If you want to find where to point the finger to, the systems that let prescription opiates be prescribed with such reckless abandon is a good superficial target. Getting political here - if you want to find the very root cause of all this, I would present the institutions that prevent the implementation or otherwise erode preexisting social safety-nets as the culpable party.

An absolute blast from the past, thank you for unlocking the memories of me reading these cool projects way back when!

This is not verified info, but I would assume these are either A) the exact same device, just with different marketing B) "binned" production runs that did not meet the accuracy threshold for clinical/prescribed use, but are otherwise "good enough" for someone looking to healthmaxx.

I think screen activity/tiktok keeps us in some kind of purgatory where we can neither fully engage nor fully disengage.

Though I can also confirm the provisioning behavior for PAYG vs. trial accounts w/o payment info.

I got this confirmed with a salesperson ~2yrs ago when I first set up my free tier on there.

I think it's a combination of a ritual and some sort of somewhat-more-elevated engagement (or wishing thereof) with the material. Somewhere between meditative ritual and attention aid. I doubt it helped much, if at all - except for Stabilo; they were the true winners.

After discontinuation, most patients regain around 60-80% of the weight they've lost with the medication - but this figure is limited to the study duration, so the weight regain might have continued beyond that. A good starting point for dipping your toes into outcomes would be the STEP and SURMOUNT trials, these were the trials they did for marketing approval. (They did multiple rounds of these, I believe STEP4 and SURMOUNT4 specifically had groups that stopped therapy mid-way).

We see this rebound effect with weight loss mediated solely via lifestyle modification as well, however. Still no idea why. Very broadly speaking, only a small proportion of obese/overweight patients will manage to keep the weight off, and the rest of the patient population tends to be divided into two groups: those who regain most of it (usually around half of the lost weight will be regained within 2 years, and 80% by follow up year 5), and those who regain more weight than they had lost. There hasn't been a way to tell preemptively which group the patient will land in at the time of beginning of lifestyle modification.

On top of this, yoyo-ing is also a phenomenon we tend to see. Obese and overweight patients who've managed to lose weight once will regain, lose again and so on. This phenomenon is associated with worse outcomes than being obese alone, so it is important to do long-horizon thinking when initiating therapy (be it lifestyle or pharmacotherapy) e.g. is the patient willing to stay on pharmacotherapy indefinitely? what about an indefinite maintenance dose if the patient succeeds with lifestyle modification alone? has the patient had lost and regained significant amount of wt prior? etc.

Long term PPI use has non-trivial risks, including magnesium and other micronutrient deficiencies, and can lead to things like SIBO and other primarily gut related morbidity.

I would definitely suggest sitting down with your doctor if you were not specifically instructed to take it for that long.

GLP1 agonist type incretins have been available for over 20 years at this point. The first marketing approval was in 2005 for exenatide (Byetta), indicated for T2DM. Exenatide was the first in class for GLP1 agonists. Then came Liraglutide (Victoza) for the same indication around 2010, and received marketing approval for weight loss (as Saxenda) 4 years later. After that around 2017 was semaglutide (Ozempic & Wegovy).

T2DM is a chronic disease, so patients who started exenatide had to stay on it life long.

These drugs are nothing new and were already being used for T2DM. It only caught public attention because semaglutide achieved double the mean BW loss over liraglutide, making it meaningful for weight loss. Novo Nordisk first got approval for Ozempic for T2DM in 2017 and then received approval for it to be marketed for weight loss under Wegovy only in 2021, but by then clinicians were already prescribing it off-label, strictly speaking, for weight loss.

I don't know how much we could extend this "they've been around for a long time" to tirzepatide (Eli Lilly: Mounjaro & Zepbound) because it's the first dual agonist. It targets GLP1 and GIP, and thus it's meaningfully separated from the others. This goes for retatrutide (again Eli Lilly) as well if it eventually comes to market as it would be the first triple-agonist targeting the aforementioned + GCGR, the glucagon receptor.

Tools are only effective in their purpose when one knows when and how to use them. Most things are imperfect, or a game of balancing benefits vs. shortcomings.

If a patient learns the potential pitfalls and strengths of a testing method, then I would trust them to apply it judiciously. But a biweekly medical scan you can go to as easily as a spa is not that.

Similarly: data matters, sure, but the quality of the data matters just as much. If the signal to noise ratio is too low then what's the point of gathering it?

In my personal (fully anecdotal) view, I think clinicians desperately need to get better at communication, as well as meta-communication. Right now the rift between the patient and practitioner is enormous, because Drs do not take the time to dutifully explain things and processes, and what pitfalls there may be, and like you said, just boil it down to "it has to be this way" and shrug.

Some of this is down to systems design, i.e. not enough time per patient;insufficient support staff (simple example is no nurse being present to take down history concurrently as you spend time with the patient, or no dictation facilities available so you have to manually type everything down during the consult, eating away what precious time you have w/ the patient); a specialist getting bombarded with things a generalist should have treated w/ no referral needed; jurisdictions where violence towards healthcare workers is prevalent and so on..

But I would wager that compassionate listening and communication is the lion's share in why there's this huge rift. We currently do not teach effective communication in medical school, students just see how their attending treats a patient, and they copy their style. Which is funny, because the first thing we were taught in preliminary internal medicine was that 80% of making a diagnosis (any diagnosis) is down to history taking and communication.

As for how exactly we would get institutions to take communication seriously, I have no idea.

Coincidentally, I've only recently learned of the Overton Window [0] which describes that the spectrum of acceptable ideas in a society is subject to shift.

[0] <https://en.wikipedia.org/wiki/Overton_window>

So one would have to weigh the risks of being let go (and legal consequences if it was indeed whistleblowing) depending on the level of criticism being levied.

Even the Dutch had to fight tooth and nail for it. I've lived in Germany for a while and there are cities here where even I would be snubbing taking kids to school with a bakfiets, because the biking infra is not good enough, or in other words the mingling I'd have to do with other traffic would be too out of my comfort zone.

Urban planning should prioritize walking and biking very first, and cars and other utilitarian-but-dangerous/harmful transport methods should be integrated in a way that's not engulfing the more human-scale side of things. But I think the costs (both monetary and in terms of "cognitive shift") are so high that I don't think I'll see this change in my lifetime. And that's before accounting for the power of corporate interest

Like, I should be able to even berate my employer, as long as I'm not doing it from a persona that's directly tied to my employer e.g. my real name or git handle etc. They might not like it, but they sure as shit shouldn't be able to fire me for it. This would include working on extending a company's products, so long as I don't use the proprietary knowledge I'm privy to.

I realize that this guy published his thing under an alias directly tied to his work. My question was sparked from the general sentiment of your reply - and I am being genuine, sometimes I feel like this stance of mine is somehow "too radical"

I understand that this is not reality in most of the world, but I'm genuinely asking. I'm in the EU and I'm not in the software/silicon valley industry; if that helps with context.