Happy Columbus Day, if we’re still allowed to credit the old, Italian white guy with his discovery of the New World anymore, even. It’s now one of those Federal holiday Mondays, but with the government shut down for nigh on to two weeks and many government employees on furlough, what the hell does that even mean? All I know is the bond market is closed, but the stock exchange is still open. But I digress!
GLP-1s in the News
It’s been another banner week in the ever-expanding GLP-1 universe, where no human condition is too ordinary to medicate. As I’ve mentioned in prior issues of Peptide Purgatory, Mounjaro and its GLP-1 cousins have been thrown at such diverse off-label conditions as erectile dysfunction and glaucoma. The latest frontier? Osteoarthritis and addiction — two very different ailments now united under the Church of the Weekly Injection. I can’t decide whether to laugh, roll my eyes, or start a punch card for frequent flyers in the Ozempic Rewards Program. Either way, Big Pharma seems determined to cure us all — by keeping us customers forever.
Following the featured GLP-1 story, I’ll update you on my personal progress paddling upstream against Type 2 diabetes and its band of health thieves. I’ve added a SGLT-2i drug, Farxiga, to the polypharmacy mix, which should affect glucose, weight, and progression of chronic kidney disease.
This week’s Bullshit Corner flings a load at the Big Pharma sponsored characterization of obesity as a “chronic, relapsing disease.” Leave it to the marketing folks at Eli Lilly and Novo Nordisk, and you’re sure to get some innovative bullshit aimed at expanding market penetration and increasing market share. This one is a stroke of genius!
Now, sit back and learn how GLP-1s can serve as an oil can for your creaky knees and cure your heroin addiction in one swell foop!
Addicted to the Cure
GLP-1 receptor agonists have gone from treating diabetes to treating everything. The latest expansions in their medical empire? Osteoarthritis and addiction. Yes, you read that right — one drug to ease your creaky knees and quiet your inner demons.
At the Congress of Clinical Rheumatology West, Rush Medical College’s Anne Marie Malfait called osteoarthritis a “barren field,” lamenting the lack of disease-modifying therapies. So, the industry reached into its bulging bag of pharmacologic tricks and pulled out the usual suspect: semaglutide. The STEP-9 trial found that weekly injections of Ozempic relieved OA knee pain fast — faster than expected from weight loss alone.
Cue the headlines about a “game-changer.” The rheumatology crowd swooned, the financial analysts perked up, and another corner of medicine joined the GLP-1 congregation.
But Caveats Apply
But even Malfait sounded a cautionary note: patients lose fat and muscle, and when they stop the drug, the weight rebounds “rapidly.” No one knows whether the returning mass is fat or muscle — only that it comes back with a vengeance. Some reports even found more joint replacements among GLP-1 users. The miracle therapy might relieve pain, yes — but it might also weaken the very muscles that stabilize the joints.
Fast-forward to Nashville, where addiction specialist Steven Klein, MD, PhD, was making the same pitch at an addiction-medicine conference. Small studies suggest GLP-1s can reduce cravings for opioids and alcohol, blunt reward signals in the brain, and even halve rates of intoxication or overdose. It all sounds like the next great crusade in pharmacologic salvation — until you notice the price tag and the irony.
And There’s That Little Issue of GLP-1 Cost
“Most insurers don’t even cover GLP-1s,” Klein admitted, while noting that the people most affected by addiction are often the least able to afford them. At $1,200 a month, semaglutide makes methadone look like pocket change.
And the comparison isn’t accidental. In the 1970s, methadone was hailed as a breakthrough for heroin addiction — a way to stabilize lives and reduce harm. It worked, to a point. But it also created a state-sanctioned dependency that patients could never truly escape. GLP-1s risk doing the same thing, wrapped in a sleek Novo Nordisk logo instead of a government clinic.
We’re told this is “modern addiction medicine,” but it looks suspiciously like the same old business model: take a substance people can’t quit, make it respectable, and charge them forever for the privilege of staying hooked.
Addicted to the GLP-1 Cure
It’s the ultimate irony — treating addiction by addicting people to the treatment. The dopamine hit once came from alcohol or heroin; now it’s the promise of “Ozempic Nation,” where every human frailty has a GLP-1-shaped solution. Feeling hungry? Inject. Knees hurt? Inject. Feeling blue, bloated, or bored? Inject.
And when you stop? The pounds, pain, and cravings return — a perfectly engineered form of relapse that guarantees the next refill. It’s less about healing and more about monetizing chronicity.
The same crowd that once swore it wanted to end the opioid crisis has now built a safer, cleaner, more insurable version of it — a new dependency, administered weekly, clinically coded, and handsomely reimbursed.
Mounjaro Turkey Health Update
Before we get to this week’s Bullshit Corner, I’ll give you a brief update on my health travails and associated stats. As I mentioned last week, I initiated Farxiga for its proven ability to forestall the progression of chronic kidney disease (CKD). My CKD is at Stage 3A (A1) meaning my eGFR is between 45 and 60 and I excrete negligible protein in my urine. I don’t want that to worsen to Stage 2, which enters dialysis territory.
Farxiga also facilitates weight loss (to a much smaller extent than Mounjaro), so I want to be careful to consume enough calories, particularly protein, to not waste away. I’m trying to stick with 2,350 kcal/day, including 120 g of protein. Protein is a balancing act between maintaining kidney health and promoting strong musculature, the stated number being a negotiated settlement between the two target numbers.
The Main Target
Farxiga’s original purpose was to control blood sugar, so I’ll be watching the glucose more carefully, especially given my increase in carbohydrate intake. Although I am carb sensitive, I have noted that spikes are muted and fall more quickly for the week I’ve been on the drug.
I completed the third of three iron infusions on Friday. Dr. Macallan will be reviewing labs in six weeks to determine how well the IV iron worked and where we go from here.
- Body Weight: 172.8 lbs (78.5 kg) – down 1.4 lbs
- Fasting Avg. Glucose: 108 mg/dL (6.0 mmol/L) – down 4 mg/dL
- Average Glucose (Stelo sensor): 112 mg/dL (6.2 mmol/L) – up 3 mg/dL
- Current HbA1c (17 September): 5.5% (37 mmol/mol)
Bullshit Corner: The Disease Formerly Known as Lunch
Somewhere between the first Big Mac and the first GLP-1 injection, overeating got reclassified as a chronic, relapsing disease. That’s right — according to the World Health Organization, the American Medical Association, and the army of pharma-funded “obesity specialists,” your waistline is now a lifelong affliction. Forget self-control, environment, or lifestyle. You’ve got a disease, pal — one that just happens to require a lifetime subscription to a refrigerated injectable.
The timing is no coincidence. Once obesity was officially stamped “disease,” the industry suddenly had a moral imperative to treat it — endlessly. GLP-1 receptor agonists like Ozempic, Wegovy, and Mounjaro rushed in to fill the void, with SGLT-2 inhibitors like Farxiga and Jardiance waiting eagerly in the wings, humming show tunes and practicing their choreography. After all, what’s a chronic, relapsing disease without a catchy jingle and a dance troupe of smiling diabetics bouncing around a football stadium, waving pom-poms with a big “J” on their sweaters?
The “relapsing” part is the marketing masterstroke. If you regain weight after stopping the drug, it’s not that your appetite returns or your habits resume — no, the disease relapsed. Cue the refill. It’s the perfect setup for a lifelong customer base: a condition that can’t be cured, only managed with expensive injections and cheerful commercials reminding you that your suffering is a medical opportunity.
Even the surgeons have joined the chorus line. “Bariatric surgery” has become “metabolic surgery,” because resecting your stomach sounds so much nobler when you frame it as treating a systemic disease. And now, as Hoyt et al. (2024) describe in Diabetes, Obesity & Metabolism, there’s “duodenal mucosal resurfacing” — an endoscopic way to ablate and regrow part of your intestine, because apparently your duodenum caught the chronic, relapsing bug too. (Designer duodenums. Who knew?)
Sure, genes influence weight — just as they influence height, hairline, and whether you can sing in key. But that doesn’t make overeating a pathology any more than a karaoke addiction makes you tone-deaf. Predisposition isn’t destiny. Yet this new dogma insists you’re powerless without pharmaceutical salvation, preferably dispensed once a week through a very expensive pen.
So the next time you see those jubilant, heavyset cheerleaders pirouetting to celebrate their “better blood sugar numbers,” remember: they’re not just selling medication. They’re selling the notion that obesity is an incurable condition — conveniently treatable with a lifelong soundtrack and a copay card.
In reality, obesity isn’t chronic or relapsing. It’s responsive. You change the inputs — food, movement, lifestyle — and the outputs follow. But “responsive” doesn’t move product. “Disease” does.
So go ahead, sing along: “Go, Jardiance, Go!” — just don’t forget who wrote the lyrics, and who’s cashing the royalties.
That’s a Wrap for This Week
I hope you enjoy my weekly curated foray into the GLP-1 world, where I try to give you a fresh perspective that diverges from the usual social media cheerleading. I try to keep it balanced, with an undercurrent of hypocrisy, at once disdaining Big Pharma, but presuming to benefit from a couple of its nontrivially priced products, namely Mounjaro and Farxiga. [Insert huge Tom Selleck sigh here.]
Some days I wonder if the drug companies even remember what “cure” means. The new business model is simple: medicate, manage, repeat — preferably until the warranty runs out. It’s not about getting well; it’s about staying billable. The real chronic condition isn’t obesity, arthritis, or addiction — it’s dependence on the people selling the fix. And if that leaves a bad taste in your mouth, don’t worry. Big Pharma’s probably working on a mint-flavored version — available soon by prescription only.
For an annotated catalog of all my Peptide Purgatory and Mounjaro updates, visit my Mounjaro Update Catalog page.
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