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The Ozempic class war has begun Obesity drugs herald a struggle the poor will lose

Soon, skinny won't be for everyone. (Stefanie Keenan/Getty Images for Baby2Baby)

Soon, skinny won't be for everyone. (Stefanie Keenan/Getty Images for Baby2Baby)


March 8, 2023   6 mins

If you, a commoner, encountered a feudal lord in the year 1200, the latter would likely be wearing fine armour, carrying a well-polished sword, and riding a horse. Upon seeing these visual cues, you would address him properly, lest he punish you for failing to show proper deference. But as the centuries passed, particularly in the years following the American and French revolutions, this notion of privilege faded; the rich might be a class apart, but at times they might be dressed much like you, even if their apparel was slightly better-made. 

Today, however, the rich are separating themselves in perhaps the most obvious way of all: by perfecting their bodies, rather than what they put on them. The rich are fit and the poor are fat: reams of research confirms that the prevalence of obesity decreases as income increases. In the United States, where 41% of the entire population is obese — compared with 25% in the United Kingdom — it is a rare wealthy person who is morbidly overweight (blimp-sized Illinois governor J.B. Pritzker and portly former New Jersey governor Chris Christie are outliers). Increasingly, the rich in late middle age have come to resemble Jeff Bezos and Sarah Jessica Parker: ripped to shreds and almost certainly “enhanced” with various anti-ageing drugs and techniques, ranging from steroids and growth hormones to Botox injections and liposuction. 

Into this mix comes semaglutide, an antidiabetic medication better known by its trade name Ozempic. Sold by pharmaceutical manufacturer Novo Nordisk, the drug, which reduces food intake by curbing appetite and slowing digestion, was approved by the US Food and Drug Administration to treat obesity in 2021. Since then, celebrities and fitness influencers have routinely shared before-and-after pics captioned with details of their courageous weight-loss journeys, which entailed jabbing themselves with a 1.5ml pen that contains a month’s worth of doses and costs roughly $900 without insurance.

Predictably, stories about Ozempic have proliferated in the tabloids and on social media. Some see the drug as a challenge to the celebrity movement that touts “fat acceptance”, and brought us the “slim-thick” era of curvy female superstars. They argue that Ozempic may work hand-in-hand with the return of the “heroin chic” look of the late Nineties. As interesting as it is to consider where these mixed messages might lead us — to a culture in which poor people are told it’s fabulous to be obese, while the rich get ever thinner and fitter — if this is a conspiracy, it’s not a new one. The rich have lusted after youth, beauty and fitness, in others and themselves, since time immemorial, always keeping the poor as downtrodden as possible while pacifying them with bromides about equality, liberty and fraternity. Ozempic, then, is not simply the key to thinness; those who pay for it are buying even more distance between themselves and the hoi polloi. 

In short, this appears to be yet another sign that the elite are headed toward some sort of crude transhumanist utopia, complete with gene therapy and designer-baby selection. Some may scoff that this is science fiction, but this future looms: once they’re sufficiently fine-tuned, gene editing tools will likely eradicate heart disease, muscle wasting, neurodegenerative disorders, and other conditions in embryos that are still in utero — but their price will be nothing short of staggering. Similarly expensive gene therapies will enhance the overall performance of already-healthy humans, raising ethical questions about whether these procedures should “improve” a person or merely “fix” a condition. The rich, of course, will leave those debates to the philosophers and pay upfront for the best bodies that their considerable resources can buy. Already, news stories abound of billionaires pursuing immortality, with a few commentators trying to sanitise the pursuit by arguing that the research will somehow benefit even the least of us.   

I have first-hand experience in the big-bucks world of anti-ageing science, and I can state unequivocally that the most compelling benefits are not going to trickle down. In 2017, I worked for a transhumanist medical organisation, producing marketing content related to stem-cell therapy and other forms of anti-ageing medicine. I received several treatments myself, and while I can only speak anecdotally, they significantly relieved decades of aches and pains related to hard training. And these were one-off procedures, not the monthly “Cadillac plan”, which involved steroids, growth hormones, and Botox. Wealthy clients would walk in as untrained, middle-aged slobs and, less than a year later, boast gym-hardened physiques that might take unenhanced trainees a decade to develop. 

The organisation’s telos was the stuff of nightmares: the acquisition of a yacht to serve as a floating hospital so that various procedures that are illegal in North America could be performed in international waters; or the same-day infusion of stem cells harvested from a delivery of rich clients’ babies. Although peer-reviewed research has shown no difference between using frozen and freshly-harvested stem cells, there was marketing value in promising clients the freshest ingredients possible. It allowed for a considerable markup in the price of the procedure. It wasn’t the “these vampires want to drink baby blood” of conspiracy-nut ramblings — but it did resemble them. 

So, when I see discussions of Ozempic’s social impact, I don’t think about plus-sized singer Lizzo and skeletal commentator Ann Coulter trading barbs about the ideal female physique. That sort of chatter is all a sideshow for the general public; the rich clients doping themselves to remain forever young do not much care about how the poor and middle class choose to identify (be it fat or fit) as long as few have the money to identify as rich. Without truly high-end gene editing that might enable skeletal and organ reconfiguration — still a way off, though one never knows — the rich are limited to the basic shape and size of their natal bodies. But being able to invest tens of thousands of dollars per annum in upkeep will nevertheless produce an optimised body utterly unlike that of the poor American.

The culture of fitness influencers and body performers is downstream of this. Their bodies represent an investment that will yield riches, which can in turn be reinvested in the upkeep of those bodies. They are selling you a picture of health that doubles as a picture of wealth, often lying about just how much they spend on effective drugs. In the marketing of bodies, deception is the key to the kingdom. You might, for example, promote your Ozempic transformation on TikTok while failing to mention the $6,000 “micro-liposuction” procedure you’ve used to improve problem areas, because you’re sponsored by an online clinic that writes prescriptions for the drug. Or you might fail to mention your Ozempic and steroid use completely, touting instead a diet that is far less effective in the absence of all these chemical crutches, but tied to prepared meals and meal-replacement shakes you’re being paid to promote. 

As a lifelong strength athlete, I have toiled in filthy gyms and basements to maintain my own physical condition. I would like to say that remaining “natural” or practising intense physical discipline offers some intrinsic reward. Unfortunately, it does not; it is a hard-to-follow path made more tortuous in my case by my stubborn unwillingness to take any effective shortcuts (even though the stem cell injections I received worked like a charm). But a resistance to emptying my wallet, and an aversion to some of the side effects from these drugs — cancerous tumours in the case of Ozempic — has hindered my route to body optimisation.

For me, glorifying the “natural” in and of itself, then, is little better than writing some trite ode to manual labour. There are loads of people, nearly all of them poor and sick, whose bodies are relatively resistant to weight loss. For them, the simplicity of the Ozempic jab — as opposed to the creation of a stomach pouch via laparoscopic gastric bypass surgery — might offer an improved quality of life in much the same way that cheaper insulin and other band-aids help ease the pains associated with sedentary, unhealthy lifestyles.

But the rhetorical appeal of this medicine — that it will produce gains that will “trickle down” from the upper classes to the masses — is an old lie. Time is a thief, stealing each passing minute from us, but as money proves able to purchase ever-increasing amounts of it, it will be disproportionately hoarded by those rich people who are already proficient at squirrelling away their money. Whether by violent nature or scientific nurture, the body is merely something to be overcome. And if you’ve the money to opt for the latter, why wouldn’t you?

In the meantime, those of us doomed to remain mere humans can only watch this process unfold while the rich become superhuman. Consigned to increasingly rare “normal” bodies that are both temples and tombs, the middle class must study this journey from the sidelines, watching on as a vast array of battered, bloated and ruined bodies are left in the wake of a transhumanist train that goes in only one direction. 


Oliver Bateman is a historian and journalist based in Pittsburgh. He blogs, vlogs, and podcasts at his Substack, Oliver Bateman Does the Work

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Peter B
Peter B
1 year ago

It is hard to understand the stupidity of this narcissism. Even if you can edit out the imperfections in your own body – perhaps downsizing your nose – you’re probably setting up your children to have to do the same (they’ll likely inherit the same “faults” you’ve spent so much money airbrushing out and feel pressure to do the same). So you end up almost imposing unnecessary surgery on your own children.
These are the very same people lecturing us about how they need to take more of money from ordinary working people to hand out to “more deserving” people who are the “victims” of life’s unfairnesses. While blowing fortunes on their vanity and not dipping into their own pockets (and often paying very little tax).
They truly are the Bourbons of the modern age.
Ignore these fools trying to tell you how you should look or behave. Just be yourself.

Warren Trees
Warren Trees
1 year ago
Reply to  Peter B

But what if being yourself is not good enough to get you a stunningly gorgeous trophy wife or a ripped, studly boy toy? It’s all about the sex, nothing more.

matt birdio
matt birdio
1 year ago
Reply to  Peter B

Vane, vane, vane
Nobody really gives a shit about you looking like a plastic action man figure, unnatural, super white teeth, skinny….it’s a fashion symbol of thinking you look good…..pride in vanity, history tells us this always goes on. Nobody cares apart from the clique that do it. Rich to poor, there are such cliques.
Won’t resolve your inner self issues, if you have them.
The biggest issue here is the gap between the rich and others, never in history has it been this wide and at some point the masses have to rebel. Laws, regulations, government policy all very very beneficial to take more from us peasants.
Work hard and you’ll hit a glass ceiling….in the past, physically you could take, now it’s shielded by a web of tech. Not to say its right to physically take but that was a means when the rich got too out of control- as mentioned in the article.
Unfortunately it’s not going to improve and the world’s assets will be sucked into the few and the ridiculous gluttony and waste will continue as others suffer.
Sermon over, I’m lucky that I’m at the glass ceiling and only significantly taxed for the privilege of working hard and having a bit of luck. I detest what’s happening and the lack of wealth distribution and advantageous acts of the few, who take take take.

Dominic S
Dominic S
1 year ago
Reply to  Peter B

I was astonished by the number of human barrels I saw in costco yesterday – and most of them have obviously picked up bad habits from the indigenous population. They’ll buy the daft jabs, and be surprised when they don’t work.

Warren Trees
Warren Trees
1 year ago
Reply to  Peter B

But what if being yourself is not good enough to get you a stunningly gorgeous trophy wife or a ripped, studly boy toy? It’s all about the sex, nothing more.

matt birdio
matt birdio
1 year ago
Reply to  Peter B

Vane, vane, vane
Nobody really gives a shit about you looking like a plastic action man figure, unnatural, super white teeth, skinny….it’s a fashion symbol of thinking you look good…..pride in vanity, history tells us this always goes on. Nobody cares apart from the clique that do it. Rich to poor, there are such cliques.
Won’t resolve your inner self issues, if you have them.
The biggest issue here is the gap between the rich and others, never in history has it been this wide and at some point the masses have to rebel. Laws, regulations, government policy all very very beneficial to take more from us peasants.
Work hard and you’ll hit a glass ceiling….in the past, physically you could take, now it’s shielded by a web of tech. Not to say its right to physically take but that was a means when the rich got too out of control- as mentioned in the article.
Unfortunately it’s not going to improve and the world’s assets will be sucked into the few and the ridiculous gluttony and waste will continue as others suffer.
Sermon over, I’m lucky that I’m at the glass ceiling and only significantly taxed for the privilege of working hard and having a bit of luck. I detest what’s happening and the lack of wealth distribution and advantageous acts of the few, who take take take.

Dominic S
Dominic S
1 year ago
Reply to  Peter B

I was astonished by the number of human barrels I saw in costco yesterday – and most of them have obviously picked up bad habits from the indigenous population. They’ll buy the daft jabs, and be surprised when they don’t work.

Peter B
Peter B
1 year ago

It is hard to understand the stupidity of this narcissism. Even if you can edit out the imperfections in your own body – perhaps downsizing your nose – you’re probably setting up your children to have to do the same (they’ll likely inherit the same “faults” you’ve spent so much money airbrushing out and feel pressure to do the same). So you end up almost imposing unnecessary surgery on your own children.
These are the very same people lecturing us about how they need to take more of money from ordinary working people to hand out to “more deserving” people who are the “victims” of life’s unfairnesses. While blowing fortunes on their vanity and not dipping into their own pockets (and often paying very little tax).
They truly are the Bourbons of the modern age.
Ignore these fools trying to tell you how you should look or behave. Just be yourself.

Phillipa Fioretti
Phillipa Fioretti
1 year ago

I feel a bit sorry for these poor people. All that money and yet so much fear. The joys of existence, simple and plain, swapped for an endless battle with the inevitable.

Steve Murray
Steve Murray
1 year ago

And how much more anguishing it’ll be for them, when the inevitable happens.

Steve Murray
Steve Murray
1 year ago

And how much more anguishing it’ll be for them, when the inevitable happens.

Phillipa Fioretti
Phillipa Fioretti
1 year ago

I feel a bit sorry for these poor people. All that money and yet so much fear. The joys of existence, simple and plain, swapped for an endless battle with the inevitable.

Chris Twine
Chris Twine
1 year ago

Momento Mori – don’t underestimate Mother Nature or Father Time – they’ll get you in the end. Remember the cadaver tombs of medieval England. Yes, you can delay the journey to compost but isn’t it better just to face up to it instead?

Arthur G
Arthur G
1 year ago
Reply to  Chris Twine

Spot on. 12 months after we’re dead, we all look the same.

Steve Murray
Steve Murray
1 year ago
Reply to  Arthur G

Or in the case of the ancient Egyptian elite, they look like their mummies.

CHARLES STANHOPE
CHARLES STANHOPE
1 year ago
Reply to  Arthur G

Worms: “They go in thin and come out stout”.*

(*Anon.)

Steve Murray
Steve Murray
1 year ago
Reply to  Arthur G

Or in the case of the ancient Egyptian elite, they look like their mummies.

CHARLES STANHOPE
CHARLES STANHOPE
1 year ago
Reply to  Arthur G

Worms: “They go in thin and come out stout”.*

(*Anon.)

Val Colic-Peisker
Val Colic-Peisker
1 year ago
Reply to  Chris Twine

I liked your comment but let’s get our Latin right – it’s ‘memento mori’

Arthur G
Arthur G
1 year ago
Reply to  Chris Twine

Spot on. 12 months after we’re dead, we all look the same.

Val Colic-Peisker
Val Colic-Peisker
1 year ago
Reply to  Chris Twine

I liked your comment but let’s get our Latin right – it’s ‘memento mori’

Chris Twine
Chris Twine
1 year ago

Momento Mori – don’t underestimate Mother Nature or Father Time – they’ll get you in the end. Remember the cadaver tombs of medieval England. Yes, you can delay the journey to compost but isn’t it better just to face up to it instead?

Nicky Samengo-Turner
Nicky Samengo-Turner
1 year ago

When I gave up drinking, I lost 4 stone in about 5 months: My ” diet advisors” were jockeys, who live ” to the pound” as they are weighed sometimes 32 times a day when evening racing occurs.

I learned from their sage advice that the key to losing weight is to break the ” habit signal” between mind and stomach, and after only 3 days of 1 small meal a day, it starts to kick in. After that its about planning a weekly intake, and adjusting it upwards and downwards. 20 years on, it has worked for me!

CHARLES STANHOPE
CHARLES STANHOPE
1 year ago

Nuli Secundus!

Nicky Samengo-Turner
Nicky Samengo-Turner
1 year ago

I then proceeded to, in the following 4 years, break 8 ribs, sternum, 3 verterbrae, all my fingers and disclocate my jaw out hunting, proving that swapping an alcohol addiction for the ” buzz” of riding over hedges and fences, ” sans talent” , was just another addict proclivity… but at least I was thin!

Nicky Samengo-Turner
Nicky Samengo-Turner
1 year ago

I then proceeded to, in the following 4 years, break 8 ribs, sternum, 3 verterbrae, all my fingers and disclocate my jaw out hunting, proving that swapping an alcohol addiction for the ” buzz” of riding over hedges and fences, ” sans talent” , was just another addict proclivity… but at least I was thin!

CHARLES STANHOPE
CHARLES STANHOPE
1 year ago

Nuli Secundus!

Nicky Samengo-Turner
Nicky Samengo-Turner
1 year ago

When I gave up drinking, I lost 4 stone in about 5 months: My ” diet advisors” were jockeys, who live ” to the pound” as they are weighed sometimes 32 times a day when evening racing occurs.

I learned from their sage advice that the key to losing weight is to break the ” habit signal” between mind and stomach, and after only 3 days of 1 small meal a day, it starts to kick in. After that its about planning a weekly intake, and adjusting it upwards and downwards. 20 years on, it has worked for me!

Hendrik Mentz
Hendrik Mentz
1 year ago

Humanity’s biggest danger is at its moment of optimum possibility it opts for dumbing down, and superficiality.

Last edited 1 year ago by Hendrik Mentz
CHARLES STANHOPE
CHARLES STANHOPE
1 year ago
Reply to  Hendrik Mentz

Rather like the Classical Roman Empire opting for the ridiculous creed of the Nazarene, otherwise known as Christianity.

Nathan Sapio
Nathan Sapio
1 year ago

Logos and literacy. Change your life.

Jeremy Sansom
Jeremy Sansom
1 year ago

Opting for? Then, as now, the ‘ridiculous’ creed of the Nazarene has irresistible power to deliver life and liberty.
Sadly, Rome opted largely for the creed. The Nazarene himself is never an instrument of the State…..

Nathan Sapio
Nathan Sapio
1 year ago

Logos and literacy. Change your life.

Jeremy Sansom
Jeremy Sansom
1 year ago

Opting for? Then, as now, the ‘ridiculous’ creed of the Nazarene has irresistible power to deliver life and liberty.
Sadly, Rome opted largely for the creed. The Nazarene himself is never an instrument of the State…..

CHARLES STANHOPE
CHARLES STANHOPE
1 year ago
Reply to  Hendrik Mentz

Rather like the Classical Roman Empire opting for the ridiculous creed of the Nazarene, otherwise known as Christianity.

Hendrik Mentz
Hendrik Mentz
1 year ago

Humanity’s biggest danger is at its moment of optimum possibility it opts for dumbing down, and superficiality.

Last edited 1 year ago by Hendrik Mentz
Phillipa Fioretti
Phillipa Fioretti
1 year ago

I feel a bit sorry for rich people if this is what they focus on all the time. Not much of a life, is it. All that money and they spend it on cosmetic drugs and procedures? Poor buggers.

Warren Trees
Warren Trees
1 year ago

All the while lecturing us about equity and inclusion. Now if they donated 10% of their wealth to charity, then I would think differently about them.

Anthony Michaels
Anthony Michaels
1 year ago
Reply to  Warren Trees

Oh they do. More. But of course their “charity” means imposing their vision on the world – i.e. translating money into power ala Bill Gates. There’s only so much money one can consume, so the rest must feed the ego in other ways. Hard to avoid at a certain scale.

Peter B
Peter B
1 year ago

The “charitable” stuff often involves huge tax breaks in the US and is often done for financial reasons.
But not always. There is a real and strong tradition of philanthropy by billionaires going back at least to Andrew Carnegie (including building countless public libraries back in the UK).
Sorry, I don’t buy into the Bill Gates conspiracy theories. People’s motivations vary and are not always malign. We should not always assume the worst case.

michael harris
michael harris
1 year ago
Reply to  Peter B

It’s not that Gates is malign. But he’s a software guy through and through.
RNA, DNA. They’re biologic forms of software. The body can be happily reprogrammed. Hence mrna vaccines.

jane baker
jane baker
1 year ago
Reply to  Peter B

I didn’t use to until I saw him,Gates doing an interview. It was his facial movements. Smiling inappropriately at the wrong times. Answering too quick or far too slow. When someone says 15K children are going to die all the while self satisfied smiling it just comes across as wrong. If he is autistic or something he’s not doing that community any favours.

michael harris
michael harris
1 year ago
Reply to  Peter B

It’s not that Gates is malign. But he’s a software guy through and through.
RNA, DNA. They’re biologic forms of software. The body can be happily reprogrammed. Hence mrna vaccines.

jane baker
jane baker
1 year ago
Reply to  Peter B

I didn’t use to until I saw him,Gates doing an interview. It was his facial movements. Smiling inappropriately at the wrong times. Answering too quick or far too slow. When someone says 15K children are going to die all the while self satisfied smiling it just comes across as wrong. If he is autistic or something he’s not doing that community any favours.

Peter B
Peter B
1 year ago

The “charitable” stuff often involves huge tax breaks in the US and is often done for financial reasons.
But not always. There is a real and strong tradition of philanthropy by billionaires going back at least to Andrew Carnegie (including building countless public libraries back in the UK).
Sorry, I don’t buy into the Bill Gates conspiracy theories. People’s motivations vary and are not always malign. We should not always assume the worst case.

Anthony Michaels
Anthony Michaels
1 year ago
Reply to  Warren Trees

Oh they do. More. But of course their “charity” means imposing their vision on the world – i.e. translating money into power ala Bill Gates. There’s only so much money one can consume, so the rest must feed the ego in other ways. Hard to avoid at a certain scale.

Warren Trees
Warren Trees
1 year ago

All the while lecturing us about equity and inclusion. Now if they donated 10% of their wealth to charity, then I would think differently about them.

Phillipa Fioretti
Phillipa Fioretti
1 year ago

I feel a bit sorry for rich people if this is what they focus on all the time. Not much of a life, is it. All that money and they spend it on cosmetic drugs and procedures? Poor buggers.

Chris Wheatley
Chris Wheatley
1 year ago

Plus ça change, plus c’est la mĂȘme chose. The rich always have and always will divorce themselves from reality – because they can. See Lineker’s recent comments.
The people who can afford to escape real life have to make their own reality.

Last edited 1 year ago by Chris Wheatley
Nils Espenlaub
Nils Espenlaub
1 year ago
Reply to  Chris Wheatley

The own reality would be ok in itself. Problematic are the gated communities (or own worlds) spreading along with it. Despite having a conservative liberal worldview, I conclude with ĆœiĆŸek among others that this is not a thing to wish for if one is interested in keeping civilization intact in some form.

Chris Wheatley
Chris Wheatley
1 year ago
Reply to  Nils Espenlaub

Hm. Yes, we really need to control people


Simon Blanchard
Simon Blanchard
1 year ago
Reply to  Chris Wheatley

We’re all being controlled. The question is who you believe it to be by.

Nils Espenlaub
Nils Espenlaub
1 year ago
Reply to  Chris Wheatley

Imho it is not about directly or indirectly controlling people. There are a lot of different ways to assess the problem of gated communities (both on the political and the cultural spectrum 
). It would take it too far starting discussing them here, but I found it a pity that people seem to have problems imagining possible solutions that go beyond autocratic policies, although I understand the defensive reflex (and know it myself) just assuming something repressive…

Simon Blanchard
Simon Blanchard
1 year ago
Reply to  Chris Wheatley

We’re all being controlled. The question is who you believe it to be by.

Nils Espenlaub
Nils Espenlaub
1 year ago
Reply to  Chris Wheatley

Imho it is not about directly or indirectly controlling people. There are a lot of different ways to assess the problem of gated communities (both on the political and the cultural spectrum 
). It would take it too far starting discussing them here, but I found it a pity that people seem to have problems imagining possible solutions that go beyond autocratic policies, although I understand the defensive reflex (and know it myself) just assuming something repressive…

Warren Trees
Warren Trees
1 year ago
Reply to  Nils Espenlaub

When have the rich not lived in gated communities or walled enclaves?

Nils Espenlaub
Nils Espenlaub
1 year ago
Reply to  Warren Trees

Sure, the question is to which extent (qualitative and quantitative) and what rich people we’re speaking of. Super rich? Wealthy?

Nils Espenlaub
Nils Espenlaub
1 year ago
Reply to  Warren Trees

Sure, the question is to which extent (qualitative and quantitative) and what rich people we’re speaking of. Super rich? Wealthy?

Chris Wheatley
Chris Wheatley
1 year ago
Reply to  Nils Espenlaub

Hm. Yes, we really need to control people


Warren Trees
Warren Trees
1 year ago
Reply to  Nils Espenlaub

When have the rich not lived in gated communities or walled enclaves?

Nils Espenlaub
Nils Espenlaub
1 year ago
Reply to  Chris Wheatley

The own reality would be ok in itself. Problematic are the gated communities (or own worlds) spreading along with it. Despite having a conservative liberal worldview, I conclude with ĆœiĆŸek among others that this is not a thing to wish for if one is interested in keeping civilization intact in some form.

Chris Wheatley
Chris Wheatley
1 year ago

Plus ça change, plus c’est la mĂȘme chose. The rich always have and always will divorce themselves from reality – because they can. See Lineker’s recent comments.
The people who can afford to escape real life have to make their own reality.

Last edited 1 year ago by Chris Wheatley
Emmanuel MARTIN
Emmanuel MARTIN
1 year ago

Progresss and technology DO trickle down
Almost every European enjoys access to a level of medication, nutrition and health resources that are inline with the best of the best available a century ago.
Put trickle down is a long process, and probably in 50y middle class people will routinlely get Ozempic like shape enhancing medication while the elite of the future will have brain transplant body rejuvenation

Nils Espenlaub
Nils Espenlaub
1 year ago

If we do not find other ways to deal with obesity in our societies, then yes, it will unfortunately become a normal thing at some distant point in time. But I also believe there will be a change in thinking on the way, just because it is already happening, that will counter the severity of the development towards the “just fix it with a pill” mentality.

Chris Wheatley
Chris Wheatley
1 year ago
Reply to  Nils Espenlaub

What would drive this change in thinking? I can’t see it. The average person I know lives for treats. Almost all of these treats involve eating or drinking something:
Now I’ve been shopping I deserve a treat – a cup of tea and a chocolate biscuit, or,
I’ve had a hard week – let’s go out for a curry on Friday, or.. It’s John’s birthday tomorrow, let’s take him out for a meal. Etc, etc.
What else is there to look forward to?

Nils Espenlaub
Nils Espenlaub
1 year ago
Reply to  Chris Wheatley

It is indeed hard to see. But, hey, we are here talking about at least the possibilities of change.
If you look at it from a historical perspective, the mainstream mind set within a nation or a cultural sphere is constantly changing. I think we are heading forward towards a “dark age” (not in the sense of everything is bad, civilization going to collapse, worlds ending and so on…). Things will be confusing and changes more erratic and less streamlined than in the last maybe 200 years. Society won’t be the same in 50 years as it is now. I do not see the worth in fatalistic thinking regarding the future, regardless of being a rather pessimistic person myself.

CHARLES STANHOPE
CHARLES STANHOPE
1 year ago
Reply to  Chris Wheatley

A tour of the major Edwardian Castles in say North Wales? Failing that Welsh Cistercian Abbeys perhaps?

Chris Wheatley
Chris Wheatley
1 year ago

I know the MacDonalds in Caernarfon so we could eat as well.

CHARLES STANHOPE
CHARLES STANHOPE
1 year ago
Reply to  Chris Wheatley

Isn’t it Caernarvon?
Or have you “gone native”?

Last edited 1 year ago by CHARLES STANHOPE
Chris Wheatley
Chris Wheatley
1 year ago

Definitely ‘f’.

CHARLES STANHOPE
CHARLES STANHOPE
1 year ago
Reply to  Chris Wheatley

Wasn’t it built on the orders of the King of England, who incidentally was also nicknamed “Hammer of the Scotch”?

Chris Wheatley
Chris Wheatley
1 year ago

Also called, ‘Longshanks’. I believe he imported 20,000 craftsmen from Europe to do the job.

CHARLES STANHOPE
CHARLES STANHOPE
1 year ago
Reply to  Chris Wheatley

Certainly Master St George of Savoy. But 20,000 others! I would have thought that was logistically Impossible in the 13th century.

These people were NOT Romans after all.

CHARLES STANHOPE
CHARLES STANHOPE
1 year ago
Reply to  Chris Wheatley

Certainly Master St George of Savoy. But 20,000 others! I would have thought that was logistically Impossible in the 13th century.

These people were NOT Romans after all.

Chris Wheatley
Chris Wheatley
1 year ago

Also called, ‘Longshanks’. I believe he imported 20,000 craftsmen from Europe to do the job.

CHARLES STANHOPE
CHARLES STANHOPE
1 year ago
Reply to  Chris Wheatley

Wasn’t it built on the orders of the King of England, who incidentally was also nicknamed “Hammer of the Scotch”?

Chris Wheatley
Chris Wheatley
1 year ago

Definitely ‘f’.

CHARLES STANHOPE
CHARLES STANHOPE
1 year ago
Reply to  Chris Wheatley

Isn’t it Caernarvon?
Or have you “gone native”?

Last edited 1 year ago by CHARLES STANHOPE
Chris Wheatley
Chris Wheatley
1 year ago

I know the MacDonalds in Caernarfon so we could eat as well.

rue boileau
rue boileau
1 year ago
Reply to  Chris Wheatley

Oh, there is so much to look forward to beside food and drink!!!! Gardening, enjoying the birds, butterflies, and flowers in your garden, cuddling with your cat, going for a walk with your dog, riding and caring for your horse. A kiss, a hug, holding hands, the sparkle in your partner’s eyes when they look at you, sex of course, painting, listening to music (be it at home, a concert or the symphony – all things I greatly look forward to), making music (this is what my husband looks forward to whenver he is away from his instruments), taking a bath, enjoying fragrances in all kinds of forms – flowers, herbs, fresh cut grass, essential oils. Colors – the blue of the sky, the orange red of a cardinal and the yellow of a goldfinch on my birdfeeder. The sound, scent and beauty of the ocean. Amazing architecture, gorgeous old buildings, the beautiful canopy of my neighborhood’s tree lined streets. And a million more things. I mean, there is SO MUCH to enjoy and look forward to!!!! Food & drink are pretty much at the bottom of my list. 

jane baker
jane baker
1 year ago
Reply to  rue boileau

Great reply,exactly my thoughts but I could never have found those great words to express it. Plant a garden,there’s always something to add anticipate

jane baker
jane baker
1 year ago
Reply to  rue boileau

Great reply,exactly my thoughts but I could never have found those great words to express it. Plant a garden,there’s always something to add anticipate

Nils Espenlaub
Nils Espenlaub
1 year ago
Reply to  Chris Wheatley

It is indeed hard to see. But, hey, we are here talking about at least the possibilities of change.
If you look at it from a historical perspective, the mainstream mind set within a nation or a cultural sphere is constantly changing. I think we are heading forward towards a “dark age” (not in the sense of everything is bad, civilization going to collapse, worlds ending and so on…). Things will be confusing and changes more erratic and less streamlined than in the last maybe 200 years. Society won’t be the same in 50 years as it is now. I do not see the worth in fatalistic thinking regarding the future, regardless of being a rather pessimistic person myself.

CHARLES STANHOPE
CHARLES STANHOPE
1 year ago
Reply to  Chris Wheatley

A tour of the major Edwardian Castles in say North Wales? Failing that Welsh Cistercian Abbeys perhaps?

rue boileau
rue boileau
1 year ago
Reply to  Chris Wheatley

Oh, there is so much to look forward to beside food and drink!!!! Gardening, enjoying the birds, butterflies, and flowers in your garden, cuddling with your cat, going for a walk with your dog, riding and caring for your horse. A kiss, a hug, holding hands, the sparkle in your partner’s eyes when they look at you, sex of course, painting, listening to music (be it at home, a concert or the symphony – all things I greatly look forward to), making music (this is what my husband looks forward to whenver he is away from his instruments), taking a bath, enjoying fragrances in all kinds of forms – flowers, herbs, fresh cut grass, essential oils. Colors – the blue of the sky, the orange red of a cardinal and the yellow of a goldfinch on my birdfeeder. The sound, scent and beauty of the ocean. Amazing architecture, gorgeous old buildings, the beautiful canopy of my neighborhood’s tree lined streets. And a million more things. I mean, there is SO MUCH to enjoy and look forward to!!!! Food & drink are pretty much at the bottom of my list. 

Chris Wheatley
Chris Wheatley
1 year ago
Reply to  Nils Espenlaub

What would drive this change in thinking? I can’t see it. The average person I know lives for treats. Almost all of these treats involve eating or drinking something:
Now I’ve been shopping I deserve a treat – a cup of tea and a chocolate biscuit, or,
I’ve had a hard week – let’s go out for a curry on Friday, or.. It’s John’s birthday tomorrow, let’s take him out for a meal. Etc, etc.
What else is there to look forward to?

Warren Trees
Warren Trees
1 year ago

Quite so. The same went for automobiles, fresh fruit, colored televisions, cell phones and world class health care. All were at one time only in the purview of the rich.

jane baker
jane baker
1 year ago

Which is why they are now removing it.

Nils Espenlaub
Nils Espenlaub
1 year ago

If we do not find other ways to deal with obesity in our societies, then yes, it will unfortunately become a normal thing at some distant point in time. But I also believe there will be a change in thinking on the way, just because it is already happening, that will counter the severity of the development towards the “just fix it with a pill” mentality.

Warren Trees
Warren Trees
1 year ago

Quite so. The same went for automobiles, fresh fruit, colored televisions, cell phones and world class health care. All were at one time only in the purview of the rich.

jane baker
jane baker
1 year ago

Which is why they are now removing it.

Emmanuel MARTIN
Emmanuel MARTIN
1 year ago

Progresss and technology DO trickle down
Almost every European enjoys access to a level of medication, nutrition and health resources that are inline with the best of the best available a century ago.
Put trickle down is a long process, and probably in 50y middle class people will routinlely get Ozempic like shape enhancing medication while the elite of the future will have brain transplant body rejuvenation

sal b dyer
sal b dyer
1 year ago

Early follow up studies show people gain weight just as quickly after stopping Ozempic as after any other form of weight loss. It’s also suspected of causing Thyroid cancer in animals as well as being teratogenic. There are no free rides in this life.

CHARLES STANHOPE
CHARLES STANHOPE
1 year ago
Reply to  sal b dyer

Yes there are, working for the wretched British Civil Service for one.

Brendan O'Leary
Brendan O'Leary
1 year ago

And then taking early retirement on a DB pension.

Brendan O'Leary
Brendan O'Leary
1 year ago

And then taking early retirement on a DB pension.

CHARLES STANHOPE
CHARLES STANHOPE
1 year ago
Reply to  sal b dyer

Yes there are, working for the wretched British Civil Service for one.

sal b dyer
sal b dyer
1 year ago

Early follow up studies show people gain weight just as quickly after stopping Ozempic as after any other form of weight loss. It’s also suspected of causing Thyroid cancer in animals as well as being teratogenic. There are no free rides in this life.

Phil Rees
Phil Rees
1 year ago

There’s increasing confusion in unherd articles between UK and USA. On the day I received this one, NHS announced the drug will be available in UK on the NHS, and that rather negates the whole article!

Phil Rees
Phil Rees
1 year ago

There’s increasing confusion in unherd articles between UK and USA. On the day I received this one, NHS announced the drug will be available in UK on the NHS, and that rather negates the whole article!

John Riordan
John Riordan
1 year ago

The supposition that no “trickle-down” effect will happen is not actually defended here beyond mere assertion. Mainly because as soon as anyone uses the phrase, they automatically place themselves into a logical cul-de-sac because there is not and never has been such a thing as “trickle-down” economics in the modern age.

The modern age has been characterised by mass prosperity, and that prosperity has been driven principally on how to deliver technological gains at a level of resource use that makes it possible for people on modest incomes to afford those gains themselves. There is no reason given in the above article as to why this same mechanism won’t apply in due course to the healthspan extension presently enjoyed only by wealthy people, and the reason is simply that as soon as it becomes technically efficient to produce the various drugs and treatments, the people who own the rights to them will find that they make more money selling millions of treatments for $1000 than they do selling a hundred treatments for a million each.

As to some of the other comments here which dismiss all this as mere vanity, no it isn’t, because what you look like is only part of the issue. The rest of it is about how much longer your life can be while remaining physically robust and vigorous, and wanting that period of your life to last as long as possible is entirely understandable and it’s no surprise that people will pay a lot of money for it if they can.

There is also, of course, possibly a huge economic benefit in making adults live longer by extending the middle part of their lives – when they can work – instead of extending the decrepit part of their lives at the end when they require the economic output of others to live. The possibilities here are actually rather amazing – doctors, lawyers, software programmers, artists, architects etc whose professional careers aren’t just 40 years long but, say, a whole century long. And it would solve the demographic challenge about how a shrinking working age population can support expanding legions of retired people who all want their pensions and healthcare – it would put that trend into reverse. Just a thought.

Last edited 1 year ago by John Riordan
John Riordan
John Riordan
1 year ago

The supposition that no “trickle-down” effect will happen is not actually defended here beyond mere assertion. Mainly because as soon as anyone uses the phrase, they automatically place themselves into a logical cul-de-sac because there is not and never has been such a thing as “trickle-down” economics in the modern age.

The modern age has been characterised by mass prosperity, and that prosperity has been driven principally on how to deliver technological gains at a level of resource use that makes it possible for people on modest incomes to afford those gains themselves. There is no reason given in the above article as to why this same mechanism won’t apply in due course to the healthspan extension presently enjoyed only by wealthy people, and the reason is simply that as soon as it becomes technically efficient to produce the various drugs and treatments, the people who own the rights to them will find that they make more money selling millions of treatments for $1000 than they do selling a hundred treatments for a million each.

As to some of the other comments here which dismiss all this as mere vanity, no it isn’t, because what you look like is only part of the issue. The rest of it is about how much longer your life can be while remaining physically robust and vigorous, and wanting that period of your life to last as long as possible is entirely understandable and it’s no surprise that people will pay a lot of money for it if they can.

There is also, of course, possibly a huge economic benefit in making adults live longer by extending the middle part of their lives – when they can work – instead of extending the decrepit part of their lives at the end when they require the economic output of others to live. The possibilities here are actually rather amazing – doctors, lawyers, software programmers, artists, architects etc whose professional careers aren’t just 40 years long but, say, a whole century long. And it would solve the demographic challenge about how a shrinking working age population can support expanding legions of retired people who all want their pensions and healthcare – it would put that trend into reverse. Just a thought.

Last edited 1 year ago by John Riordan
Cynthia W.
Cynthia W.
1 year ago

“They are selling you a picture of health that doubles as a picture of wealth” … that doubles as a picture of happiness. In many cases, the reality is the opposite.

Cynthia W.
Cynthia W.
1 year ago

“They are selling you a picture of health that doubles as a picture of wealth” … that doubles as a picture of happiness. In many cases, the reality is the opposite.

julianne kenny
julianne kenny
1 year ago

The other side of this strive for immortality and endless youth is the drugging and chemical engineering by state heath entities -leading to obesity and diabetes etc. Anti depressants ,neuroleptics mood “enhancers” and more. A naturally thin youth can gain 50kg over two or three years medicated with these regularly prescribed drugs.Obesity by prescription. No counter measures to address it. That is why we see so many obese people – not due to diet greed but prescribed by health service professionals. Epidemic in the USA- reaching that point here.

julianne kenny
julianne kenny
1 year ago

The other side of this strive for immortality and endless youth is the drugging and chemical engineering by state heath entities -leading to obesity and diabetes etc. Anti depressants ,neuroleptics mood “enhancers” and more. A naturally thin youth can gain 50kg over two or three years medicated with these regularly prescribed drugs.Obesity by prescription. No counter measures to address it. That is why we see so many obese people – not due to diet greed but prescribed by health service professionals. Epidemic in the USA- reaching that point here.

Allison Barrows
Allison Barrows
1 year ago

So Lizzo is “plus-sized” but Ann Coulter is “skeletal”? Lizzo is morbidly obese, but you didn’t describe her as whale-like. Why such an uneven use of adjectives?

AL Crowe
AL Crowe
1 year ago

The writer has to make sure he consistently signals his alignment with the left in order to avoid the outrage and ostracism mob from targeting him. This is what too much reliance on a tribalistic political alignment does, it leaves people obfuscating and unable to step beyond the collective narratives of their chosen tribe for fear that they will be rejected and forced to go grovelling to the dreaded others for support.

Roddy Campbell
Roddy Campbell
1 year ago

What’s wrong with plain old ‘very fat’? When did we become so mealy-mouthed?

Andrew McDonald
Andrew McDonald
1 year ago
Reply to  Roddy Campbell

Just wait a bit and it’ll come round again, as ‘queer’ has.

Dave R
Dave R
1 year ago
Reply to  Roddy Campbell

Alt-wokeness: mandatory speech-codes.

Andrew McDonald
Andrew McDonald
1 year ago
Reply to  Roddy Campbell

Just wait a bit and it’ll come round again, as ‘queer’ has.

Dave R
Dave R
1 year ago
Reply to  Roddy Campbell

Alt-wokeness: mandatory speech-codes.

AL Crowe
AL Crowe
1 year ago

The writer has to make sure he consistently signals his alignment with the left in order to avoid the outrage and ostracism mob from targeting him. This is what too much reliance on a tribalistic political alignment does, it leaves people obfuscating and unable to step beyond the collective narratives of their chosen tribe for fear that they will be rejected and forced to go grovelling to the dreaded others for support.

Roddy Campbell
Roddy Campbell
1 year ago

What’s wrong with plain old ‘very fat’? When did we become so mealy-mouthed?

Allison Barrows
Allison Barrows
1 year ago

So Lizzo is “plus-sized” but Ann Coulter is “skeletal”? Lizzo is morbidly obese, but you didn’t describe her as whale-like. Why such an uneven use of adjectives?

Richard Craven
Richard Craven
1 year ago

“For me, glorifying the “natural” in and of itself, then, is little better than writing some trite ode to manual labour.”
This stuff is all just rich people making rods for their own backs. I’ve never been tempted to take steroids, but just go to the gym because I like being quite fit and strong and want to enjoy my old age. And once upon a time I worked as a builder’s labourer and really liked it.

Last edited 1 year ago by Richard Craven
John Riordan
John Riordan
1 year ago
Reply to  Richard Craven

I’m in my mid 50s and have been going to the gym for over 30 years now. Gone are the days when I care what I look like in the mirror, but the benefits of simply remaining strong and fit are enough on their own to make it worth it.

John Riordan
John Riordan
1 year ago
Reply to  Richard Craven

I’m in my mid 50s and have been going to the gym for over 30 years now. Gone are the days when I care what I look like in the mirror, but the benefits of simply remaining strong and fit are enough on their own to make it worth it.

Richard Craven
Richard Craven
1 year ago

“For me, glorifying the “natural” in and of itself, then, is little better than writing some trite ode to manual labour.”
This stuff is all just rich people making rods for their own backs. I’ve never been tempted to take steroids, but just go to the gym because I like being quite fit and strong and want to enjoy my old age. And once upon a time I worked as a builder’s labourer and really liked it.

Last edited 1 year ago by Richard Craven
Nils Espenlaub
Nils Espenlaub
1 year ago

Lately I have been contemplating here and there about the body cults of our time and their dynamics with class questions. This article helps with its insights of the pharma and medical industry.
Personally, I would like to add that as a former nurse I have solid knowledge about side effects and the problems connected with new treatments or alternative use of long known medication, and I’ve got around quite in my work life. In the places I worked in and patients I treated, both wealthy with private insurance (but seldom celebrities and 1% per centers of the wealthy classes), the work ethic has always been mainly conservative: Don’t use medication or treatment that aren’t really necessary for your overall health. Because of that, I think it is worth noting that despite the dystopic urgency conveyed in the article, the phenomena described are far away from being standard mindset and way to go neither among poor nor rich people.

Lesley van Reenen
Lesley van Reenen
1 year ago
Reply to  Nils Espenlaub

Are statins good for your overall health? Most of the medical fraternity will say yes even with marginal high cholesterol.

Chris Wheatley
Chris Wheatley
1 year ago

Here in the UK doctors and nurses approve of statins because they have to. When confronted by a patient they have three choices:
1) Prescribe approved tablets – perhaps after routine blood tests. There are fixed rules about when to prescribe or not,
2) Send him/her up the line to a specialist,
3) Both of those.
Nowhere is the doctor allowed to use an independent answer because that could lead to litigation. Lifestyle advice is taboo as well.
Are statins good for your health? Only time can tell.

Last edited 1 year ago by Chris Wheatley
Nils Espenlaub
Nils Espenlaub
1 year ago
Reply to  Chris Wheatley

I had a check-up just a week ago. Everything was fine aside from a little high cholesterol. My physician didn’t even mention the option of taking statins (but we did talk about possible causes and measures against it). Another physician may have suggested it. In Switzerland there are guidelines but no fixed rules. Doctors should have their opinion and discuss it with their patients. Is that really not the standard in GB or are you exaggerating a bit maybe?
I don’t expect any big scandals in the future around statins, rather something like with antiplatelet drugs (like Aspirin Cardio). They were widely prescribed for a while to basically anyone with risk factors, the standard now is: When it is needed. No heavy damage but also not a high benefit was the conclusion made…
Further, there’s an awareness around polypharmacy nowadays. People are often taking too many pills. Nobody can possibly know all the interactions happening in those cocktails…

Chris Wheatley
Chris Wheatley
1 year ago
Reply to  Nils Espenlaub

I am not exaggerating. I obviously can’t say that ALL doctors (100%) behave in the same way but most do. If you are intelligent, UnHerd subscribers maybe, you have knowledge and confidence so you might initiate a discussion about health. That, I think, is slightly different.

Rocky Martiano
Rocky Martiano
1 year ago
Reply to  Chris Wheatley

I can confirm that most doctors in England do conform to this model of prescribing statins. There is a standard NHS test which is supposed to provide your ‘risk score’ of heart disease due to excess cholesterol. For years I was marginally below the threshold and firmly refused when my doctor wanted to prescribe statins ‘just in case’. Then then threshold was lowered by 25% without explanation and so I was marginally above it.
Although the doctor insisted on prescribing statins I have never taken them. All the evidence suggests marginal benefits, but a high risk of unpleasant side effects. Some practitioners even dispute the link between high cholesterol and heart disease.

Chris Wheatley
Chris Wheatley
1 year ago
Reply to  Rocky Martiano

Exactly the same for me.

Chris Wheatley
Chris Wheatley
1 year ago
Reply to  Rocky Martiano

Exactly the same for me.

AL Crowe
AL Crowe
1 year ago
Reply to  Chris Wheatley

I think this is fairly standard across the UK for how GPs operate whether with statins or with other medications. The NHS guidance gives them very little leeway to use their own discretion, hence why I tend to go round and round in circles with mine.

It seems ridiculous to have highly intelligent individuals who spend years learning about medicine and the human body reduced to reading out what their computer tells them after they’ve inputted a series of symptoms, but that is apparently what they’ve been reduced to under the current NHS bureaucracy.

Roddy Campbell
Roddy Campbell
1 year ago
Reply to  AL Crowe

GPs, like hospital consultants, are categorised as ‘independent practitioners’. This means that they aren’t obliged to follow any fixed guidelines or protocols and may deviate from algorithms as much as they please if they consider it’s in the patient’s best interests.

There are 2 hefty provisos here: first, they must be able to justify what they have done; and secondly, if they are going to go ‘off piste’, it must be with the informed agreement of the patient. This takes more time.

Most doctors are motivated by what they feel is their patients’ best interests and guided by well-researched clinical guidelines. In over 20 years’ practice, I have only very rarely met a doctor who didn’t genuinely want to do the best for his or her patients. So they do follow guidelines, which nowadays are very evidence-based. (Note that the benefits of a guideline apply to to a population and may not apply to a particular individual. That’s where a really good doctor will feel it’s appropriate to do something else.)

Deviating from guidelines takes time and may involve professional risk; and doctors are by nature risk-averse. They also don’t have a lot of time. There aren’t enough doctors and their supporting and administrative infrastructure is generally poor in the NHS.

GPs are also motivated by centralist incentives, linking targets to funding. This is an example of top-down micromanagement from non-medical NHS senior managers who don’t like the idea of providing the resources and trusting what are generally well motivated professionals to do their job. Don’t blame GPs for following NHS central incentives, blame the Stalinist NHS for forcing often inappropriate targets onto them. A GP practice that ignores them will go bust.

So doctors do tend to follow the guidelines by default. They don’t do it because they’re lazy, greedy, stupid, ignorant or in the pay of Evil Big Pharma (if only
).

They do it because they don’t have much time, because the guidelines tend to work and are strongly evidence-based, and because going off-piste involves professional risk and doctors don’t like risk.

Last edited 1 year ago by Roddy Campbell
Nils Espenlaub
Nils Espenlaub
1 year ago
Reply to  Roddy Campbell

Thanks to all for taking the time to share the experiences with and opinions about the health care system of England. As a foreigner I read them with a keen interest.

Nils Espenlaub
Nils Espenlaub
1 year ago
Reply to  Roddy Campbell

Thanks to all for taking the time to share the experiences with and opinions about the health care system of England. As a foreigner I read them with a keen interest.

Roddy Campbell
Roddy Campbell
1 year ago
Reply to  AL Crowe

GPs, like hospital consultants, are categorised as ‘independent practitioners’. This means that they aren’t obliged to follow any fixed guidelines or protocols and may deviate from algorithms as much as they please if they consider it’s in the patient’s best interests.

There are 2 hefty provisos here: first, they must be able to justify what they have done; and secondly, if they are going to go ‘off piste’, it must be with the informed agreement of the patient. This takes more time.

Most doctors are motivated by what they feel is their patients’ best interests and guided by well-researched clinical guidelines. In over 20 years’ practice, I have only very rarely met a doctor who didn’t genuinely want to do the best for his or her patients. So they do follow guidelines, which nowadays are very evidence-based. (Note that the benefits of a guideline apply to to a population and may not apply to a particular individual. That’s where a really good doctor will feel it’s appropriate to do something else.)

Deviating from guidelines takes time and may involve professional risk; and doctors are by nature risk-averse. They also don’t have a lot of time. There aren’t enough doctors and their supporting and administrative infrastructure is generally poor in the NHS.

GPs are also motivated by centralist incentives, linking targets to funding. This is an example of top-down micromanagement from non-medical NHS senior managers who don’t like the idea of providing the resources and trusting what are generally well motivated professionals to do their job. Don’t blame GPs for following NHS central incentives, blame the Stalinist NHS for forcing often inappropriate targets onto them. A GP practice that ignores them will go bust.

So doctors do tend to follow the guidelines by default. They don’t do it because they’re lazy, greedy, stupid, ignorant or in the pay of Evil Big Pharma (if only
).

They do it because they don’t have much time, because the guidelines tend to work and are strongly evidence-based, and because going off-piste involves professional risk and doctors don’t like risk.

Last edited 1 year ago by Roddy Campbell
Rocky Martiano
Rocky Martiano
1 year ago
Reply to  Chris Wheatley

I can confirm that most doctors in England do conform to this model of prescribing statins. There is a standard NHS test which is supposed to provide your ‘risk score’ of heart disease due to excess cholesterol. For years I was marginally below the threshold and firmly refused when my doctor wanted to prescribe statins ‘just in case’. Then then threshold was lowered by 25% without explanation and so I was marginally above it.
Although the doctor insisted on prescribing statins I have never taken them. All the evidence suggests marginal benefits, but a high risk of unpleasant side effects. Some practitioners even dispute the link between high cholesterol and heart disease.

AL Crowe
AL Crowe
1 year ago
Reply to  Chris Wheatley

I think this is fairly standard across the UK for how GPs operate whether with statins or with other medications. The NHS guidance gives them very little leeway to use their own discretion, hence why I tend to go round and round in circles with mine.

It seems ridiculous to have highly intelligent individuals who spend years learning about medicine and the human body reduced to reading out what their computer tells them after they’ve inputted a series of symptoms, but that is apparently what they’ve been reduced to under the current NHS bureaucracy.

Chris Wheatley
Chris Wheatley
1 year ago
Reply to  Nils Espenlaub

I am not exaggerating. I obviously can’t say that ALL doctors (100%) behave in the same way but most do. If you are intelligent, UnHerd subscribers maybe, you have knowledge and confidence so you might initiate a discussion about health. That, I think, is slightly different.

Steve Murray
Steve Murray
1 year ago
Reply to  Chris Wheatley

There’s another factor, more imperative than any of those you’ve mentioned.
GPs who have a certain percentage of their patient population on statins receive a financial bonus for doing so. The main driver of statin prescription is greed, both by the GP and the pharmaceutical companies.
As a very naturally fit male, when i went for a routine GP checkup aged 60 the idiot (yes, the GP) tried to put me on statins. My BMI is bang in mid-range, my cholesterol levels normal. I asked him why: he replied “just in case”. I said i’d get back to him on that, did some basic research on side effects (i have healthcare experience and know what i’m looking at) and made a point of never going near that particular GP again.
How GPs are Paid to Prescribe Ineffective Drugs – Patrick Holford

CHARLES STANHOPE
CHARLES STANHOPE
1 year ago
Reply to  Steve Murray

However beware at 60 you enter the “beaten zone”!

Rocky Martiano
Rocky Martiano
1 year ago
Reply to  Steve Murray

Thanks for the link. I had no idea that GPs were remunerated for prescribing drugs.
Having lived a long time in France I can also confirm that the UK is far from the leader in over-prescribing. No visit to the ‘mĂ©decin de famille’ was considered worthwhile unless the patient left with a prescription for 3 or 4 pills, sometimes double that.

Roddy Campbell
Roddy Campbell
1 year ago
Reply to  Steve Murray

A plea for granularity.

The main driver for doctors prescribing statins is that they work if prescribed to the right people. That is, applied to a population of people considered at a higher risk of cardiovascular disease, they result in a significantly lower overall rate of heart attacks and strokes. That’s based on metadata from numerous robust trials, leading to objective evidence: more credible than scattered and colourful anecdote (but, of course, less entertaining!)

The NHS does link statin prescribing to GP target-based funding, but only for patients who fulfil the at-risk descriptors. So, yes, there is a non-medical incentive there for GPs to prescribe for borderline cases, and perhaps there shouldn’t be.

However, cardiologists and general physicians also prescribe statins pretty liberally, and they have no financial incentive to do so.

A few people experience adverse effects from statins that can occasionally be serious. Most don’t, and statins do provide a benefit if prescribed to the right people.

As always, nuance is more valuable than sweeping condemnation or anec-data. The devil – or saint – is in the detail.

Andrew McDonald
Andrew McDonald
1 year ago
Reply to  Roddy Campbell

I think rather than non-medical’ you should say ‘public health motivated’ – your point of view is spot on, but in fact the decisions about how to (financially) motivate population-based prescribing by independent contractors are taken by clinicians and implemented by managers, not the other way round. Alas the funds are provided by politicians and warped by their motives.

Andrew McDonald
Andrew McDonald
1 year ago
Reply to  Roddy Campbell

I think rather than non-medical’ you should say ‘public health motivated’ – your point of view is spot on, but in fact the decisions about how to (financially) motivate population-based prescribing by independent contractors are taken by clinicians and implemented by managers, not the other way round. Alas the funds are provided by politicians and warped by their motives.

CHARLES STANHOPE
CHARLES STANHOPE
1 year ago
Reply to  Steve Murray

However beware at 60 you enter the “beaten zone”!

Rocky Martiano
Rocky Martiano
1 year ago
Reply to  Steve Murray

Thanks for the link. I had no idea that GPs were remunerated for prescribing drugs.
Having lived a long time in France I can also confirm that the UK is far from the leader in over-prescribing. No visit to the ‘mĂ©decin de famille’ was considered worthwhile unless the patient left with a prescription for 3 or 4 pills, sometimes double that.

Roddy Campbell
Roddy Campbell
1 year ago
Reply to  Steve Murray

A plea for granularity.

The main driver for doctors prescribing statins is that they work if prescribed to the right people. That is, applied to a population of people considered at a higher risk of cardiovascular disease, they result in a significantly lower overall rate of heart attacks and strokes. That’s based on metadata from numerous robust trials, leading to objective evidence: more credible than scattered and colourful anecdote (but, of course, less entertaining!)

The NHS does link statin prescribing to GP target-based funding, but only for patients who fulfil the at-risk descriptors. So, yes, there is a non-medical incentive there for GPs to prescribe for borderline cases, and perhaps there shouldn’t be.

However, cardiologists and general physicians also prescribe statins pretty liberally, and they have no financial incentive to do so.

A few people experience adverse effects from statins that can occasionally be serious. Most don’t, and statins do provide a benefit if prescribed to the right people.

As always, nuance is more valuable than sweeping condemnation or anec-data. The devil – or saint – is in the detail.

Jeremy Bray
Jeremy Bray
1 year ago
Reply to  Chris Wheatley

I have only had one discussion with a GP about statins when my cholesterol was slightly high. The GP, a friend, said that although the recommendation was to take statins it was up to me and that they simply shifted the risks a tiny percentage. I chose not to take them. Since he retired I have seldom seen a GP during and after the pandemic and no interest in my cholesterol has been expressed.

Nils Espenlaub
Nils Espenlaub
1 year ago
Reply to  Chris Wheatley

I had a check-up just a week ago. Everything was fine aside from a little high cholesterol. My physician didn’t even mention the option of taking statins (but we did talk about possible causes and measures against it). Another physician may have suggested it. In Switzerland there are guidelines but no fixed rules. Doctors should have their opinion and discuss it with their patients. Is that really not the standard in GB or are you exaggerating a bit maybe?
I don’t expect any big scandals in the future around statins, rather something like with antiplatelet drugs (like Aspirin Cardio). They were widely prescribed for a while to basically anyone with risk factors, the standard now is: When it is needed. No heavy damage but also not a high benefit was the conclusion made…
Further, there’s an awareness around polypharmacy nowadays. People are often taking too many pills. Nobody can possibly know all the interactions happening in those cocktails…

Steve Murray
Steve Murray
1 year ago
Reply to  Chris Wheatley

There’s another factor, more imperative than any of those you’ve mentioned.
GPs who have a certain percentage of their patient population on statins receive a financial bonus for doing so. The main driver of statin prescription is greed, both by the GP and the pharmaceutical companies.
As a very naturally fit male, when i went for a routine GP checkup aged 60 the idiot (yes, the GP) tried to put me on statins. My BMI is bang in mid-range, my cholesterol levels normal. I asked him why: he replied “just in case”. I said i’d get back to him on that, did some basic research on side effects (i have healthcare experience and know what i’m looking at) and made a point of never going near that particular GP again.
How GPs are Paid to Prescribe Ineffective Drugs – Patrick Holford

Jeremy Bray
Jeremy Bray
1 year ago
Reply to  Chris Wheatley

I have only had one discussion with a GP about statins when my cholesterol was slightly high. The GP, a friend, said that although the recommendation was to take statins it was up to me and that they simply shifted the risks a tiny percentage. I chose not to take them. Since he retired I have seldom seen a GP during and after the pandemic and no interest in my cholesterol has been expressed.

Jacqueline Burns
Jacqueline Burns
1 year ago

They weren’t good for me…I was almost crippled by the side effects & it took many months to even get back to being able to walk normally.

Chris Wheatley
Chris Wheatley
1 year ago

Here in the UK doctors and nurses approve of statins because they have to. When confronted by a patient they have three choices:
1) Prescribe approved tablets – perhaps after routine blood tests. There are fixed rules about when to prescribe or not,
2) Send him/her up the line to a specialist,
3) Both of those.
Nowhere is the doctor allowed to use an independent answer because that could lead to litigation. Lifestyle advice is taboo as well.
Are statins good for your health? Only time can tell.

Last edited 1 year ago by Chris Wheatley
Jacqueline Burns
Jacqueline Burns
1 year ago

They weren’t good for me…I was almost crippled by the side effects & it took many months to even get back to being able to walk normally.

Brendan O'Leary
Brendan O'Leary
1 year ago
Reply to  Nils Espenlaub

Interesting discussion. I’ve recently had statins and aspirin added to my daily blood pressure tablets because my cholesterol was “a bit high” (which may have been understatement). I’m not aware of any downside at the moment.
Widowed male in his late 60s, and I must admit being a bit freaked by a number of seemingly fit contemporaries or younger who’ve died of heart attacks or had debilitating strokes in recent years.

Lesley van Reenen
Lesley van Reenen
1 year ago
Reply to  Nils Espenlaub

Are statins good for your overall health? Most of the medical fraternity will say yes even with marginal high cholesterol.

Brendan O'Leary
Brendan O'Leary
1 year ago
Reply to  Nils Espenlaub

Interesting discussion. I’ve recently had statins and aspirin added to my daily blood pressure tablets because my cholesterol was “a bit high” (which may have been understatement). I’m not aware of any downside at the moment.
Widowed male in his late 60s, and I must admit being a bit freaked by a number of seemingly fit contemporaries or younger who’ve died of heart attacks or had debilitating strokes in recent years.

Nils Espenlaub
Nils Espenlaub
1 year ago

Lately I have been contemplating here and there about the body cults of our time and their dynamics with class questions. This article helps with its insights of the pharma and medical industry.
Personally, I would like to add that as a former nurse I have solid knowledge about side effects and the problems connected with new treatments or alternative use of long known medication, and I’ve got around quite in my work life. In the places I worked in and patients I treated, both wealthy with private insurance (but seldom celebrities and 1% per centers of the wealthy classes), the work ethic has always been mainly conservative: Don’t use medication or treatment that aren’t really necessary for your overall health. Because of that, I think it is worth noting that despite the dystopic urgency conveyed in the article, the phenomena described are far away from being standard mindset and way to go neither among poor nor rich people.

jane baker
jane baker
1 year ago

I’m very suspicious ,(always) this new drug is not about blessing poor fat people with desirable slimness. Its allied to food,making you not want to eat food…. I don’t know any more. I haven’t got a theory,(for once) but it’s about something else. I don’t like it.
Now about 20 years ago,cos I was back at our old house there was a light hearted story in a newspaper. It was jolly and funny and it triggered something in my brain. A big rock star,maybe Rod Stewart or Keith Richards was sunning his rock star body on a beach near Nice when he met his either binman or postman . He has a nice friendly chat and a picture was taken by whoever that made a feature in the papers. Rock star and binman holiday on same exclusive beach. And for some strange reason my brain said ” what’s the point of being rich if your service people can live to the same high standard as you”.
That wasn’t my credo I hasten to add. I thought it was wonderful that over a century of campaigning and union in strength had brought about an equable world in which hard working and wits about them working people could live well,which is the point of life,and the whole point of working. But obviously someone was having that same wicked thought that strayed into my head.

jane baker
jane baker
1 year ago

I’m very suspicious ,(always) this new drug is not about blessing poor fat people with desirable slimness. Its allied to food,making you not want to eat food…. I don’t know any more. I haven’t got a theory,(for once) but it’s about something else. I don’t like it.
Now about 20 years ago,cos I was back at our old house there was a light hearted story in a newspaper. It was jolly and funny and it triggered something in my brain. A big rock star,maybe Rod Stewart or Keith Richards was sunning his rock star body on a beach near Nice when he met his either binman or postman . He has a nice friendly chat and a picture was taken by whoever that made a feature in the papers. Rock star and binman holiday on same exclusive beach. And for some strange reason my brain said ” what’s the point of being rich if your service people can live to the same high standard as you”.
That wasn’t my credo I hasten to add. I thought it was wonderful that over a century of campaigning and union in strength had brought about an equable world in which hard working and wits about them working people could live well,which is the point of life,and the whole point of working. But obviously someone was having that same wicked thought that strayed into my head.

Michelle Johnston
Michelle Johnston
1 year ago

Maybe because my forebears emerged out of a small terraced property next to the River Calder in Dewsbury with an outside toilet the thought of spending all that money, when I can achieve the same result by exercise and a passion for the right food, fills me with no enthusiasm. I also have the mental “get” that I made the effort in both directions and own the result.

Last edited 1 year ago by Michelle Johnston
Michelle Johnston
Michelle Johnston
1 year ago

Maybe because my forebears emerged out of a small terraced property next to the River Calder in Dewsbury with an outside toilet the thought of spending all that money, when I can achieve the same result by exercise and a passion for the right food, fills me with no enthusiasm. I also have the mental “get” that I made the effort in both directions and own the result.

Last edited 1 year ago by Michelle Johnston
Alex Cranberg
Alex Cranberg
1 year ago

Much ado about very little indeed. If some people want to experiment on themselves while the rest of us observe and learn, so much the better.

What are the side effects of this stuff that requires traveling outside the FDA’s purview to obtain? How serious are the cancers that Ozempic causes? The so-called “rich elite” will tell us.

As for “trickle down” name one miracle treatment that the elite of previous generations took that was even modestly effective! And any drug from past generations is today stupidly cheap.

Alex Cranberg
Alex Cranberg
1 year ago

Much ado about very little indeed. If some people want to experiment on themselves while the rest of us observe and learn, so much the better.

What are the side effects of this stuff that requires traveling outside the FDA’s purview to obtain? How serious are the cancers that Ozempic causes? The so-called “rich elite” will tell us.

As for “trickle down” name one miracle treatment that the elite of previous generations took that was even modestly effective! And any drug from past generations is today stupidly cheap.

William Jackson
William Jackson
1 year ago

Question, do the ‘improvers’ live any longer, do we have enough evidence to show any potential harm, finally what happens if/when the money dries up?

William Jackson
William Jackson
1 year ago

Question, do the ‘improvers’ live any longer, do we have enough evidence to show any potential harm, finally what happens if/when the money dries up?

Kirsten Walstedt
Kirsten Walstedt
1 year ago

Ozempic can cause laryngeal cancer. It’s for this reason doctors recommend their patients only take it in the short term. It’s no panacea for weight loss.

Kirsten Walstedt
Kirsten Walstedt
1 year ago

Ozempic can cause laryngeal cancer. It’s for this reason doctors recommend their patients only take it in the short term. It’s no panacea for weight loss.

Leejon 0
Leejon 0
1 year ago

Death cures all vanities.

Leejon 0
Leejon 0
1 year ago

Death cures all vanities.