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Is it ethical to take the diabetes drug Ozempic when you don't have diabetes?
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AdahPotatah2024 wrote: »Oh, I don't know if that would even be possible here, a private script. I would consider it unethical of the Dr./pharmacists as well if it is low supply for those who need it medically and they allow that. Anyway, it seems to me like there will be plenty to go around soon, at least in the U.S. I would take the one specifically for weight loss, not Ozempic, if I didn't have diabetes and was into losing weight that way, regardless. I was reading there's been many casualties due to overdose of Ozempic. 🫣
Anything not on the PBS here is called a private script
PBS capped price covers most medications, people dont need health insurance for them - sometimes people want something for perfectly legitimate reasons - eg a vaccination they do not meet funded criteria for - and they get this on a private script and pay full price.1 -
AdahPotatah2024 wrote: »If I were just trying to lose 40 pounds for aesthetician reasons, I'd try to suppress my appetite naturally first. There's oats, peanut butter, avocado, beans and last resort, like he said, other supplements out there that do the same thing.
Recent research suggests some foods contribute to a GLP-1 type hormone being produced within the body.
Short summary: Certain sub-types of fermentable fiber from food trigger release of GLP-1 in the intestinal tract. Some types of gut microbes contribute to the process. The natural GLP-1 doesn't last as long in the body as the semaglutide drugs, but the overall dietary context can extend the time of benefit to some extent. There's also a potential helpful increase in Peptide YY (PYY), which decreases appetite. Fiber supplements don't necessarily contain the relevant type(s) of fiber.
Here's an article from a usually not terrible source:
https://www.npr.org/sections/health-shots/2023/10/30/1208883691/diet-ozempic-wegovy-weight-loss-fiber-glp-1-diabetes-barley2 -
Isn't the biggest factor of Ozempic for weight loss, just the appetite suppressing? There are other supplements that can do that for much less if that's the desire.
But, if one can't learn how to suppress their eating without Ozempic, the weight will return. So they'd have to be on Ozempic forever to maintain.
Nothing wrong with being on a medication for your entire life if it is what you need to stay healthy.
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@AnnPT77 Thanks for the link!
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AdahPotatah2024 wrote: »If I were just trying to lose 40 pounds for aesthetician reasons, I'd try to suppress my appetite naturally first. There's oats, peanut butter, avocado, beans and last resort, like he said, other supplements out there that do the same thing.
Recent research suggests some foods contribute to a GLP-1 type hormone being produced within the body.
Short summary: Certain sub-types of fermentable fiber from food trigger release of GLP-1 in the intestinal tract. Some types of gut microbes contribute to the process. The natural GLP-1 doesn't last as long in the body as the semaglutide drugs, but the overall dietary context can extend the time of benefit to some extent. There's also a potential helpful increase in Peptide YY (PYY), which decreases appetite. Fiber supplements don't necessarily contain the relevant type(s) of fiber.
Here's an article from a usually not terrible source:
https://www.npr.org/sections/health-shots/2023/10/30/1208883691/diet-ozempic-wegovy-weight-loss-fiber-glp-1-diabetes-barley
Barley…. Hrmmm….
Three times the fiber of oats.
https://www.health.harvard.edu/heart-health/grain-of-the-month-barley
Good to know. Thanks.
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Isn't the biggest factor of Ozempic for weight loss, just the appetite suppressing? There are other supplements that can do that for much less if that's the desire.
But, if one can't learn how to suppress their eating without Ozempic, the weight will return. So they'd have to be on Ozempic forever to maintain.
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You are very correct and my "issue" with it, who knows what that will do long term.
With that said, my SIL was diagnosed with T2D as well as severe fatty liver. The doctor is going through the insurance hoops to get her on Ozempic or some similar drug. We know it won't change behavior, but at this point, morbidly obese, T2D and fatty liver, she needs to drop weight fast. Hopefully she can get things stabilized and work on eating habits.
It's like patching the hole in the boat with super glue to get back to shore. Not a long term fix.2 -
MargaretYakoda wrote: »Isn't the biggest factor of Ozempic for weight loss, just the appetite suppressing? There are other supplements that can do that for much less if that's the desire.
But, if one can't learn how to suppress their eating without Ozempic, the weight will return. So they'd have to be on Ozempic forever to maintain.
Nothing wrong with being on a medication for your entire life if it is what you need to stay healthy.
But in most cases behavior modification should be able (in theory anyway) to get one off the drug. And we don't know the long term effects of these drugs. If I was in a situation where I needed them, it would be a huge wake up call and I'd modify my behavior so I could stay off them.3 -
Theoldguy1 wrote: »MargaretYakoda wrote: »Isn't the biggest factor of Ozempic for weight loss, just the appetite suppressing? There are other supplements that can do that for much less if that's the desire.
But, if one can't learn how to suppress their eating without Ozempic, the weight will return. So they'd have to be on Ozempic forever to maintain.
Nothing wrong with being on a medication for your entire life if it is what you need to stay healthy.
But in most cases behavior modification should be able (in theory anyway) to get one off the drug. And we don't know the long term effects of these drugs. If I was in a situation where I needed them, it would be a huge wake up call and I'd modify my behavior so I could stay off them.
That’s a case by case basis.
Not everyone can get to the point where they can stop taking medication, even with prefect behavior and diet.
(Note: I am not saying behavioral changes aren’t ever necessary , they often are)
Different people are different.
Genetics plays a huge role, but there are other factors also.
For example: we know for sure that exposure to certain chemicals can cause long term illness. Dioxin is just one example. And not every employer or product manufacturer is 100% honest and forthcoming about the chemicals they expose people to.
I’m definitely interested in long term research on this class of drugs. I’m old enough to remember the fen-phen debacle.
But even though that drug is no longer used as an appetite suppressant, it’s still occasionally used for other purposes.
Still a good tool in the proper context.
It’s all about risk vs benefit.
Agreeing, of course, that behavior management is absolutely one good tool in the box.
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I get what posters are saying about lifestyle changes for weight loss.
However for type 2 diabetics, yes they may need to stay on it for life, even with weight loss and behaviour changes.
Not all type 2 diabetics are overweight anyway.
Yes the long term risks may be unknown - but the long term risks of poorly controlled blood sugars are not unknown at all and are far more likely to be problematic.4 -
I would agree everyone should try diet, movement and behavior modification first, before taking the medication for weightloss.
So, if... diet, movement and behavior modification did not work for a person, who tried on and off with sincere efforts.... short term or longer, over years, even decades...
-- who persistently gained additional weight over time as obesity progressed... particularly this expresses towards the end with critical co-morbidity issues in the super-morbidly obese population (a failure of diet, movement and behavior modification.)
-- WHY would we anticipate diet, movement and behavior modification to work therapeutically post-medications if the person goes off the meds, and appetite and other physical problems return that the medication helped?
-- it is THIS i can understand the possible long-term/lifetime need for the medication for weight management of obesity and related disease processes.
Although the medication may have been developed for diabetes, it has been extended and approved for use for obesity and perhaps, soon for other diseases, just like extending it for when heart disease is also present.
For this, I do believe it is ethical for a patient to use a legally approved medication.
Shortages, pricing and lack of insurance coverages is in part, perhaps, fall-out of a real and larger demand than anticipated.
-- rather than deny a group of (obese) people the approved medication, the shortages, price and insurance should be addressed.2 -
well of course the manufactures are trying to address the shortage - would be poor business sense not to.
Question is whether it is ethical now when there is a shortage - not about later when that problem has been resolved.
and reality now is if you dont deny obese people just wanting it for weight loss then diabetics who need it for blood sugar control will be denied it by its unavailability
Question is whether we should prioritise now while there is a shortage -and I think the answer is yes.
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@paperpudding in this discussion you have been subtly supporting the position that diabetics as a group, are somehow more deserving than obese people as a group in terms of getting access to this treatment. Thus, as a group, they deserve priority and obese people should be excluded.
And you are saying that we are dealing with a scarcity situation.
Which I am not strictly sure is true. There is enough supply floating around that in case of acute medical need the drug salespeople could pull a couple of samples out of their pocket to throw at someone who is dying!
So, if you are taking the position that wealth or a lottery is not an appropriate method to triage patients, then I will also counter that a two group dichotomy of moral deservedness is also insufficient and equally inappropriate.
I find nothing more inherently deserving in a type 2 diabetic who "chooses" not to control their blood sugar by not keeping to a <20g of carb a day ketogenic diet (or carnivore, or...) and a morbidly obese person who "chooses" not to control their binge eating.
Actually the complexity of reducing the blood sugar level of the diabetic by not eating carbs and/or by only eating a small amount of carbs immediately before exercise is less complex than the amount of work your "typical" morbidly obese binger will have to put in to reduce to and maintain at a normal weight.
In actual fact there exist a greater quantity of relatively safe and effective drugs for diabetics than for the obese. Thus for most diabetics other safe options do exist.
It sounds to me, then, that obese people with complications should be the first in line before diabetics as they have less available safe options!
Sure, you will argue, SOME diabetics have no other option because the other drugs have not worked!
And I have to respect that.
So, unlike you who is ready to throw out the medically needy obese people out with the left over cucumber salad, I would not throw the uncontrolled diabetics down into the squishy cucumber garburator!
What I would 100% agree with you is that during scarcity the drug should go first where it is medically needed and where other options have proven not to have worked effectively to date.
The unethical person is not the obese person who is taking the drug.
The unethical person is the prescriber who has been bought out to write a script when it was not medically necessary and if it is not the best option for their patient but just a "convenience" or substitute for better medical care.
I will agree with you, if that is your opinion, that many of the scripts getting written for overweight people are neither medically necessary nor the best medical option for the patient.
But the answer to that problem is not the blanket exclusion of the obese people who have a medical need for the drug equal to that of any diabetic who cannot be as effectively treated with other options.3 -
Yes there is a scarcity. At least here in Australia and as I understand it worldwide.
We are in a scarcity, at least until supplies catch up with demand but that isnt the case now.
I didn't say diabetics vs obese people were 2 separate polarised groups
I did say PBS criteria in Australia is diabetics for whom oral medication is insufficient.nobody else in Australia meets PBS criteria.
Of course there is a range of other diabetic medications for most diabetics - but moot point because as already stated,Ozempic is only for those for whom oral medication is insufficient, not diabetics who are controlled well already.
as I said before, yes IMO while there is a scarcity, people who are obese, unless dangerously morbid obesity should not be requesting private scripts and taking supply from medically neccesary use.
And of course also prescribers should not be agreeing to write such scripts.
I don't think I have been subtly saying that, was quite clear and upfront about it.
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Just tonight, saw a news report of 'ozempic babies' ~ unanticipated when taking the drug for weight loss and who had experienced infertility and treatments. There was a warning in the report that the drug may make birth control less effective as well. And, the word is being spread via social media.
~imagine there may be a building demand for this as an off-label use.
So, I wanted to come back to the question in the title: is it ethical for non-diabetics to use the drug?
-- note; shortage is not a question of the op, but has been raised on discussion, as have other points. Good discussion.
If a drug is authorized and legal to prescribe, then it is ethical to work with doctors to determine appropriate treatments... including these drugs which have been extended for conditions beyond diabetes, with other conditions being considered.
During and post-pandemic there have been many drug shortages. Sometimes alternatives are available, sometimes not. The authoroties can set priorities, but in the case of these drugs they have not restricted use to only diabetics. Seems like a moot point atp.1 -
Adventurista wrote: »Just tonight, saw a news report of 'ozempic babies' ~ unanticipated when taking the drug for weight loss and who had experienced infertility and treatments. There was a warning in the report that the drug may make birth control less effective as well. And, the word is being spread via social media.
~imagine there may be a building demand for this as an off-label use.
So, I wanted to come back to the question in the title: is it ethical for non-diabetics to use the drug?
-- note; shortage is not a question of the op, but has been raised on discussion, as have other points. Good discussion.
If a drug is authorized and legal to prescribe, then it is ethical to work with doctors to determine appropriate treatments... including these drugs which have been extended for conditions beyond diabetes, with other conditions being considered.
During and post-pandemic there have been many drug shortages. Sometimes alternatives are available, sometimes not. The authoroties can set priorities, but in the case of these drugs they have not restricted use to only diabetics. Seems like a moot point atp.
"The authoroties can set priorities, but in the case of these drugs they have not restricted use to only diabetics. Seems like a moot point atp." - this is not strictly true, at least not worldwide. The authorities don't regulate off label usage of medications, and, at least in the US at this time, they cannot "drug ration". It's first come first serve, regardless of why you use the medication. Even if it's just to flush it down the toilet, you can do that. Insurance companies don't cover a drug if it's been prescribed off label, but off label prescriptions are ENTIRELY at the doctor's discretion. This is why "doctor shopping" is a thing.1 -
@sollyn23l2 ~ agree about off label and doctor shopping, insurance coverage and all that... i was surprised to hear the news report they called 'Ozempic babies' word of which is spreading via social media... so i speculate this will create yet another demand for off label use.
I am not sure how distribution of available supplies is made in the US, in regular times or deemed emergencies, but have personally experienced inaccessabilty because the medication was reserved for others.
For Ozempic and Wegovy (and other names of these meds?) I am not aware of any current restrictions, so continue to believe, if it is approved and legal, then not a moral/ethical failure to take the drug.
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There is "slack" in the system that can be tapped to deal with real medical necessity if there really exists no alternative for a specific patient.
I am more cynical than most, I guess.
If doors were falling out of the sky and people were dying the shortage would quickly become counterproductive and stricter allocation would take place.
The shortage is currently great for business and the scarcity and inconvenience generates buzz, interest, and good publicity.0 -
The alternative for the diabetic patients is insulin or not achieving good blood sugar control or putting up with side effects of oral medication.
( of course most diabetics don't have side effects from oral meds but inability to tolerate oral meds is a PBS criteria for Ozempic. )
Regardless of what reasons are behind the shortage ( and I think it is a simple demand outstripping supply thing) the reality for diabetic patients is a shortage.1 -
This dichotomy seems a little weird to me, contrasting obese people taking Ozempic vs. diabetic people taking it.
Yes, those are two different conditions, but in the Venn diagram there's significant overlap. Supposedly around 30% of overweight people are diabetic, and around 85% of diabetics are overweight. Since these are possibly dimensions of metabolic syndrome, it seems no big surprise if quite a few in that overlap also have heart disease of some type, fatty liver, fertility problems, and probably some other conditions that tend to co-exist with metabolic syndrome, and that may ultimately prove to be improved by taking the GLP-1 drugs.
I understand allocation concerns in a time of shortage, I do. But it seems like the bigger concern would be people taking the drugs who are "only" overweight, or who aren't even overweight but want a weight loss drug purely for aesthetic reasons. (I don't know how often that actually happens. I know there was some media hand-wringing about celebrities or other elites hogging up GLP-1 drugs to look cuter, but I don't know whether there was any substance to the rumor.)1 -
Re: Drug manufacturers and unholy levels of profiteering
https://fortune.com/europe/2024/03/28/ozempic-maker-novo-nordisk-facing-pressure-as-study-finds-1000-appetite-suppressant-can-be-made-for-just-5/1
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