I am glad you dove into this, and look forward to reading the rest of the series. I was so utterly disgusted when I read about this. But I was also too angry - as someone who has had one of these surgeries, and also as someone who took Ozempic ONE time (and only one time because the side effects were that horrid) - to even think straight.
Thanks for this special edition. I knew it was bad when I saw the press release circulating but didn't realize how bad. This brief intro reads like a who's who of who wants to eliminate a certain subset of children from the planet. :(
I was expecting this. I'm sure you'll dig into the fact that just 5 years ago, the AAP put out guidelines that told pediatricians to stop telling children and teens to lose weight and instead, in a section called "Evidence-based Management Strategies," admitted that dieting doesn't work, that family meals help encourage healthier eating, that weight talk and teasing - especially from families - does long term damage to both mental and physical health, and that encouraging a positive body image promotes long term mental and physical health and a reduced risk of eating disorders.
In other words, they pushed doctors to accept HAES, although they didn't call it that, because the medical world STILL has a knee-jerk reaction to HAES with false beliefs that it "encourages ob*sity" (an absurd and stigmatizing phrase), promotes unhealthy lifestyles (when it does the opposite), and claims that "fat people are automatically healthy" (which, really, tells on how many doctors assume not-fat people are automatically healthy).
Frankly, I'm furious. The diabetes drug being pushed as a weight loss cure is a dangerous drug for -diabetics- and doesn't magically become safe when used for weight loss. The WLS industry is out of control. They used to deny WLS to people with eating disorders and who were under 18, but the call of the dollar sign has shoved that out of the way, based on half-assed studies that STILL don't show proper long term safety. We don't know - and won't know for decades - the long term health results of a 15-year-old who gets this surgery *while their body is still developing*. What will happen when they're 50? Will they even live until 50? Nobody knows.
This is horrifying and terrifying. Being fat does not kill children. Eating disorders kill children. Drugs and surgery that seriously injure and kill adults isn't going to be magically safe for teenagers. The AAP has put money before the lives of children.
It's so horrifying and terrifying... and deadly :(
we're having such issues with drug shortages right now, too. I heard that someone who is taking one of these meds for Actual Diabetes can't get their meds because the pharmacy keeps selling out-- because of the increase in weight loss scripts. So we're prescribing entirely unnecessary (and very likely quite dangerous) meds for no medical reason, which isn't just hurting the non-diabetic fat adults and children taking meds for no medical reason, but it's also hurting diabetics who now can't access the meds they need to manage their ACTUAL medical conditions.
This is the literal opposite of "do no harm." This is yet another way the healthcare system is absolutely crumbling, all in the name of the next quarter's profits.
It's really a bad med for diabetics. Most medications for diabetes have their downsides, although they range from mild to life threatening. For example, metformin has milder side effects (some people experience GI problems; it can be deadly only in one particular circumstance) and the older sulfonylureas mainly have a risk of hypoglycemia. The TZDs aka Glitizones are mostly gone; only Avandia is still available in the US, due to the dangers of liver and heart failure.
I've said it before and I'll keep saying it: A drug that works by forcing the pancreas to work harder is not the best idea for non-diabetes reasons, and is iffy for diabetes use in general. That it comes with an increased risk of pancreatitis *in diabetics* and may increase the risk of thyroid cancer says that a lot of people will be needlessly suffering from this med. I frequently wonder how many people will die before it finally gets pulled off the market.
Really glad to see you say this. And really sad that it has to be said.
I wondered about the logic of making a struggling organ struggle even harder, in terms of long-term success rate. I worry that this is the natural result of the industry getting most of its approvals based on very short-term data: we've now simply stopped seeing ourselves in 5 years. (Or, rather, doctors and pharma companies have.)
I do think the newer meds are real bad news, too, but I can't fault anyone taking them. There may well be a reason they're not on a different med or combo of meds. Of course, I also wonder how many doctors are prioritizing the wt loss aspect of it rather than the long-term diabetes management aspect of it when choosing a medication. It's probably most likely that the shiny new drugs have fresh-faced reps shilling those drugs with the finest of lunches and sports ball tickets.
When my partner was diagnosed with t2d, his A1c was high, but not "get thee to a hospital" high. I think his fasting glucose was just under 300 every time it was taken. He was immediately put on xigduo (a combo of metformin and the new med dapagliflozin). He had insurance at the time, so he just took it without questioning (when I read the side effects, I was pretty worried). Once he lost insurance and the price tag is about $1k/month (or $500 with goodrx), he stepped down to metformin alone, and his blood sugar is just as controlled, with fewer POTS flareups and no worry of Fournier gangrene. Plus it's $15 for a 3 month supply, and he has no serious side effects taking it.
I'm 99% sure that super pill was the first thing he was prescribed because the drug rep was in there regularly, and when he was first prescribed it, he walked out with a 6 month supply of samples and a free glucose meter.
Thank you for this Ragen, it’s so disturbing (yet entirely unsurprising) that these guidelines have come out. Especially in light of the Wegovy ‘developments’. UGH. Have written a little bit for my newsletter tomorrow and will link back to this information - thank you for taking the time to put it together xx
This is horrifying, even just the list of authors and their conflicts! I feel so helpless... is there anything at all that i can do besides join ASDAH??
I also cannot validate the nova nordisk donations/partnership w American academy of pediatrics. The openpayments link posted in comments is dead link.
Would love a real refence if anyone can validate otherwise ill have to assume its not true… searched the AAP website and saw no donations from them (nova nordisk) either
I am glad you dove into this, and look forward to reading the rest of the series. I was so utterly disgusted when I read about this. But I was also too angry - as someone who has had one of these surgeries, and also as someone who took Ozempic ONE time (and only one time because the side effects were that horrid) - to even think straight.
Thanks for this special edition. I knew it was bad when I saw the press release circulating but didn't realize how bad. This brief intro reads like a who's who of who wants to eliminate a certain subset of children from the planet. :(
Wow. WOW! This is so disturbing. My heart hurts for the children who will be hurt by this. Thanks so much for the work you're doing to educate HCWs!
I’ve shared to Twitter and Facebook. Thanks for this excellent response to the horrific guidelines.
I was expecting this. I'm sure you'll dig into the fact that just 5 years ago, the AAP put out guidelines that told pediatricians to stop telling children and teens to lose weight and instead, in a section called "Evidence-based Management Strategies," admitted that dieting doesn't work, that family meals help encourage healthier eating, that weight talk and teasing - especially from families - does long term damage to both mental and physical health, and that encouraging a positive body image promotes long term mental and physical health and a reduced risk of eating disorders.
In other words, they pushed doctors to accept HAES, although they didn't call it that, because the medical world STILL has a knee-jerk reaction to HAES with false beliefs that it "encourages ob*sity" (an absurd and stigmatizing phrase), promotes unhealthy lifestyles (when it does the opposite), and claims that "fat people are automatically healthy" (which, really, tells on how many doctors assume not-fat people are automatically healthy).
Frankly, I'm furious. The diabetes drug being pushed as a weight loss cure is a dangerous drug for -diabetics- and doesn't magically become safe when used for weight loss. The WLS industry is out of control. They used to deny WLS to people with eating disorders and who were under 18, but the call of the dollar sign has shoved that out of the way, based on half-assed studies that STILL don't show proper long term safety. We don't know - and won't know for decades - the long term health results of a 15-year-old who gets this surgery *while their body is still developing*. What will happen when they're 50? Will they even live until 50? Nobody knows.
This is horrifying and terrifying. Being fat does not kill children. Eating disorders kill children. Drugs and surgery that seriously injure and kill adults isn't going to be magically safe for teenagers. The AAP has put money before the lives of children.
It's so horrifying and terrifying... and deadly :(
we're having such issues with drug shortages right now, too. I heard that someone who is taking one of these meds for Actual Diabetes can't get their meds because the pharmacy keeps selling out-- because of the increase in weight loss scripts. So we're prescribing entirely unnecessary (and very likely quite dangerous) meds for no medical reason, which isn't just hurting the non-diabetic fat adults and children taking meds for no medical reason, but it's also hurting diabetics who now can't access the meds they need to manage their ACTUAL medical conditions.
This is the literal opposite of "do no harm." This is yet another way the healthcare system is absolutely crumbling, all in the name of the next quarter's profits.
makes my blood boil.
It's really a bad med for diabetics. Most medications for diabetes have their downsides, although they range from mild to life threatening. For example, metformin has milder side effects (some people experience GI problems; it can be deadly only in one particular circumstance) and the older sulfonylureas mainly have a risk of hypoglycemia. The TZDs aka Glitizones are mostly gone; only Avandia is still available in the US, due to the dangers of liver and heart failure.
I've said it before and I'll keep saying it: A drug that works by forcing the pancreas to work harder is not the best idea for non-diabetes reasons, and is iffy for diabetes use in general. That it comes with an increased risk of pancreatitis *in diabetics* and may increase the risk of thyroid cancer says that a lot of people will be needlessly suffering from this med. I frequently wonder how many people will die before it finally gets pulled off the market.
Really glad to see you say this. And really sad that it has to be said.
I wondered about the logic of making a struggling organ struggle even harder, in terms of long-term success rate. I worry that this is the natural result of the industry getting most of its approvals based on very short-term data: we've now simply stopped seeing ourselves in 5 years. (Or, rather, doctors and pharma companies have.)
I do think the newer meds are real bad news, too, but I can't fault anyone taking them. There may well be a reason they're not on a different med or combo of meds. Of course, I also wonder how many doctors are prioritizing the wt loss aspect of it rather than the long-term diabetes management aspect of it when choosing a medication. It's probably most likely that the shiny new drugs have fresh-faced reps shilling those drugs with the finest of lunches and sports ball tickets.
When my partner was diagnosed with t2d, his A1c was high, but not "get thee to a hospital" high. I think his fasting glucose was just under 300 every time it was taken. He was immediately put on xigduo (a combo of metformin and the new med dapagliflozin). He had insurance at the time, so he just took it without questioning (when I read the side effects, I was pretty worried). Once he lost insurance and the price tag is about $1k/month (or $500 with goodrx), he stepped down to metformin alone, and his blood sugar is just as controlled, with fewer POTS flareups and no worry of Fournier gangrene. Plus it's $15 for a 3 month supply, and he has no serious side effects taking it.
I'm 99% sure that super pill was the first thing he was prescribed because the drug rep was in there regularly, and when he was first prescribed it, he walked out with a 6 month supply of samples and a free glucose meter.
these drug companies are absolutely incorrigible.
Ragen - Great work! I'd be interested in the reactions you got at the Grand Rounds.
This is horrifying, even just this list of authors and their obvious conflicts of interest!! I feel so helpless. What can I do? Besides join ASDAH??
Thank you for this Ragen, it’s so disturbing (yet entirely unsurprising) that these guidelines have come out. Especially in light of the Wegovy ‘developments’. UGH. Have written a little bit for my newsletter tomorrow and will link back to this information - thank you for taking the time to put it together xx
This is horrifying, even just the list of authors and their conflicts! I feel so helpless... is there anything at all that i can do besides join ASDAH??
Hi Iona. The site I use to look these things up is openpayments.cms.gov
If that wasn't what you meant just let me know and I'll be happy to help however I can!
~Ragen
I also cannot validate the nova nordisk donations/partnership w American academy of pediatrics. The openpayments link posted in comments is dead link.
Would love a real refence if anyone can validate otherwise ill have to assume its not true… searched the AAP website and saw no donations from them (nova nordisk) either
Thanks
They've updated the page since this writing - here is the page as of 11/16/2023
https://web.archive.org/web/20231205025242/https://www.aap.org/en/philanthropy/corporate-and-organizational-partners/current-partners/