This was sticking to the facts - this is original research into Sacks’ letters and unpublished writing. It’s for readers who read Sacks in the New Yorker and want to see another side of his life.
May be his pharmacy struggling with supply -- I hear lots of folks are titrating outside of the guidelines because they can't get the appropriate dosage.
I wish more folks would get comfortable crushing tablets and weighing out their own dosage on scales. It’s not that hard to cut tabs in half or crush two and make 3 doses out of those, then put them back into caps. Empty gelatin caps are cheap and easy to work with.
Should anyone have to do this? Of course not, but if the choice is between this or projectile vomit every waking hour, it’s not a hard choice IMO.
Lastly, I just wanted to take a moment to think about how useless pharmacies have become that they can’t actually do this for you anymore and literally just count out pills, or more realistically push a button on a machine that counts out the correct amount.
I agree with your general point, although (and it may not be the same everywhere, but is certainly true in the UK) Ozempic is supplied as a pre-filled pen injector that handles the dose for you, and is taken once a week - there are no markings for a half-dose (and the patient info sheet seems to suggest that a partial dose isn't possible)
Having taken it, I can say that attempting a half-dose of Wegovy pens would have wildly varying results. The smaller Ozempic pens can easily titrate down, but Wegovy pens are not at all designed for it.
Even some pills cannot be split really easily. One example I like to give is Vyvanse. It uses extended release balls that are not evenly distributed in terms of what they contain (I’m no expert here, just going off a doctor’s summary). The only way to properly split it is to pour it into a glass of water and let it dissolve, then take the percentage of the dosage that you need and consume that percentage of water before the contents settle and while they still remain in a well mixed suspension. The remainder of the dosage is essentially no longer any good by virtue of being inactivated over time by being in the water and must be discarded.
My understanding of Vyvanse is that it uses metabolic mechanisms in order to time the release of the drug which helps to prevent abuse. I'm far from a doctor however.
vyvanse relies heavily on the second pass effect to activate, which is what makes it resistant to abuse. it also means if you don’t make sure to eat lunch the second half of the dose doesn’t kick in until supper and you end up being awake until 4-5am. ask me how i know…
don't some medicines have a time delay release mechanism that this would defeat? getting that much of a dose of some medicines all at once wouldn't be ideal I'd think. caveat emptor and all that.
The point you're making seems similar to the argument that GMOs have a lot in common with earlier selective breeding techniques.
I think the difference is that while historically grandma or restaurant chefs were biased towards repeatable, appetizing products, they weren't using focus groups and industrial/scientific methods to get there. I.e. you can't send your grandma to General Mills and have her create Spaghetti-Os.
There seems to be medical consensus that "ultraprocessed" food, as squishy as that term is, is obesogenic. Part of that may be influenced by the marketing and marketing science behind the food as well, but there seem to be human and animal studies that support that our food has changed.
> they weren't using focus groups and industrial/scientific methods to get there. I.e. you can't send your grandma to General Mills and have her create Spaghetti-Os.
But that's exactly what I'm pushing back against -- you've never needed focus groups or fancy methods to figure out what the tastiest amount of sugar or salt or fat is for a recipe. It's remarkably easy to figure out on your own. Focus groups just serve as objective evidence over the opinion of a single chef, and can reveal that different markets prefer slightly different ratios (e.g. Brazilians prefer sweeter desserts than Americans). And Spaghetti-O's are just spaghetti in tomato sauce in a different shape, for those who prefer their tomato sauce sweeter rather than saltier, like kids do -- and of course grandma made spaghetti.
> There seems to be medical consensus that "ultraprocessed" food, as squishy as that term is, is obesogenic.
There isn't even remotely consensus on what the causality is here -- it's one of the thorniest problems to untangle. But the idea that tastier food is contributing seems extremely far-fetched. Look at sugary soft drinks first of all, look at decreased physical activity, look at changing cultural norms around portion sizes and body weights, look at the reduction of fats that have raised carbohydrate intakes.
Snickers bars have been around since 1930. People in the 1950's were eating every kind of supposed "hyperpalatable food" and obesity was a minor issue. So the idea the flavor is somehow new or responsible for health issues just doesn't hold up to scrutiny.
They did it in a metabolic ward, so about as controlled as you can get in a diet study. Created 2 diets that were matched - so caloric density and macronutrients of the food were the same. Let people eat as much of the food as they wanted, and the ultraprocessed group consumed 500 calories per day more.
Thanks for linking that -- it's a rigorous study for what it attempts.
However, there are two fatal flaws. The first it that it neither controls for nor even measures the glycemic index of the two diets, and the second is that it neither controls for nor even measures the vitamins and minerals in either diet.
The major critique around dividing foods into "unprocessed" vs. "ultraprocessed" is that high-GI foods like rice and raisins are considered unprocessed, while lower-GI foods like pasta (and zero-GI foods like hamburger patties) are considered ultra-processed. And in this study, the authors could assemble whatever GI they wanted for each diet, and never revealed it.
But there's a clue -- in the study, the additional calorie intake and weight gain in the "ultraprocessed" diet is entirely consistent with a vastly higher GI of that diet, which is almost certainly indicated by the nearly doubled non-beverage energy density (2.147 vs 1.151, Table 1).
Which means the study is actually entirely consistent with the idea that higher-GI foods lead to weight gain, and that "ultraprocessing" itself is entirely irrelevant.
The study’s author, KevinH_PhD is a good follow on Twitter and generally responsive to his critics there:
“Glycemic index was calculated to be ~52 for both diets with respect to oral glucose. There were no significant differences in CGM determined mean glucose or glycemic variability as assessed by glucose CV.”
I think this underestimated the abilities of the “common white collar criminal” — there are lots of chat logs of SBF and his coconspirators saying essentially “we’re doing fraud.”
Common white collar criminals say “let’s take this offline” in their chat transcripts.
Well there’s another high-profile case in the works where there are lots of transcripts of the coconspirators saying (occasionally explicitly), “we’re doing fraud.”
Tetlock’s Superforecasters performed better than experts, though:
>In the Good Judgment Project, "the top forecasters... performed about 30 percent better than the average for intelligence community analysts who could read intercepts and other secret data"
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