing the marginal patient with a psychiatric condition makes their life worse. Of the two mechanisms they looked at, stigma seems more involved than drug side effects. My opinion: this study was done on conscripts undergoing a mandatory psych evaluation for the army, who had no previous reason to think they had a psych disease and had not sought treatment. This is a different situation from somebody who comes to a psychiatrist asking for relief from specific symptoms they have noticed. Also, Sweden c. 2005 is a different culture from America 2025 in terms of how much stigma a psych diagnosis carries. I think it’s possible that if you never considered that you had psychiatric problems, and were suddenly given a diagnosis in 2005 Sweden and told you couldn’t serve in the army, that’s likely to destabilize your self-image more than a person who knows they’re depressed going to a psychiatrist in 2025 US and getting antidepressants. 14: RIP Felix Hill, research scientist at DeepMind and mentor to many in the AI community. You can read his suicide note here, though the obvious content warning applies. He says he took ketamine for mild anxiety and it plunged him into an incredibly deep depression that he couldn’t get out of; he leaves his story behind as a warning for others. I appreciate his warning, but I wish he had said more about what dose he used; different people’s ketamine doses vary by almost two orders of magnitude, I’d previously thought that the low doses were pretty safe and the high doses were sketchy, and I would like to know whether I should update or not. 15: RIP Max Chiswick, professional poker player, effective altruist, and ACX reader. 16: Adrian Dittman, a Twitter account widely accused of being Elon Musk’s alt, has been revealed to be . . . a guy named Adrian Dittman. Congrats to Maia Crimew and the Spectator for actually investigating this, unlike many other news sources which spread the Musk conspiracy theory. Also, the people involved got banned from X for some reason, maybe because this qualified as doxxing Dittman. 17: Related: Musk claims to be among the top players in the world at several computer games. A veteran Path of Exile gamer presents evidence that Musk faked his PoE2 accomplishments by hiring a Chinese guy to play on his account. Some Musk supporters in the comments suggest that maybe he hires the Chinese guy to level up his account, but his accomplishments (eg speedruns) are still his own? 18: Related: Sam Harris says he has been friends with Musk since 2008, but he noticed a sudden shift for the worse in his personality around 2020 which made it impossible to stay friends with him. He gives the example of Musk losing a bet with him that there would be 35,000+ COVID cases in the US, refusing to pay up, and launching personal attacks on Sam when asked to do so. What happened? Some theories: Musk turned right-wing, which ended his friendship with Sam for the same reason political differences have always ended friendships (but then what about the bet, which seems like objectively bad behavior?)

Links For July 2025

July 01, 2025 · Original source

54: Cremieux: Novo Nordisk, manufacturer of Ozempic, forgot to pay the patent fee in Canada, and now it’s off-patent there. And an obscure FDA regulation lets Americans import certain drugs from Canada. With a sufficiently permissive legal theory, you could combine these facts into a way for the government to get unlimited cheap Ozempic without technically violating IP laws.

Inline links: Cremieux

Astral Codex Ten

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Astral Codex Ten

Table of Contents

Atlas

Ozempic

Ozempic

Article

Metadata

Appears In

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External Links

Source Context

Backlinks