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greyenlightenment  investments: META/FBL, TSLA, TQQQ, TECL, MSFT ...  1yr ago (npr.org)   2623 thread views

Eli Lilly releases data for a new weight-loss drug to tackle obesity : Shots - Health News : NPR

npr.org

This drug is a true gamechanger

In the SURMOUNT-1 study, people who took the highest dose of tirzepatide, most of whom had a BMI of about 30 or higher but did not have diabetes, lost about 21% of their body weight during the 72 week study. As researchers point out, for people who have bariatric surgery, typical weight loss is about 25% to 30% of their weight, one or two years after the surgery. In the tirzepatide study, 36% of people taking the highest dose lost 25% or more of their body weight.

this is comparable to bariatric surgery

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As NPR has reported, when patients can't afford to stay on obesity medications, they are likely to gain much of the weight back.

If I were Eli Lilly and Company, I would invest into food science, trying to make as many different hyperpalatable foods aimed at teenagers and young adults as possible. The more people have BMI of 30 by the time they are 30, the bigger the market for their drug is. Imagine the government first handing out food stamps to poor Americans, then paying for their obesity treatment via Medicaid.

I'd guess that if the drugs are really effective and the collective societal BMI starts going down, it eventually creates a feedback cycle where obesity generally becomes less and less acceptable and thus there's going to be less people having BMI 30 by 30.

Alternatively people are going to start pigging out even more because now calories are consequence-free until, miracle drug or no, something gives.

As I understand, the miracle drug in question is an appetite suppressant, not something that supercharges your metabolism like the drug in Doctorow's Makers.

Maybe one day, we'll get that crazy food pill thing like in Naruto where it instantly burns all your fat for a rush of energy.

Can't decide if I'm relieved or disappointed.

i doubt it. type 2 diabetes can be attenuated with diet modification yet society tolerates it. Down Syndrome is tolerated even though it can be prevented with prenatal screening.

Neither of those is a particularly good comparison. Down Syndrome is not something you can "fix" anyway, there's never going to be a miracle drug for it. Type 2 diabetes is not immediately visible (conditions like obesity that are visible make it more likely, but being obese does not guarantee you have diabetes and having diabetes does not necessarily mean you are obese).

What I mean here is that I suspect that simply having more obese people all around us has made us more tolerant of obesity in general (personally or in others) than we would be otherwise, or society would have been some decades past when obesity was less common, and having actually effective weight loss drugs available would then mean less obese people around us and the pre-00s greater-than-current disdain for obese persons returning.

I don't think this will change anything. Trans people, for example, are just 1% of population yet trans rights/inclusion has exploded

What do you mean by Down syndrome is tolerated? We do screen all pregnancies for Down syndrome and terminate pregnancy in case of positive test. Sometimes the screening test is not done or the test fails but those are exceptions and not the norm.

who is we? where? this is not true in the US. that is the decision of the mother.

It always should be. But the idea is that almost always the decision is made to terminate the pregnancy. That's the point of making the test. Maybe in some countries that percentage is still not sufficiently high due to poorly understood information and we should think how to improve that.

Who do you mean by "we"? My understanding is that the rate of abortions after testing for Down Syndrome vary pretty heavily from country to country (googling around, seeing USA around 67%, France around 77% and Denmark around 98%, though that's from 2011).

Though I guess the real issue here is referring to "society" tolerating something when of course what "society" tolerates varies a great deal from one part of the world to the other (for now, at least).

Down Syndrome is tolerated even though it can be prevented with prenatal screening.

Statements like this really make you appreciate how hard AI alignment will be. We can't even get humans to reliably differentiate between "prevent illness" and "kill sick people and replace them with healthy people".

Down Syndrome people aren't 'sick'. Having Down Syndrome is their default state. It's not a sickness, it's congenital.

Now, why are we equivocating between abortion and murder?

Alignment is easy. Agreement is hard. The Bailey is «aligning the AI to the generic mode of operation where it makes sure the user's intent is understood correctly and does not go all monkey's paw». The Motte is «having the AI align the future to your preference, very much not obliging the user when the instruction is against my preferences».

This is the general problem of politics.

Body-positive cultural genocide.

Are "whales" really where McDonald's makes its money, as if it's like a company putting out free-2-play games for PCs and smartphones? I remember the iconic message you'd sometimes see spelled out on those signs outside: "Over 1 Billion Served." I'd assume that McD's business model relies less on sporadic-yet-still-plentiful gluttons and more on the literal billions of average joes who might choose the convenience of a double cheeseburger, fries, and a drink at least every once in a while.

That said, I'll acknowledge that your basic point might still be right, that this might be at least a small disaster for certain parts of the food and drink industry.

"Billions served" wasn't about the number of unique customers. By the time they stopped posting the counter in the 90s, they were up to 100 billion. It was the number of orders served.

Even so, I think they didn't get to that number by skimming for the obsessives.

You don't have to be a whale to be a regular customer. A Big Mac, a small serving of fries and a diet soda is a perfectly cromulent lunch. A bit high in fats and tastes like nothing, but generally fine if you're an office worker. Hell, you can have the same setup for dinner and an Egg McMuffin Meal for breakfast and you'll be fine as a "thrice a day customer".

Of course, upgrading to medium fries adds 90 Cal per serving, a single packet of ranch is 110 Cal more, a small soda is 150 Cal, boom, you're eating 700 extra calories and putting on weight without being a "whale" that eats ten burgers every day. And that's without any other snacks and creamy sugary coffees the same person might have throughout the day.

but the way that their discounting/deals are structured suggests a keen awareness of this in practice

That wasn't my initial read of what the coupon books and occasional mobile discount appear to be for; I believe that's more to convince the semi-regular customers to find it worth coming to the store (given that they're basically 2/5ths off what a single person would want to buy). Sure, it's still perfectly possible to go full whale at that point, but I'm not sure what the amount of crosstalk is between coupon users and those who spend 40 for one big meal.

Or maybe those milkshakes are far more popular than I think they are, since that's probably the cheapest way to maximize calories.

The sheer difference in revenue between a 'twice a day' customer and a 'twice a year, when drunk'

There's a lot of middle missing in that statement; people who are too lazy or busy to pack a lunch or cook dinner tend to be people who visit fast food places semi-regularly. They're also the ones that respond well to those discounts. (Maybe it's a universal human experience to consider this a failure?)

I'm relatively certain that (though my sample size is small) with respect to "whales" the source of their size is diffuse factors and not from any one source in particular; I think packaged candy/chocolate/potato chip manufacturers will be most impacted because people don't need to re-buy them as much. Fast food tends to be people going from 0 meal to 1, less 1 meal to 2, so it's not "a magic drug that makes people stop going out to eat" and more "they only buy one meal's worth of food where they might otherwise buy 1.5-2x", thus they'll not likely be affected as much.

I think there's a large market of once a week customers (though I haven't gone to McDonalds in a long time.) Does McDonald's near you have a play gym? My mom would bring us there about once a week so that we could let out some energy.

It's an inexpensive meal for people who were running late and needed to get something on the way to work. Or couldn't go grocery shopping on the weekend due to a sick kid. The drive through has a huge appeal, especially when there's a one year old in the backseat.

I wouldn't eat at McDonalds (I can afford better options) but I can see the appeal. I would bet a large segment of the market is poorer families with young kids.

It's a disaster for weight loss industry . weight watchers, Adkins, nutrisystem, slimfast, and so on

These industries were never very large anyway (comparatively).

Now hold on, I'm pre-registering the prediction that it will have a tangible effect, but I'm skeptical it will be a wonder-pill that will send multiple industries into a downward spiral.

At least one industry (weight loss centres) is already feeling the effect:

https://www.cnn.com/2023/04/28/business/jenny-craig-weight-loss-ozempic/index.html

the drugs are expensive and the rollout will be slow. And even then, a 250+ lb person who slims 20% is still going to be eating a lot. Investing in Eli Lilly and and McDonald's mean I win either way

In the NEJM tirzepatide study, they reported a final fat-to-lean ratio of 0.7, which means that the subjects were still about 0.7/1.7 = 40% body fat.

That's why we need EMH to protect people from making simple mistakes like that. :)

Eli Lily can and will make good money on tirzepatide but it is a big company with tens of different drugs on the market. Some of them will be unprofitable which makes it hard to predict the final stock price of this company.

Also, it doubtful that it will make a noticeable dent in McDonald's profits. McDonald's is not the only fast food chain. People buy food in supermarkets too and throw out about half of it for whatever reason. It is very hard to predict what impact the appetite loss in a number of fat people will have.

Plenty of companies are already doing that. Doubtful that Eli Lilly's contribution would move the needle much.

By the way, do you have the same reaction to companies that produce cancer drugs -- that they should invest in causing as much cancer as possible to expand their addressable market?

Good question, thanks. I certainly have this reaction to companies that produce ART drugs: I would expect them to celebrate gay lifestyle and talk how the government should treat HIV in IV drug users "for free", but stay silent about distributing clean needles in safe injection centers or combating the overprescription of opioids.

I guess the difference between these two cases and cancer drugs is twofold:

  • obesity and AIDS are "vice" illnesses, while cancer is only partially so

  • cancer treatment either saves you or you die, you aren't expected to have regular chemotherapy for the rest of your life

cancer treatment either saves you or you die, you aren't expected to have regular chemotherapy for the rest of your life

Cancer treatment is extremely expensive and cancer patients (especially those caught after Stage I) are often medicalized for life even in the cases where they live for decades afterward.

Moreover what does the duration of the treatment matter? Why should the pharma company's incentives be different as between a therapeutic that is extremely expensive over the short term and a therapeutic that is moderately expensive over the long term, if the NPVs are the same?

Shouldn't your theory predict, for example, that pharma companies selling expensive therapeutics for lung cancer should oppose smoking cessation efforts?

They wouldn't do that because it would be so obvious conflict of interest that the outrage would follow and the government would simply shut the company or fined them billions.

We have done this to companies for much smaller conflicts of interests. For example, the company that misleadingly advertised opioids as non-addictive got liquidated (https://en.wikipedia.org/wiki/Purdue_Pharma).

Hmm... My model is a bit different.

I think it matters which individuals have control of these things and what their incentives are.

And my model is that if I'm a sociopathic CEO I really only care about maximizing the bottom line for the next few years.

I'm not going to bother to dump microplastics into the water supply because the ROI on the cancer rate increase is way too far in the future to benefit me.

cancer treatment either saves you or you die

The vast majority of cancer therapy will boost your expected lifespan on the order of months to a few years. Cures are quite rare and usually surgical in nature except for some slower growing cancers or newer immunotherapies.

Pharma companies just change their prices accordingly if you're only taking the drug for a few months. It's unfortunately arbitrary and pretty disconnected from actual benefit conferred to the patient.

TIL that "ART" in the context of medicine could mean either "assisted reproductive technology" (like IVF) or "antiretroviral therapy" (like HIV drugs). I feel bad for people with both HIV and fertility issues!

Invest in both McDonald's stock and Eli Lilly.

Literally was talking to a friend on what’s the indirect buy on these drugs. Said the exact same thing Pepsi and McDonald’s.

Wait, no. The point of these drugs is that they kill your appetite. McDonald's is going to get wrecked.

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