The Wednesday Wellness threads are meant to encourage users to ask for and provide advice and motivation to improve their lives. It isn't intended as a 'containment thread' and any content which could go here could instead be posted in its own thread. You could post:
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Requests for advice and / or encouragement. On basically any topic and for any scale of problem.
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Updates to let us know how you are doing. This provides valuable feedback on past advice / encouragement and will hopefully make people feel a little more motivated to follow through. If you want to be reminded to post your update, see the post titled 'update reminders', below.
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Advice. This can be in response to a request for advice or just something that you think could be generally useful for many people here.
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Encouragement. Probably best directed at specific users, but if you feel like just encouraging people in general I don't think anyone is going to object. I don't think I really need to say this, but just to be clear; encouragement should have a generally positive tone and not shame people (if people feel that shame might be an effective tool for motivating people, please discuss this so we can form a group consensus on how to use it rather than just trying it).
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I did my first solo post-grad teaching session! I was anxious as hell, to the point where I woke up at 5 am with palpitations and couldn't go back to sleep, but it worked out and my talk was well received. More than a fear of public speaking, I've always been on edge about more senior doctors deciding today's the day to pimp me with keen/absurd questions, but thankfully I knew enough not to make a fool of myself.
If you're curious, the study I dissected was on novel evidence suggesting semaglutide decreased incidence of Alzheimer's. I happened to discuss other related studies that found it effective in many, apparently unrelated conditions ranging from Parkinson's to gambling addictions, though you can always read Scott's post on semaglutide instead. And a cheap and cheerful cost-benefit analysis from the perspective of the NHS, because I need to pad out the runtime somehow.
Mechanistically, this seems plausible, given the evidence implicating insulin resistance and systemic inflammation in neurodegenerative diseases. Was that all, or did the study incorporate epidemiological evidence?
https://alz-journals.onlinelibrary.wiley.com/doi/10.1002/alz.14313
It was a target trial emulation, using over a hundred million patient EHRs to find 1.1 million eligible ones.
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Wait. The NHS thinks semaglutide is cost-effecrive? In what formulation? Could you share the math/link with us?
https://www.nice.org.uk/guidance/ta875/documents/final-appraisal-determination-document
Here's the original analysis that NICE put out, and more recently, it's been approved for morbid obesity with a bunch of strict criteria and not a first-line treatment as far as I'm aware. More of a backstop where all else failed. That's just for obesity though, it's somewhat easier to get for diabetes if memory serves. I believe it's all injectable, or at least that's what I saw in the analysis.
The UK literally has an organization called NICE?
It's actually "!NICE", pronounced with an alveolar click.
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"Cost-effective" does not mean it saves more money that it costs, if that's why you're surprised. It means that its net cost/benefit ratio meets a certain GBP/QALY threshold.
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