I take tirzepatide, cut down my calories to about 1500, walk 4-6 miles a day, and exercise 3 times a week. With the help of tirzepatide, I have been able to curb the cravings. I have lost about 25 pounds so far with 25 more to go. I always understood that it was on shaky ground however pay the $350/mo to get 5 mg of tirzepatide. My work has a Medical Weight Loss program that uses semaglutide instead which is free. I plan to switch to that. If it becomes unavailable, then I will have to switch back to regular discipline, food tracking, exercise, etc that I probably should have did all along. I will do whatever I have to do in the meantime to safely lose weight.
I think you've accomplished something really incredible with your weightloss and I'm very proud of you! .... but this part right here concerns me.
The reasons for eating beyond maintenance calories are broad, complicated and robust and I don't think it's fair to say "I should have just been more disciplined, 4head". The negative side-effects of food cravings can be really serious and "too hard" to fight against and that's a reasonable enough stance, especially when there are chemical changes you can make for yourself, such as this medication, that can help you.
In a very related sense, I was taking a (relatively) high dosage of a medication for myself that I needed for a time. I gained 30 pounds over about 2 years while on that stronger medication. I also tried to lose weight; but the cravings for food were becoming too much - far too much; and I had just come off the best shape of my life, where I actually had to force myself to eat *more* so that I would gain muscle. I just plain wasn't hungry. But this med I was on, yeah, I just ate more, regularly. It was easier - but trying to slow down my eating? The cravings were bad. Unlike any I'd ever had. And if I didn't eat, I was tired, angry, unfocused, a world of problems.
Now that I've reduced this medication (with the help of a psychiatrist), the cravings have effectively disappeared; and when they are present, it's very easy to overpower them and just move on. They don't cause my to be literally unable to sleep. I don't lose all my focus, it's just ... easier - easier enough that it's actually doable.
And a medication changed helped that.
Crutches are a very good thing when you can't walk or when it hurts too much to walk. It's okay to use a crutch. It is not a personal failing, it is a medical aide and an accessibility tool.
Please, I encourage you, give yourself some grace :)
I agree, but let me get on a soapbox for a moment. In the context of weight loss, "cravings" is just a judgemental way of saying "hunger".
I have gained a ton of weight in the past four years, going from a BMI of 19 to a BMI of 28. I do not have "cravings". I experience constant hunger. I got tired of being hungry all the time and started eating until I am no longer hungry, and that's why I'm fat now.
Calories in, calories out, and all that nonsense that doesn't account for hunger is just a way of dismissing the very real struggle of people who, for whatever reason, have a disproportionate amount of hunger relative to the amount of energy they need on a daily basis.
Same. Down 80. Healthy weight for the first time since I was a child. Taking this has led me to feeling less shame about my previous weight and that maybe a lot of this discipline you talk about might also be some of our biology just being not super compatible with modernity. I've personally gone from feeling a bit like a fat cat who you have to take the bowl away from to one who just eats responsibly. Wouldn't really be an issue for the cat in the wild or us 100 years ago. But here we are needing to take away our own bowls. Maybe it really just isn't as easy for some of us.
>> our biology just being not super compatible with modernity.
This! our body through millions of years of evolution is just not built for an abundance of easy to obtain dense caloric food, while living in relative leisure. It just isn't.
CICO proponents don't understand you are asking an individual to fight millions of years of evolution with self-discipline.
Out of curiosity, do you find yourself eating more nutritiously or just fewer calories?
For most people (now), their food habits don't deliver very good nutrition in just 1500 calories and the problems with that compound if they're living an active life that needs more nutrients. Neurotic dieters have hurt themselves through that problem for decades, as so much cultural focus in on "calories in, calories out" that they don't even think about whether their broader nutritional needs are still being met during calorie restriction.
Do you find that these drugs have provided any help in making your diet sufficiently dense in nutrition to compensate for the reduction in volume? I hear that they strongly affect appetite and food appeal, so I worry for what it might mean for people who dive in without taking nutrition density seriously. It seems so easy to just buy the drug and let it help you eat less, but that's such a dangerous thing to do naively.
I find it significantly easier to eat healthier foods.
I am struggling with getting enough calories in general - even on the lowest dose I have to force myself to eat more than a meal a day. But I don't miss the processed/fried/etc. foods while on tirzepatide the way I do when I'm just counting calories, etc. I throw in a a protein shake and a broad spectrum of supplements to help. (I stick to the ones that have actual research studies to back their efficacy - examine.com is great for quickly sorting things into 'ignore as marketing garbage' and 'research more' piles)
I've also found it significantly easier to be motivated to work out.
> do you find yourself eating more nutritiously or just fewer calories?
I am definitely eating better and watching what I eat. Mostly because I care now. I am up to 80-100g of protein per day. I stopped drinking soda altogether. I drink water multiple days. I am no longer suffering from sleep apnea.
> Do you find that these drugs have provided any help in making your diet sufficiently dense in nutrition to compensate for the reduction in volume? I hear that they strongly affect appetite and food appeal
You are satiated faster when used in combination with protein heavy meals. I am also weighing my food and following the serving sizes.
They do affect your appetite but I also think it was a mindshift because I can stop taking the medication after it wears off beyond my weekly shot and I am not that hungry anymore. I attribute it to maybe my stomach got smaller and I used this opportunity to retrain myself and have better healthy eating habits.
I absolutely eat better than before. Part of it may be mindfulness, but overall I do not crave specific kinds of foods like I did before and by that I mean... any specific kind of food.
One way of thinking about it is that I have always enjoyed fruits like apples, blueberries, etc but I have always enjoyed a bag of chips or a great sandwich more. What I've found now is if I keep fruits, yogurts, cottage cheese etc in the fridge I will opt for them over the more junky foods, or at least just as much.
I started out getting injured just walking 2 miles. It was bad. I weighed 255 lb at start and that didnt seem like a lot but it makes sense now why I would get injured just walking around a big city like Washington DC with my family. I was out of shape. Now I can walk 6 miles a day every day (this took me 2 months to get to) without injury.
Great to hear the kind of progress you are making. Keep it up!. One thing I have found to be successful for exercising(weight training, running, swimming) is taking a mindful and inquisitive approach to it. It goes like this:
- Be mindful of when your mind wanders from paying attention to Form(Posture/Gait/Technique), Breath and Pace. When it wanders, bring it back to focus on these aspects.
- Try observing when the first feeling and proceeding thought enters your mind and try separating the feeling like tiredness, anxiousness, overwhelmed from the distracting thoughts you have due to it(e.g. "I wanna quit", or "I can't do this"). But stay with the feeling and this thought. Just observe it and bring back your attention to the aforementioned things: your Form, Breath and Pace. Over time the though and feeling dissipate and you come to be at ease with the process.
Over time, this has helped my motivation because often I was fighting my thoughts(which in the long run is like stuffing mail in a full post box) and not paying attention to the actual exercise.
I don't know if weight loss via calorie tracking and self control is really worthwhile if you can just do a cycle of appetite suppressant to keep weight around target baseline.
Seems like drugs have made weight management a solved problem. No reason to over think it for genpop if you can cycle drugs.
The unsolved problem is body composition -> picking right exercise regimes and diet macronutrients so you're losing more fat than muscle.
But really that should also be a solved problem if west weren't stupid about steroids and poured serious research into them.
Just eat4 grams of inulin gummies and a teaspoon of allulose in the morning amd evening. Costs maybe 30 bucks a months also pounds glp1 just like semaglutide. Mirafiber makes some decent ones in usa market. Restorafiber is sold in two packs at costco for cgep in canada
The patent for semaglutide doesn't expire until 2030 (in the US), so a generic is not currently available. I say this as someone who is looking into purchasing the drug: I don't think many people buying the compounded formula know it is not a "generic" and is not FDA approved. The companies selling it often do not even say where it comes from.
It shouldn't be surprising that Novo Nordisk is fighting these compounding pharmacies that are purely interested in undercutting them. Not to say they need our sympathy, since I'm sure a significant cost of Ozempic is due to the injection pen with a million patents.
The pill version is showing similar safety and efficacy profiles as the injectable (leveraging higher dosage to get through the gut to the bloodstream), so runs to Canada and Mexico are probably in consumer futures to evade patent regulatory capture until 2030 (or getting it mailed from India, I have had personal success with this for other non controlled pharma products).
> The pill version is showing similar safety and efficacy profiles as the injectable
The pill, Rybelsus, barely works. They've having to put 700%+ more than the injections to still get a lower overall effectiveness. They're actively working on alternative delivery methods to resolve this.
A daily pill GLP-1 will be a massive commercial success. Rybelsus isn't very good for either the manufacturer or the consumer. You're burning a lot of expensive peptide to get a worse outcome at every dose level.
Yeah, but the Mounjaro/Zepbound cost with injector in the UK is £139 for 4 weekly 5mg injections/month. They're still making over 90% margins. The margins in the US are completely insane >99%.
Victoza (liraglutide)'s patent expired, but its effect on weight loss is pitiful relative to later-generation GLP-1 agonists. Same story for Trulicity (dulaglutide), for which patent protections end in 2027.
Liraglutide is an older version that is now available as a generic, but it's results, particularly for weight loss, are far behind semaglutide, tirzepatide, etc.
I'd be more sympathetic if they actually met the demand of their prescribed base. I have about a 40% success rate actually getting my rx filled and have to use compounded versions.
My feeling is that Ozempic, and Wegovy, has been prescribed to too many, to fast. It was always clear that Novo Nordisk would not be able to the need of both diabetics, people who truly need to lose weight and those who just want to lose weight. The latter group should not be serviced at all at this point.
Starting to push Wegovy was just a money grab, Novo must have known that it would disrupt their delivery of Ozempic.
The venn diagram of people who are diabetic and people who need to lose weight are almost a circle.
If you're drastically overweight and not diabetic, that's because not enough time has passed.
What people fail to realize is that obesity correlates highly with pretty much every bad thing you can develop. The faster you control obesity, the lower your risk will be. Virtually every organ in the body, from liver to kidneys to heart to lungs, is negatively impacted by obesity.
I view it as people taking those drugs pre-emptively. They would require them, eventually.
It's frustrating that nobody actually offers evidence for the drugs either being available or unavailable. Can Nordisk point to a warehouse with enough available supply to meet the capacity that the compounders are cranking out? Or can the compounders point to a bunch of customers waiting on unfulfilled shipments from Nordisk?
My understanding is that they're almost completely separate customer bases right now. Ozempic is (generally) only approved by insurance when used as a diabetic drug and off insurance, it's in the $1000/month range.
Weightloss folks are shit out of luck for insurance coverage, and so they go to compounding pharmacies and pay in the $200/month range. Forcing them to ~5 times the price will have a lot of folks unable or unwilling to do so and demand will drop.
Our insurance just started covering Ozempic for weight loss, but they will only supply it via their online pharmacy for diabetes. If you are prescribed it for weight loss, you have to find it retail and pay a $200 copay. But at least it's for branded Ozempic, not grey market compounded meds. Mounjaro is the better product if you need for both weight loss and diabetes, but the supply on that is even worse than for Ozempic.
Interesting that the insurance companies aren't interested in supporting weight loss, the complications from being overweight are gonna be a whole lot worse than getting the drug. Did someone run the tables and find that obese people are dying too quickly to end up with medical bills?
I have to admit that I'm baffled as to what is happening here. Semaglutide is still under patent protection, so anyone producing feedstock is doing so under license with Nova Nordisk. Why on earth would NN offer licensing terms that allow them to sell the feedstock to anyone but NN? There are no generic manufacturers because the patent is still active.
Compounding pharmacies are getting the drug from the feedstock producers, but how on earth are they contractually permitted to sell it?
Your usage of the term 'feedstock' here is confusing, and it seems like you're probably operating under the erroneous assumption that contract manufacturer supplies commissioned by Novo Nordisk are somehow being routed to compounding pharmacies, which isn't the case.
In practice, there are generic manufacturers for semaglutide, and many other peptides still protected by US patents, mostly located in China. The more reputable of these manufacturers produce these drugs at levels of purity rivaling the 'name brand'. These manufacturers export lyophilized product en masse to middlemen that operate in the grey/black-market 'research chemical' sales market, or ship to compounding pharmacies. The consumers purchasing on the grey/black market reconstitute the drug at home (which requires a trivial level of effort), and assume some extra degree of risk in terms of product purity and sterility. Consumers wanting an extra level of assurance for product quality purchase from a compounding pharmacy that ostensibly is conducting its own assessments of product purity, and following best practices for sterile reconstitution.
Henry's, one of the compounding pharmacies, says that they get the chemicals from legitimate licensed producers of feedstock [1].
There is a compounding loophole, but there is no loophole for patent encumbrances -- if a compounding pharmacy is violating NN's intellectual property, then can just sue them directly; they don't have to pursue the regulatory crackdown they're going for now.
There are companies that do grey/black market reconstitutions, like Pivotal Peptides. But they are not compounders. The compounders are legally selling the real thing directly to customers. Do you have a specific source that indicates that any compounding pharmacy is getting its feedstock illegally from China?
Compounded drugs have a difficult line to walk. AFAIK, compounded drugs are those which are made custom to the patient due to allergy, or unavailability. The concern is when a compounding pharmacy makes a drug that already exists on the market, but the pharmacy sells it anyways even though it's identical, or at a lower cost.
There's also value in individualized dosing. I take tirzepatide, and 5mg is too intense for the first couple days, but 2.5 doesn't last long enough. Ideally I'd take 2.5 every 4 days, instead of 5.0 every 7 days, but that option doesn't exist, but is something that compounding could provide. But I'm not willing to risk the safety-murkiness of compounding, so just stick with the 5.0 and deal with it.
compounding veterinary medication was also common during Covid during medication shortages.
It’s a way to get the same medicine just through different suppliers and circumventing various restrictions/regulations, and then prepared by the compounding pharmacy for ingestion by the patient.
Common use cases are, in animals for example, you might need to put a dog a medication and the supplier may not manufacture the right size dose (or maybe your animal won’t eat pills so the compounding pharmacy reformulates it into a liquid)
My veterinarian recommended sticking with brand name meds for my dog even though I was having trouble due to the size of the pill. Her reasoning was compounded equivalents simply aren’t tested in any medical or academic trials, only brand name formulations are tested in trials, so there’s no guarantee of efficacy since you’re literally taking a formulation of a medication that has gone through zero scientific testing (the isolated ingredients or a similar formula may have trials and testing, but not the exact formula you’re taking)
Which is also why no compounded drug can be FDA approved.
Logically I want to trust compounding pharmacies and I want to believe the efficacY and side effects are equivalent to name brand.
But the fact that my veterinarian cautioned me against compounding my dog’s medicine gave me pause about compounding medicine for myself…
the modern twist is that large health startups like Hims and 23andme are getting into the compounding business and the drug makers arent happy to have the competition.
At one point I was going to a human compounding pharmacy to get drugs for my cat. I don’t even remember what it was but they put it in fish oil to make it more palatable. Did not work.
I purchased four 5ml bottles of semaglutide from China for $50. It's available at underground lab steroid sites and easy to find. Many people are ordering this and getting them tested and the results are posted. I realize the risk.
It's a hugely important thing to do for your health in general, but the amount of effort needed to counteract the modern diet via exercise is absurd.
The alternative is eating better - better food, less calories. But for a lot of people, they have tried and failed to do this for years. Even people that have had a history of being able to do this successfully can find themselves struggling. And once you're fat, the feedback loops kick in and make it more and more difficult. Is it within everyone's power to not be fat? Yes. Is it significantly harder for some people for a variety of reasons? Also yes.
So we could act like this is a moral failing and fat people should just be fat until they manage to scrape together the willpower to ignore their body pushing them to eat, or we could recognize that these medications are extremely effective at helping tame those signals their body is sending. (Plus seeing a tons of other positive impact on things like fat deposits in the liver, insulin resistance, cardiovascular protection, sleep apnea, etc. - and these are seen even before significant weight loss occurs.)
These medications aim to reduce the addictiveness of foods. A very apt analogy is nicotine gum/patches. This is that, but for food (although early studies also show success for opioids and alcoholism).
I feel like there is a lot of hypocrisy going on around this. People asking overweight/obese people "why not just eat less?!" and people responding "GLP-1 medications help me do just that," and the critics essentially saying "it is unfair fair that this drugs helps you do the thing I claim I want you to do."
Also, calorie restriction, not exercise is what successful people use to lose weight. Exercise is highly recommended and will help you live a long and healthy life, but it won't help an Obese person loose >20 lbs of body fat. TDEE and calorie restriction will though.
"Why not do the more difficult thing instead of the very easy and cheap thing that also accomplishes your goal?" will always be a bizarre question to ask in earnest. The answer should be so glaringly obvious that the question just falls out of your head.
I'm 6' 2" and weigh 215. I ride my bike 20 miles/week. Not a lot, but not nothing. My goal isn't really to lose a bunch of weight. I'm always hungry and I'm eating plenty. There's an ongoing hunger background noise in my stomach and brain. I'm definitely doing some self experimentation to get this figured out.
Someone made a drug, and they want all of the money for their work.
Maybe that's justified, maybe it isn't.
But because we use money as both our dopamine reward and also the entire basis of how we allocate all scarce resources in our finite reality, and because patents are the only way for them to get said dopamine reward/resources, the strat is to just let millions of people sit in the crossfire while we work out what kind of money they should get.
They already got many many billions. If there's a mechanism for medicine to skip extra studies when extraordinary efficacy is shown, why is there no mechanism to skip the patent protection and crank out at scale what can prevent so many bad health outcomes in the future. Hell, give them another $10B, who even cares, it's saving much more in healthcare expenditures.
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I think you've accomplished something really incredible with your weightloss and I'm very proud of you! .... but this part right here concerns me.
The reasons for eating beyond maintenance calories are broad, complicated and robust and I don't think it's fair to say "I should have just been more disciplined, 4head". The negative side-effects of food cravings can be really serious and "too hard" to fight against and that's a reasonable enough stance, especially when there are chemical changes you can make for yourself, such as this medication, that can help you.
In a very related sense, I was taking a (relatively) high dosage of a medication for myself that I needed for a time. I gained 30 pounds over about 2 years while on that stronger medication. I also tried to lose weight; but the cravings for food were becoming too much - far too much; and I had just come off the best shape of my life, where I actually had to force myself to eat *more* so that I would gain muscle. I just plain wasn't hungry. But this med I was on, yeah, I just ate more, regularly. It was easier - but trying to slow down my eating? The cravings were bad. Unlike any I'd ever had. And if I didn't eat, I was tired, angry, unfocused, a world of problems.
Now that I've reduced this medication (with the help of a psychiatrist), the cravings have effectively disappeared; and when they are present, it's very easy to overpower them and just move on. They don't cause my to be literally unable to sleep. I don't lose all my focus, it's just ... easier - easier enough that it's actually doable.
And a medication changed helped that.
Crutches are a very good thing when you can't walk or when it hurts too much to walk. It's okay to use a crutch. It is not a personal failing, it is a medical aide and an accessibility tool.
Please, I encourage you, give yourself some grace :)
I have gained a ton of weight in the past four years, going from a BMI of 19 to a BMI of 28. I do not have "cravings". I experience constant hunger. I got tired of being hungry all the time and started eating until I am no longer hungry, and that's why I'm fat now.
Calories in, calories out, and all that nonsense that doesn't account for hunger is just a way of dismissing the very real struggle of people who, for whatever reason, have a disproportionate amount of hunger relative to the amount of energy they need on a daily basis.
Same. Down 80. Healthy weight for the first time since I was a child. Taking this has led me to feeling less shame about my previous weight and that maybe a lot of this discipline you talk about might also be some of our biology just being not super compatible with modernity. I've personally gone from feeling a bit like a fat cat who you have to take the bowl away from to one who just eats responsibly. Wouldn't really be an issue for the cat in the wild or us 100 years ago. But here we are needing to take away our own bowls. Maybe it really just isn't as easy for some of us.
This! our body through millions of years of evolution is just not built for an abundance of easy to obtain dense caloric food, while living in relative leisure. It just isn't.
CICO proponents don't understand you are asking an individual to fight millions of years of evolution with self-discipline.
Besides all the other benefits of exercise, it will help keep the weight off. You can't stay on ozempic forever.
For most people (now), their food habits don't deliver very good nutrition in just 1500 calories and the problems with that compound if they're living an active life that needs more nutrients. Neurotic dieters have hurt themselves through that problem for decades, as so much cultural focus in on "calories in, calories out" that they don't even think about whether their broader nutritional needs are still being met during calorie restriction.
Do you find that these drugs have provided any help in making your diet sufficiently dense in nutrition to compensate for the reduction in volume? I hear that they strongly affect appetite and food appeal, so I worry for what it might mean for people who dive in without taking nutrition density seriously. It seems so easy to just buy the drug and let it help you eat less, but that's such a dangerous thing to do naively.
I am struggling with getting enough calories in general - even on the lowest dose I have to force myself to eat more than a meal a day. But I don't miss the processed/fried/etc. foods while on tirzepatide the way I do when I'm just counting calories, etc. I throw in a a protein shake and a broad spectrum of supplements to help. (I stick to the ones that have actual research studies to back their efficacy - examine.com is great for quickly sorting things into 'ignore as marketing garbage' and 'research more' piles)
I've also found it significantly easier to be motivated to work out.
I am definitely eating better and watching what I eat. Mostly because I care now. I am up to 80-100g of protein per day. I stopped drinking soda altogether. I drink water multiple days. I am no longer suffering from sleep apnea.
> Do you find that these drugs have provided any help in making your diet sufficiently dense in nutrition to compensate for the reduction in volume? I hear that they strongly affect appetite and food appeal
You are satiated faster when used in combination with protein heavy meals. I am also weighing my food and following the serving sizes.
They do affect your appetite but I also think it was a mindshift because I can stop taking the medication after it wears off beyond my weekly shot and I am not that hungry anymore. I attribute it to maybe my stomach got smaller and I used this opportunity to retrain myself and have better healthy eating habits.
One way of thinking about it is that I have always enjoyed fruits like apples, blueberries, etc but I have always enjoyed a bag of chips or a great sandwich more. What I've found now is if I keep fruits, yogurts, cottage cheese etc in the fridge I will opt for them over the more junky foods, or at least just as much.
- Be mindful of when your mind wanders from paying attention to Form(Posture/Gait/Technique), Breath and Pace. When it wanders, bring it back to focus on these aspects.
- Try observing when the first feeling and proceeding thought enters your mind and try separating the feeling like tiredness, anxiousness, overwhelmed from the distracting thoughts you have due to it(e.g. "I wanna quit", or "I can't do this"). But stay with the feeling and this thought. Just observe it and bring back your attention to the aforementioned things: your Form, Breath and Pace. Over time the though and feeling dissipate and you come to be at ease with the process.
Over time, this has helped my motivation because often I was fighting my thoughts(which in the long run is like stuffing mail in a full post box) and not paying attention to the actual exercise.
I don't know if weight loss via calorie tracking and self control is really worthwhile if you can just do a cycle of appetite suppressant to keep weight around target baseline.
Seems like drugs have made weight management a solved problem. No reason to over think it for genpop if you can cycle drugs.
The unsolved problem is body composition -> picking right exercise regimes and diet macronutrients so you're losing more fat than muscle.
But really that should also be a solved problem if west weren't stupid about steroids and poured serious research into them.
It shouldn't be surprising that Novo Nordisk is fighting these compounding pharmacies that are purely interested in undercutting them. Not to say they need our sympathy, since I'm sure a significant cost of Ozempic is due to the injection pen with a million patents.
The pill, Rybelsus, barely works. They've having to put 700%+ more than the injections to still get a lower overall effectiveness. They're actively working on alternative delivery methods to resolve this.
A daily pill GLP-1 will be a massive commercial success. Rybelsus isn't very good for either the manufacturer or the consumer. You're burning a lot of expensive peptide to get a worse outcome at every dose level.
https://www.simpleonlinepharmacy.co.uk/online-doctor/weight-...
Deleted Comment
Aren't there a handful of similar drugs in that class though? I wonder if some of them come off patent sooner.
Liraglutide is an older version that is now available as a generic, but it's results, particularly for weight loss, are far behind semaglutide, tirzepatide, etc.
Starting to push Wegovy was just a money grab, Novo must have known that it would disrupt their delivery of Ozempic.
If you're drastically overweight and not diabetic, that's because not enough time has passed.
What people fail to realize is that obesity correlates highly with pretty much every bad thing you can develop. The faster you control obesity, the lower your risk will be. Virtually every organ in the body, from liver to kidneys to heart to lungs, is negatively impacted by obesity.
I view it as people taking those drugs pre-emptively. They would require them, eventually.
Weightloss folks are shit out of luck for insurance coverage, and so they go to compounding pharmacies and pay in the $200/month range. Forcing them to ~5 times the price will have a lot of folks unable or unwilling to do so and demand will drop.
Compounding pharmacies are getting the drug from the feedstock producers, but how on earth are they contractually permitted to sell it?
In practice, there are generic manufacturers for semaglutide, and many other peptides still protected by US patents, mostly located in China. The more reputable of these manufacturers produce these drugs at levels of purity rivaling the 'name brand'. These manufacturers export lyophilized product en masse to middlemen that operate in the grey/black-market 'research chemical' sales market, or ship to compounding pharmacies. The consumers purchasing on the grey/black market reconstitute the drug at home (which requires a trivial level of effort), and assume some extra degree of risk in terms of product purity and sterility. Consumers wanting an extra level of assurance for product quality purchase from a compounding pharmacy that ostensibly is conducting its own assessments of product purity, and following best practices for sterile reconstitution.
Henry's, one of the compounding pharmacies, says that they get the chemicals from legitimate licensed producers of feedstock [1].
There is a compounding loophole, but there is no loophole for patent encumbrances -- if a compounding pharmacy is violating NN's intellectual property, then can just sue them directly; they don't have to pursue the regulatory crackdown they're going for now.
There are companies that do grey/black market reconstitutions, like Pivotal Peptides. But they are not compounders. The compounders are legally selling the real thing directly to customers. Do you have a specific source that indicates that any compounding pharmacy is getting its feedstock illegally from China?
[1] https://www.reddit.com/r/henrymeds/comments/1av14cm/comment/..., discovered via https://www.astralcodexten.com/p/the-compounding-loophole
It’s a way to get the same medicine just through different suppliers and circumventing various restrictions/regulations, and then prepared by the compounding pharmacy for ingestion by the patient.
Common use cases are, in animals for example, you might need to put a dog a medication and the supplier may not manufacture the right size dose (or maybe your animal won’t eat pills so the compounding pharmacy reformulates it into a liquid)
My veterinarian recommended sticking with brand name meds for my dog even though I was having trouble due to the size of the pill. Her reasoning was compounded equivalents simply aren’t tested in any medical or academic trials, only brand name formulations are tested in trials, so there’s no guarantee of efficacy since you’re literally taking a formulation of a medication that has gone through zero scientific testing (the isolated ingredients or a similar formula may have trials and testing, but not the exact formula you’re taking)
Which is also why no compounded drug can be FDA approved.
Logically I want to trust compounding pharmacies and I want to believe the efficacY and side effects are equivalent to name brand.
But the fact that my veterinarian cautioned me against compounding my dog’s medicine gave me pause about compounding medicine for myself…
Deleted Comment
It's a hugely important thing to do for your health in general, but the amount of effort needed to counteract the modern diet via exercise is absurd.
The alternative is eating better - better food, less calories. But for a lot of people, they have tried and failed to do this for years. Even people that have had a history of being able to do this successfully can find themselves struggling. And once you're fat, the feedback loops kick in and make it more and more difficult. Is it within everyone's power to not be fat? Yes. Is it significantly harder for some people for a variety of reasons? Also yes.
So we could act like this is a moral failing and fat people should just be fat until they manage to scrape together the willpower to ignore their body pushing them to eat, or we could recognize that these medications are extremely effective at helping tame those signals their body is sending. (Plus seeing a tons of other positive impact on things like fat deposits in the liver, insulin resistance, cardiovascular protection, sleep apnea, etc. - and these are seen even before significant weight loss occurs.)
I feel like there is a lot of hypocrisy going on around this. People asking overweight/obese people "why not just eat less?!" and people responding "GLP-1 medications help me do just that," and the critics essentially saying "it is unfair fair that this drugs helps you do the thing I claim I want you to do."
Also, calorie restriction, not exercise is what successful people use to lose weight. Exercise is highly recommended and will help you live a long and healthy life, but it won't help an Obese person loose >20 lbs of body fat. TDEE and calorie restriction will though.
"Why not do the more difficult thing instead of the very easy and cheap thing that also accomplishes your goal?" will always be a bizarre question to ask in earnest. The answer should be so glaringly obvious that the question just falls out of your head.
Someone made a drug, and they want all of the money for their work.
Maybe that's justified, maybe it isn't.
But because we use money as both our dopamine reward and also the entire basis of how we allocate all scarce resources in our finite reality, and because patents are the only way for them to get said dopamine reward/resources, the strat is to just let millions of people sit in the crossfire while we work out what kind of money they should get.
Citation needed.