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Notes -
Agree it's what it would require.
It'd be interesting because I think the result would actually be to bring America to EU style price controls. I imagine the intelligensia is more in favour of the socialist price controlled system than the US one. The big loser would be pharma RnD (and stock prices). It is crazy the extent to which the US subsidises pharma RnD for the rest of the world. I saw a graph showing pharma investment returns slowly projecting down over time, reaching 0% around 2020 then going negative. I think this is based off a low-hanging-fruit theory and the data supports it.
On Ozempic I am rather bearish. There are very few buttons in the body which can be pushed for gain without many side effects. It sort of violates a no-free-lunch theorem (which I do believe in) regarding pharmacology. I think over time many people will decide the side effects aren't worth the benefits for them and the positive effects are actually quite modest when viewed in their totality.
I have actually seen some things which violate this no-free-lunch recently. Follistatin gene therapies appear to boost muscle mass, QoL and maybe longevity (30% boost in mice). This counts for me; even though it's not a drug it's a single protein and it's impressive you can get so many positives boosting one thing. There will likely be others along this line, but I don't imagine too many being available.
That seems too strong. A no-free-lunch theorem for pharmacology might make sense for things that we expect to have been already optimized by evolution. Maintaining a good weight in an environment of caloric abundance and whatever else is causing the obesity crisis (corn syrup? microplastics? the chemicals they put in the water to turn the frogs gay?) is probably not one of those things.
It's more that there aren't buttons you can push in without affecting everything else. The signalling systems aren't anything like a computer where there is one variable for each discrete thing. If a molecule has one major effect you can ride off and only a few other minor effects you are very lucky. Often molecules have different major effects in different parts of the body because their release is isolated. But they usually also just regulate multiple important things simultaneously, so with GLP-1's you see a lot of GI side effects. You're not pushing a button that decreases appetite, you're pushing a button that greatly upsets the entire downstream digestive process.
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