Easy Ways To Fix Brittle, Dry, Wiry Hair
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Dr. Sam Ellis, a dermatologist, specializes in skin, hair, and nail care—and she’s here with professional knowledge:
Tackling the problem at the root
As we age, hair becomes less shiny, more brittle, coarse, wiry, or gray. More concerningly for many, hair thinning and shedding increases due to shortened growth phases and hormonal changes.
The first set of symptoms there are largely because sebum production decreases, leading to dry hair. It’s worth bearing in mind though, that factors like UV radiation, smoking, stress, and genetics contribute to hair aging too. So while we can’t do much about genetics, the modifiable factors are worth addressing.
Menopause and the corresponding “andropause” impact hair health, and hormonal shifts, not just aging, drive many hair changes. Which is good to know, because it means that HRT (mostly: topping up estrogen or testosterone as appropriate) can make a big difference. Additionally, topical/oral minoxidil and DHT blockers (such as finasteride or dutasteride) can boost hair density. These things come with caveats though, so do research any possible treatment plan before embarking on it, to be sure you are comfortable with all aspects of it—including that if you use minoxidil, while on the one hand it indeed works wonders, on the other hand, you’ll then have to keep using minoxidil for the rest of your life or your hair will fall out when you stop. So, that’s a commitment to be thought through before beginning.
Nutritional deficiencies (iron, zinc, vitamin D) and insufficient protein intake hinder hair growth, so ensure proper nutrition, with sufficient protein and micronutrients.
While we’re on the topic of “from the inside” things: take care to manage stress healthily, as stress negatively affects hair health.
Now, as for “from the outside”…
Dr. Ellis recommends moisturizing shampoos/conditioners; Virtue and Dove brands she mentions positively. She also recommends bond repair products (such as K18 and Olaplex) that restore hair integrity, and heat protectants (she recommends: Unite 7 Seconds) as well as hair oils in general that improve hair condition.
For more on all of this, enjoy:
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Statistical Models vs. Front-Line Workers: Who Knows Best How to Spend Opioid Settlement Cash?
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MOBILE, Ala. — In this Gulf Coast city, addiction medicine doctor Stephen Loyd announced at a January event what he called “a game-changer” for state and local governments spending billions of dollars in opioid settlement funds.
The money, which comes from companies accused of aggressively marketing and distributing prescription painkillers, is meant to tackle the addiction crisis.
But “how do you know that the money you’re spending is going to get you the result that you need?” asked Loyd, who was once hooked on prescription opioids himself and has become a nationally known figure since Michael Keaton played a character partially based on him in the Hulu series “Dopesick.”
Loyd provided an answer: Use statistical modeling and artificial intelligence to simulate the opioid crisis, predict which programs will save the most lives, and help local officials decide the best use of settlement dollars.
Loyd serves as the unpaid co-chair of the Helios Alliance, a group that hosted the event and is seeking $1.5 million to create such a simulation for Alabama.
The state is set to receive more than $500 million from opioid settlements over nearly two decades. It announced $8.5 million in grants to various community groups in early February.
Loyd’s audience that gray January morning included big players in Mobile, many of whom have known one another since their school days: the speaker pro tempore of Alabama’s legislature, representatives from the city and the local sheriff’s office, leaders from the nearby Poarch Band of Creek Indians, and dozens of addiction treatment providers and advocates for preventing youth addiction.
Many of them were excited by the proposal, saying this type of data and statistics-driven approach could reduce personal and political biases and ensure settlement dollars are directed efficiently over the next decade.
But some advocates and treatment providers say they don’t need a simulation to tell them where the needs are. They see it daily, when they try — and often fail — to get people medications, housing, and other basic services. They worry allocating $1.5 million for Helios prioritizes Big Tech promises for future success while shortchanging the urgent needs of people on the front lines today.
“Data does not save lives. Numbers on a computer do not save lives,” said Lisa Teggart, who is in recovery and runs two sober living homes in Mobile. “I’m a person in the trenches,” she said after attending the Helios event. “We don’t have a clean-needle program. We don’t have enough treatment. … And it’s like, when is the money going to get to them?”
The debate over whether to invest in technology or boots on the ground is likely to reverberate widely, as the Helios Alliance is in discussions to build similar models for other states, including West Virginia and Tennessee, where Loyd lives and leads the Opioid Abatement Council.
New Predictive Promise?
The Helios Alliance comprises nine nonprofit and for-profit organizations, with missions ranging from addiction treatment and mathematical modeling to artificial intelligence and marketing. As of mid-February, the alliance had received $750,000 to build its model for Alabama.
The largest chunk — $500,000 — came from the Poarch Band of Creek Indians, whose tribal council voted unanimously to spend most of its opioid settlement dollars to date on the Helios initiative. A state agency chipped in an additional $250,000. Ten Alabama cities and some private foundations are considering investing as well.
Stephen McNair, director of external affairs for Mobile, said the city has an obligation to use its settlement funds “in a way that is going to do the most good.” He hopes Helios will indicate how to do that, “instead of simply guessing.”
Rayford Etherton, a former attorney and consultant from Mobile who created the Helios Alliance, said he is confident his team can “predict the likely success or failure of programs before a dollar is spent.”
The Helios website features a similarly bold tagline: “Going Beyond Results to Predict Them.”
To do this, the alliance uses system dynamics, a mathematical modeling technique developed at the Massachusetts Institute of Technology in the 1950s. The Helios model takes in local and national data about addiction services and the drug supply. Then it simulates the effects different policies or spending decisions can have on overdose deaths and addiction rates. New data can be added regularly and new simulations run anytime. The alliance uses that information to produce reports and recommendations.
Etherton said it can help officials compare the impact of various approaches and identify unintended consequences. For example, would it save more lives to invest in housing or treatment? Will increasing police seizures of fentanyl decrease the number of people using it or will people switch to different substances?
And yet, Etherton cautioned, the model is “not a crystal ball.” Data is often incomplete, and the real world can throw curveballs.
Another limitation is that while Helios can suggest general strategies that might be most fruitful, it typically can’t predict, for instance, which of two rehab centers will be more effective. That decision would ultimately come down to individuals in charge of awarding contracts.
Mathematical Models vs. On-the-Ground Experts
To some people, what Helios is proposing sounds similar to a cheaper approach that 39 states — including Alabama — already have in place: opioid settlement councils that provide insights on how to best use the money. These are groups of people with expertise ranging from addiction medicine and law enforcement to social services and personal experience using drugs.
Even in places without formal councils, treatment providers and recovery advocates say they can perform a similar function. Half a dozen advocates in Mobile told KFF Health News the city’s top need is low-cost housing for people who want to stop using drugs.
“I wonder how much the results” from the Helios model “are going to look like what people on the ground doing this work have been saying for years,” said Chance Shaw, director of prevention for AIDS Alabama South and a person in recovery from opioid use disorder.
But Loyd, the co-chair of the Helios board, sees the simulation platform as augmenting the work of opioid settlement councils, like the one he leads in Tennessee.
Members of his council have been trying to decide how much money to invest in prevention efforts versus treatment, “but we just kind of look at it, and we guessed,” he said — the way it’s been done for decades. “I want to know specifically where to put the money and what I can expect from outcomes.”
Jagpreet Chhatwal, an expert in mathematical modeling who directs the Institute for Technology Assessment at Massachusetts General Hospital, said models can reduce the risk of individual biases and blind spots shaping decisions.
If the inputs and assumptions used to build the model are transparent, there’s an opportunity to instill greater trust in the distribution of this money, said Chhatwal, who is not affiliated with Helios. Yet if the model is proprietary — as Helios’ marketing materials suggest its product will be — that could erode public trust, he said.
Etherton, of the Helios Alliance, told KFF Health News, “Everything we do will be available publicly for anyone who wants to look at it.”
Urgent Needs vs. Long-Term Goals
Helios’ pitch sounds simple: a small upfront cost to ensure sound future decision-making. “Spend 5% so you get the biggest impact with the other 95%,” Etherton said.
To some people working in treatment and recovery, however, the upfront cost represents not just dollars, but opportunities lost for immediate help, be it someone who couldn’t find an open bed or get a ride to the pharmacy.
“The urgency of being able to address those individual needs is vital,” said Pamela Sagness, executive director of the North Dakota Behavioral Health Division.
Her department recently awarded $7 million in opioid settlement funds to programs that provide mental health and addiction treatment, housing, and syringe service programs because that’s what residents have been demanding, she said. An additional $52 million in grant requests — including an application from the Helios Alliance — went unfunded.
Back in Mobile, advocates say they see the need for investment in direct services daily. More than 1,000 people visit the office of the nonprofit People Engaged in Recovery each month for recovery meetings, social events, and help connecting to social services. Yet the facility can’t afford to stock naloxone, a medication that can rapidly reverse overdoses.
At the two recovery homes that Mobile resident Teggart runs, people can live in a drug-free space at a low cost. She manages 18 beds but said there’s enough demand to fill 100.
Hannah Seale felt lucky to land one of those spots after leaving Mobile County jail last November.
“All I had with me was one bag of clothes and some laundry detergent and one pair of shoes,” Seale said.
Since arriving, she’s gotten her driver’s license, applied for food stamps, and attended intensive treatment. In late January, she was working two jobs and reconnecting with her 4- and 7-year-old daughters.
After 17 years of drug use, the recovery home “is the one that’s worked for me,” she said.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
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8 Critical Signs Of Blood Clots That You Shouldn’t Ignore
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Blood clots can form as part of deep vein thrombosis or for other reasons; wherever they form (unless they are just doing their job healing a wound) they can cause problems. But how to know what’s going on inside our body?
Telltale signs
Our usual medical/legal disclaimer applies here, and we are not doctors, let alone your doctors, and even if we were we couldn’t diagnose from afar… But for educational purposes, here are the eight signs from the video:
- Swelling: especially if only on one leg (assuming you have no injury to account for it), which may feel tight and uncomfortable
- Warmness: does the area warmer to the touch? This may be because of the body’s inflammatory response trying to deal with a blood clot
- Tenderness: again, caused by the inflammation in response to the clot
- Discolored skin: it could be reddish, or bruise-like. This could be patchy or spread over a larger area, because of a clot blocking the flow of blood
- Shortness of breath: if a clot makes it to the lungs, it can cause extra problems there (pulmonary embolism), and shortness of breath is the first sign of this
- Coughing up blood: less common than the above but a much more serious sign; get thee to a hospital
- Chest pain: a sharp or stabbing pain, in particular. The pain may worsen with deep breaths or coughing. Again, seek medical attention.
For more on recognizing these signs (including helpful visuals), and more on what to do about them and how to avoid them in the first place, enjoy:
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Further reading
You might like to read:
Dietary Changes for Artery Health
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What does it mean to be transgender?
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Transgender media coverage has surged in recent years for a wide range of reasons. While there are more transgender television characters than ever before, hundreds of bills are targeting transgender people’s access to medical care, sports teams, gender-specific public spaces, and other institutions.
Despite the increase in conversation about the transgender community, public confusion around transgender identity remains.
Read on to learn more about what it means to be transgender and understand challenges transgender people may face.
What does it mean to be transgender?
Transgender—or “trans”—is an umbrella term for people whose gender identity or gender expression does not conform to their sex assigned at birth. People can discover they are trans at any age.
Gender identity refers to a person’s inner sense of being a woman, a man, neither, both, or something else entirely. Trans people who don’t feel like women or men might describe themselves as nonbinary, agender, genderqueer, or two-spirit, among other terms.
Gender expression describes the way a person communicates their gender through their appearance—such as their clothing or hairstyle—and behavior.
A person whose gender expression doesn’t conform to the expectations of their assigned sex may not identify as trans. The only way to know for sure if someone is trans is if they tell you.
Cisgender—or “cis”—describes people whose gender identities match the sex they were assigned at birth.
How long have transgender people existed?
Being trans isn’t new. Although the word “transgender” only dates back to the 1960s, people whose identities defy traditional gender expectations have existed across cultures throughout recorded history.
How many people are transgender?
A 2022 Williams Institute study estimates that 1.6 million people over the age of 13 identify as transgender in the United States.
Is being transgender a mental health condition?
No. Conveying and communicating about your gender in a way that feels authentic to you is a normal and necessary part of self-expression.
Social and legal stigma, bullying, discrimination, harassment, negative media messages, and barriers to gender-affirming medical care can cause psychological distress for trans people. This is especially true for trans people of color, who face significantly higher rates of violence, poverty, housing instability, and incarceration—but trans identity itself is not a mental health condition.
What is gender dysphoria?
Gender dysphoria describes a feeling of unease that some trans people experience when their perceived gender doesn’t match their gender identity, or their internal sense of gender. A 2021 study of trans adults pursuing gender-affirming medical care found that most participants started experiencing gender dysphoria by the time they were 7.
When trans people don’t receive the support they need to manage gender dysphoria, they may experience depression, anxiety, social isolation, suicidal ideation, substance use disorder, eating disorders, and self-injury.
How do trans people manage gender dysphoria?
Every trans person’s experience with gender dysphoria is unique. Some trans people may alleviate dysphoria by wearing gender-affirming clothing or by asking others to refer to them by a new name and use pronouns that accurately reflect their gender identity. The 2022 U.S. Trans Survey found that nearly all trans participants who lived as a different gender than the sex they were assigned at birth reported that they were more satisfied with their lives.
Some trans people may also manage dysphoria by pursuing medical transition, which may involve taking hormones and getting gender-affirming surgery.
Access to gender-affirming medical care has been shown to reduce the risk of depression and suicide among trans youth and adults.
To learn more about the trans community, visit resources from the National Center for Transgender Equality, the Trevor Project, PFLAG, and Planned Parenthood.
If you or anyone you know is considering suicide or self-harm or is anxious, depressed, upset, or needs to talk, call the Suicide & Crisis Lifeline at 988 or text the Crisis Text Line at 741-741. For international resources, here is a good place to begin.
This article first appeared on Public Good News and is republished here under a Creative Commons license.
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Lyme Disease At-A-Glance
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It’s Q&A Day at 10almonds!
Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
❝Good info as always…was wondering if you have any recommendations for fighting Lyme disease naturally along wDr advice? Dr’s aren’t real keen on alternatives so always interested. Thanks❞
That depends on whether we’re looking at prevention or cure!
Prevention:
- Try not to get bitten by Lyme-disease-carrying ticks. Boots and long socks are your friends. As are long-gauntletted gloves for gardening.
- If you are in a high-risk area and/or engage in high-risk activities, check your body daily.
- This is because it usually takes 36–48 hours of being attached for a tick to cause an infection
- Obviously best if you can get a partner or close friend to help you with this, unless you have mastered some advanced pretzel positions of yoga.
- Contrary to many folk remedies, the safest way to remove a tick is with tweezers (carefully!).
- If you find and remove a tick, or otherwise suspect you have developed symptoms, go to your doctor immediately (not next week; today; time really counts for this).
Cure:
- No. Sorry. Regretfully, antibiotics are the only known effective treatment.
However! As with almost any kind of recovery, getting good rest, including good quality sleep, will hasten things. Also sensible is reducing stress if possible, and anything that could worsen inflammation.
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In Plain English…
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It’s Q&A Time!
This is the bit whereby each week, we respond to subscriber questions/requests/etc
Have something you’d like to ask us, or ask us to look into? Hit reply to any of our emails, or use the feedback widget at the bottom, and a Real Human™ will be glad to read it!
Q: Love to have someone research all the additives in our medicines, (risk of birth control and breast cancer) and what goes in all of our food and beverages. So much info out there, but there are so many variations, you never know who to believe.
That’s a great idea! There are a lot of medicines and food and beverages out there, so that’s quite a broad brief, but! We could well do a breakdown of very common additives, and demystify them, sorting them into good/bad/neutral, e.g:
- Ascorbic acid—Good! This is Vitamin C
- Acetic acid—Neutral! This is vinegar
- Acetylsalicylic acid—Good or Bad! This is aspirin (a painkiller and blood-thinning agent, can be good for you or can cause more problems than it solves, depending on your personal medical situation. If in doubt, check with your doctor)
- Acesulfame K—Generally Neutral! This is a sweetener that the body can’t metabolize, so it’s also not a source of potassium (despite containing potassium) and will generally do nothing. Unless you have an allergy to it, which is rare but is a thing.
- Sucralose—Neutral! This is technically a sugar (as is anything ending in -ose), but the body can’t metabolize it and processes it as a dietary fiber instead. We’d list it as good for that reason, but honestly, we doubt you’re eating enough sucralose to make a noticeable difference to your daily fiber intake.
- Sucrose—Bad! This is just plain sugar
Sometimes words that sound the same can ring alarm bells when they need not, for example there’s a big difference between:
- Potassium iodide (a good source of potassium and iodine)
- Potassium cyanide (the famous poison; 300mg will kill you; half that dose will probably kill you)
- Cyanocobalamine (Vitamin B12)
Let us know if there are particular additives (or particular medications) you’d like us to look at!
While for legal reasons we cannot give medical advice, talking about common contraindications (e.g., it’s generally advised to not take this with that, as one will stop the other from working, etc) is definitely something we could do.
For example! St. John’s Wort, very popular as a herbal mood-brightener, is on the list of contraindications for so many medications, including:
- Antidepressants
- Birth control pills
- Cyclosporine, which prevents the body from rejecting transplanted organs
- Some heart medications, including digoxin and ivabradine
- Some HIV drugs, including indinavir and nevirapine
- Some cancer medications, including irinotecan and imatinib
- Warfarin, an anticoagulant (blood thinner)
- Certain statins, including simvastatin
Q: As I am a retired nurse, I am always interested in new medical technology and new ways of diagnosing. I have recently heard of using the eyes to diagnose Alzheimer’s. When I did some research I didn’t find too much. I am thinking the information may be too new or I wasn’t on the right sites.
(this is in response to last week’s piece on lutein, eyes, and brain health)
We’d readily bet that the diagnostic criteria has to do with recording low levels of lutein in the eye (discernible by a visual examination of macular pigment optical density), and relying on the correlation between this and incidence of Alzheimer’s, but we’ve not seen it as a hard diagnostic tool as yet either—we’ll do some digging and let you know what we find! In the meantime, we note that the Journal of Alzheimer’s Disease (which may be of interest to you, if you’re not already subscribed) is onto this:
See also:
- Journal of Alzheimer’s Disease (mixture of free and paid content)
- Journal of Alzheimer’s Disease Reports (open access—all content is free)
Q: As to specific health topics, I would love to see someone address all these Instagram ads targeted to women that claim “You only need to ‘balance your hormones’ to lose weight, get ripped, etc.” What does this mean? Which hormones are they all talking about? They all seem to be selling a workout program and/or supplements or something similar, as they are ads, after all. Is there any science behind this stuff or is it mostly hot air, as I suspect?
Thank you for asking this, as your question prompted yesterday’s main feature, What Does “Balancing Your Hormones” Even Mean?
That’s a great suggestion also about addressing ads (and goes for health-related things in general, not just hormonal stuff) and examining their claims, what they mean, how they work (if they work!), and what’s “technically true but may
be misleading* cause confusion”*We don’t want companies to sue us, of course.
Only, we’re going to need your help for this one, subscribers!
See, here at 10almonds we practice what we preach. We limit screen time, we focus on our work when working, and simply put, we don’t see as many ads as our thousands of subscribers do. Also, ads tend to be targeted to the individual, and often vary from country to country, so chances are good that we’re not seeing the same ads that you’re seeing.
So, how about we pull together as a bit of a 10almonds community project?
- Step 1: add our email address to your contacts list, if you haven’t already
- Step 2: When you see an ad you’re curious about, select “share” (there is usually an option to share ads, but if not, feel free to screenshot or such)
- Step 3: Send the ad to us by email
We’ll do the rest! Whenever we have enough ads to review, we’ll do a special on the topic.
We will categorically not be able to do this without you, so please do join in—Many thanks in advance!
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The push for Medicare to cover weight-loss drugs: An explainer
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The largest U.S. insurer, Medicare, does not cover weight-loss drugs, making it tougher for older people to get access to promising new medications.
If you cover stories about drug costs in the U.S., it’s important to understand why Medicare’s Part D pharmacy program, which covers people aged 65 and older and people with certain disabilities, doesn’t cover weight-loss drugs today. It’s also important to consider what would happen if Medicare did start covering weight loss drugs. This explainer will give you a brief overview of the issues and then summarize some recent publications the benefits and costs of drugs like semaglutide and tirzepatide.
First, what are these new and newsy weight loss drugs?
Semaglutide is a medication used for both the treatment of type 2 diabetes and for long-term weight management in adults with obesity. It debuted in the United States in 2017 as an injectable diabetes drug called Ozempic, manufactured by Novo Nordisk. It’s part of a class of drugs that mimics the action of glucagon, a substance that the human body makes to aid digestion.
Glucagon-like peptide-1 (GLP-1) drugs like semaglutide help prompt the body to release insulin. But they also cause a minor delay in the pace of digestion, helping people feel sated after eating.
That second effect turned Ozempic into a widely used weight-loss drug, even before the Food and Drug Administration (FDA) gave its okay for this use. Doctors in the United States can prescribe medicines for uses beyond those approved by the FDA. This is known as off-label use.
In writing about her own experience in using the medicine to help her shed 40 pounds, Washington Post columnist Ruth Marcus in June noted that Novo Nordisk mentioned the potential for weight loss in its “ubiquitous cable ads (‘Oh-oh-oh, Ozempic!’)”
The American Society of Health-System Pharmacists has reported shortages of semaglutide due to demand, leaving some people with diabetes struggling to find supply of the medicine.
Novo Nordisk won Food and Drug Administration (FDA) approval in 2021 to market semaglutide as an injectable weight loss drug under the name Wegovy, but with a different dosing regimen than Ozempic. Rival Eli Lilly first won FDA approval of its similar GLP-1 diabetes drug, tirzepatide, in the United States in 2022 and sells it under the brand name Mounjaro.
In November of 2023, Eli Lilly won FDA approval to sell tirzepatide as a weight-loss drug, soon-to-be marketed under the brand name Zepbound. The company said it will set a monthly list price for a month’s supply of the drug at $1,059.87, which the company described as 20% discount to the cost of rival Novo Nordisk’s Wegovy. Wegovy has a list price of $1,349.02, according to the Novo Nordisk website.
Even when their insurance plans officially cover costs for weight loss drugs, consumers may face barriers in seeking that coverage for these drugs. Commercial health plans have in place prior authorization requirements to try to limit coverage of new weight-loss shots to those who qualify for these treatments. The Wegovy shot, for example, is intended for people whose weight reaches a certain benchmark for obesity or who are overweight and have a condition related to excess weight, such as diabetes, high blood pressure or high cholesterol.
State Medicaid programs, meanwhile, have taken approaches that vary by state. For example, the most populous U.S. state, California, provides some coverage to new weight-loss injections through its Medicaid program, but many others, including Texas, the No. 2 state in terms of population, do not, according to an online tool that Novo Nordisk created to help people check on coverage.
Medicare does cover semaglutide for treatment of diabetes, and the insurer reported $3 billion in 2021 spending on the drug under Medicare Part D. Congress last year gave Medicare new tools that might help it try to lower the cost of semaglutide.
Medicare is in the midst of implementing new authority it gained through the Inflation Reduction Act (IRA) of 2022 to negotiate with companies about the cost of certain medicines.
This legislation gave Medicare, for the first time, tools to directly negotiate with pharmaceutical companies on the cost of some medicines. Congress tailored this program to spare drug makers from negotiations for the first few years they put new medicines on the market, allowing them to recoup investment in these products.
Why doesn’t Medicare cover weight-loss drugs?
Congress created the Medicare Part D pharmacy program in 2003 to address a gap in coverage that had existed since the creation of Medicare in 1965. The program long covered the costs of drugs administered by doctors and those given in hospitals, but not the kinds of medicines people took on their own, like Wegovy shots.
In 2003, there seemed to be good reasons to leave weight-loss drugs out of the benefit, write Inmaculada Hernandez of the University of California, San Diego, and coauthors in their September 2023 editorial in the Journal of General Internal Medicine, “Medicare Part D Coverage of Anti-obesity Medications: a Call for Forward-Looking Policy Reform.”
When members of Congress worked on the Part D benefit, the drugs available on the market were known to have limited effectiveness and unpleasant side effects. And those members of Congress were aware of how a drug combination called fen-phen, once touted as a weight-loss miracle medicine, turned out in rare cases to cause fatal heart valve damage. In 1997, American Home Products, which later became Wyeth, took its fen-phen product off the market.
But today GLP-1 drugs like semaglutide appear to offer significant benefits, with far less risk and milder side effects, write Hernandez and coauthors.
“Other than budget impact, it is hard to find a reason to justify the historical statutory exclusion of weight loss drugs from coverage other than the stigma of the condition itself,” they write.
What’s happening today that could lead Medicare to start covering weight loss drugs?
Novo Nordisk and Eli Lilly both have hired lobbyists to try to persuade lawmakers to reverse this stance, according to Senate records. Pro tip: You can use the Senate’s lobbying disclosure database to track this and other issues. Type in the name of the company of interest and then read through the forms.
Some members of Congress already have been trying for years to strike the Medicare Part D restriction on weight-loss drugs. Over the past decade, senators Tom Carper (D-DE) and Bill Cassidy, MD, (R-LA) have repeatedly introduced bills that would do that. They introduced the current version, the Treat and Reduce Obesity Act of 2023, in July. It has the support of 10 other Republican senators and seven Democratic ones, as of Dec. 19. The companion House measure has the support of 41 Democrats and 23 Republicans in that chamber, which has 435 seats.
The influential nonprofit Institute for Clinical and Economic Review conducts in-depth analyses of drugs and medical treatments in the United States. ICER last year recommended passage of a law allowing Medicare Part D to cover weight-loss medications. ICER also called for broader coverage of weight-loss medications in state Medicaid programs. Insurers, including Medicare, consider ICER’s analyses in deciding whether to cover treatments.
While offering these calls for broader coverage as part of a broad assessment of obesity management, ICER also urged companies to reduce the costs of weight-loss medicines.
Most people with obesity can’t achieve sustained weight loss through diet and exercise alone, said David Rind, ICER’s chief medical officer in an August 2022 statement. The development of newer obesity treatments represents the achievement of a long-standing goal of medical research, but prices of these new products must be reasonable to allow broad access to them, he noted.
After an extensive process of reviewing studies, engaging in public debate and processing feedback, ICER concluded that semaglutide for weight loss should have an annual cost of $7,500 to $9,800, based on its potential benefits.
What does academic research say about the benefits and the potential costs of new obesity drugs?
Here are a couple of studies to consider when covering the ongoing story of weight-loss drug costs:
Medicare Part D Coverage of Antiobesity Medications — Challenges and Uncertainty Ahead
Khrysta Baig, Stacie B. Dusetzina, David D. Kim and Ashley A. Leech. New England Journal of Medicine, March 2023In this Perspective piece, researchers at Vanderbilt University create a series of estimates about how much Medicare may have to spend annually on weight-loss drugs if the program eventually covers these drugs.
These include a high estimate — $268 billion — based on an extreme calculation, one reflecting the potential cost if virtually all people on Medicare who have obesity used semaglutide. In an announcement of the study on the Vanderbilt website, lead author Khrysta Baig described this as a “purely hypothetical scenario,” but one that “ underscores that at current prices, these medications cannot be the only way – or even the main way – we address obesity as a society.”
In a more conservative estimate, Bhaig and coauthors consider a case where only about 10% of those eligible for obesity treatment opted for semaglutide, which would result in $27 billion in new costs.
(To put these numbers in context, consider that the federal government now spends about $145 billion a year on the entire Part D program.)
It’s likely that all people enrolled in Part D would have to pay higher monthly premiums if Medicare were to cover weight-loss injections, Baig and coauthors write.
Baig and coauthors note that the recent ICER review of weight-loss drugs focused on patients younger than the Medicare population. The balance of benefits and risks associated with weight-loss drugs may be less favorable for older people than the younger ones, making it necessary to study further how these drugs work for people aged 65 and older, they write. For example, research has shown older adults with a high blood sugar level called prediabetes are less likely to develop diabetes than younger adults with this condition.
SELECTing Treatments for Cardiovascular Disease — Obesity in the Spotlight
Amit Khera and Tiffany M. Powell-Wiley. New England Journal of Medicine, Dec. 14, 2023
Semaglutide and Cardiovascular Outcomes in Patients Without Diabetes
A Michael Lincoff, et. al. New England Journal of Medicine, Dec. 14, 2023.An editorial accompanies the publication of a semaglutide study that drew a lot of coverage in the media. The Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes (SELECT) study was a randomized controlled trial, conducted by Novo Nordisk, which looked at rates of cardiovascular events in people who already had known heart risk and were overweight, but not diabetic. Patients were randomly assigned to receive a once-weekly dose of semaglutide (Wegovy) or a placebo.
In the study, the authors report that of the 8,803 patients who took Wegovy in the trial, 569 (6.5%)
The study also reports a mean 9.4% reduction in body weight among patients taking Wegovy, while those on placebo had a mean loss of 0.88%.
The findings suggest Wegovy may be a welcome new treatment option for many people who have coronary disease and are overweight, but are not diabetic, write Khera and Powell-Wiley in their editorial.
But the duo, both of whom focus on disease prevention in their research, also call for more focus on the prevention and root causes of obesity and on the use of proven treatment approaches other than medication.
“Socioeconomic, environmental, and psychosocial factors contribute to incident obesity, and therefore equity-focused obesity prevention and treatment efforts must target multiple levels,” they write. “For instance, public policy targeting built environment features that limit healthy behaviors can be coupled with clinical care interventions that provide for social needs and access to treatments like semaglutide.”
Additional information:
The nonprofit KFF, formerly known as the Kaiser Family Foundation, has done recent reports looking at the potential for expanded coverage of semaglutide:
Medicaid Utilization and Spending on New Drugs Used for Weight Loss, Sept. 8, 2023
What Could New Anti-Obesity Drugs Mean for Medicare? May 18, 2023
And KFF held an Aug. 4 webinar, New Weight Loss Drugs Raise Issues of Coverage, Cost, Access and Equity, for which the recording is posted here.
This article first appeared on The Journalist’s Resource and is republished here under a Creative Commons license.
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