Personal essays and analysis on Ozempic, weight-loss drugs, and the culture they created. Published intermittently. Always cultural, never prescriptive. Subscribe to the monthly letter to get the next one in your inbox.
The cultural shorthand started in late 2024. Patients report blunted cravings — for food, alcohol, shopping, gambling, even Instagram. The mechanism is real: GLP-1 receptors are densely expressed in reward circuits. Here is the honest cultural read on what is signal and what is anecdote.
Read the essay →Tirzepatide wins the scale by 6.5 points and it isn’t close. Semaglutide owns a placebo-controlled outcomes trial in 17,604 patients. Almost every version of this comparison drops one of those two facts.
Read more → Analysis · Market & pricingFor two years the gray-market discount ran roughly ten to one. In 2026 it’s closer to two to one — and the reason isn’t the crackdown. It’s the drugmakers cutting their own cash prices to kill the copycats.
Read more → Analysis · Market & pricing“Insurance coverage collapse” sounds national and sudden. It wasn't. It was a map forming — and the payers walking away are almost all the ones who write the check themselves.
Read more → Analysis · Market & pricingIt isn't stinginess and it isn't a billing glitch. A copay card is an acquisition weapon, and once supply, coverage, and a flat $499 cash channel all arrived, the job it was built to do was finished.
Read more → Analysis · Market & pricingMost coverage filed the $499 vial under good news for patients. It is a price floor Lilly chose, to undercut the compounders, route around the PBMs, and reprice the cash-pay market it now controls.
Read more → Analysis · Regulatory + policyEveryone is watching the FDA. But the agency that could turn a gray-market vial into a felony is the DEA — and the reason it has stayed out is the most revealing fact in the whole story.
Read more → Analysis · Regulatory + policyIn 2023 the FDA opened an investigation into GLP-1 medications and suicidal ideation. In 2026 it's technically still open. What the data actually shows — and why "unresolved" is doing a lot of work.
Read more → Analysis · Regulatory + policyThe story has changed tense. A year ago the question was whether Lilly's oral GLP-1 pill would work. Now it's when it ships — gated by the FDA clock, the label sequence, and factory capacity, not by biology.
Read more → Analysis · Regulatory + policyNot a ban — the expiration of a temporary legal exception written into a 1997 statute. Who actually lost: not the drugmakers, but the telehealth layer and the patients paying $199 instead of $1,999.
Read more → Analysis · Regulatory + policyThe 2026 FDA action closed a grey market that was never technically open. Understanding what changed — and what was always illegal — matters for understanding where this goes next.
Read more → Analysis · Clinical dataSELECT showed a 20% relative risk reduction in serious cardiac events. But the trial only enrolled patients with established CVD and no diabetes. Here is what the numbers actually say — and for whom.
Read more → Essay · NewFor a century the equation had two terms: diet and exercise. Then a generation woke up and the sentence had a third. An essay on what that third sentence does to a culture.
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