But a “microdose” that is essentially the starter dose (for example tirzepitide 2.5mg) may be effective for some people (especially for weight). Probably little risk, but uncertain benefit in comparison to standard dose escalation.

The microdosing question is interesting, hard to know what people even mean by that. Biokinetics of weekly dosing mean that a small enough micro-dose probably never reaches steady state and may be essentially homeopathic.

I sympathize with patients who resort to compounded versions in order to afford the medication. It’s an unclear marketplace though, and hard to know who to trust from the various online vendors.

Unlike the peptides discussed in the @erictopol.bsky.social article, there is very good safety and efficacy data for GLP1s for certain conditions (weight, MASLD, etc) and emerging data for others. The issue with GLP1s is cost and lack of insurance coverage.

If we adopted a true public option (expanded medicare), negotiatated drug prices, and regulated insurers stringently to spread risk (basically Denmark) we would likely spend half as much while covering everyone and no denials of care. Denmark notably has the highest citizen satisfaction ratings.

Why not both?

If @soundersfc.com move to Longacres we would give up our season tickets. We've been ticket holders since the 1st MLS season and that's a hard stop.

No parallels there. None at all.