When supplies resume, should governments subsidise drugs like Ozempic for weight loss? We asked 5 experts
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Hundreds of thousands of people worldwide are taking drugs like Ozempic to lose weight. But what do we actually know about them? This month, The Conversation’s experts explore their rise, impact and potential consequences.
You’ve no doubt heard of Ozempic but have you heard of Wegovy? They’re both brand names of the drug semaglutide, which is currently in short supply worldwide.
Ozempic is a lower dose of semaglutide, and is approved and used to treat diabetes in Australia. Wegovovy is approved to treat obesity but is not yet available in Australia. Shortages of both drugs are expected to last throughout 2024.
Both drugs are expensive. But Ozempic is listed on Australia’s Pharmaceutical Benefits Schedule (PBS), so people with diabetes can get a three-week supply for A$31.60 ($7.70 for concession card holders) rather than the full price ($133.80).
Wegovy isn’t listed on the PBS to treat obesity, meaning when it becomes available, users will need to pay the full price. But should the government subsidise it?
Wegovy’s manufacturer will need to make the case for it to be added to the PBS to an independent advisory committee. The company will need to show Wegovy is a safe, clinically effective and cost-effective treatment for obesity compared to existing alternatives.
In the meantime, we asked five experts: when supplies resume, should governments subsidise drugs like Ozempic for weight loss?
Four out of five said yes
This is the last article in The Conversation’s Ozempic series. Read the other articles here.
Disclosure statements: Clare Collins is a National Health and Medical Research Council (NHMRC) Leadership Fellow and has received research grants from the National Health and Medical Research Council (NHMRC), the Australian Research Council (ARC), the Medical Research Future Fund (MRFF), the Hunter Medical Research Institute, Diabetes Australia, Heart Foundation, Bill and Melinda Gates Foundation, nib foundation, Rijk Zwaan Australia, the Western Australian Department of Health, Meat and Livestock Australia, and Greater Charitable Foundation. She has consulted to SHINE Australia, Novo Nordisk (for weight management resources and an obesity advisory group), Quality Bakers, the Sax Institute, Dietitians Australia and the ABC. She was a team member conducting systematic reviews to inform the 2013 Australian Dietary Guidelines update, the Heart Foundation evidence reviews on meat and dietary patterns and current co-chair of the Guidelines Development Advisory Committee for Clinical Practice Guidelines for Treatment of Obesity; Emma Beckett has received funding for research or consulting from Mars Foods, Nutrition Research Australia, NHMRC, ARC, AMP Foundation, Kellogg and the University of Newcastle. She works for FOODiQ Global and is a fat woman. She is/has been a member of committees/working groups related to nutrition or food, including for the Australian Academy of Science, the NHMRC and the Nutrition Society of Australia; Jonathan Karnon does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment; Nial Wheate in the past has received funding from the ACT Cancer Council, Tenovus Scotland, Medical Research Scotland, Scottish Crucible, and the Scottish Universities Life Sciences Alliance. He is a fellow of the Royal Australian Chemical Institute, a member of the Australasian Pharmaceutical Science Association and a member of the Australian Institute of Company Directors. Nial is the chief scientific officer of Vaihea Skincare LLC, a director of SetDose Pty Ltd (a medical device company) and a Standards Australia panel member for sunscreen agents. Nial regularly consults to industry on issues to do with medicine risk assessments, manufacturing, design and testing; Priya Sumithran has received grant funding from external organisations, including the NHMRC and MRFF. She is in the leadership group of the Obesity Collective and co-authored manuscripts with a medical writer provided by Novo Nordisk and Eli Lilly.
Fron Jackson-Webb, Deputy Editor and Senior Health Editor, The Conversation
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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What Would a Second Trump Presidency Look Like for Health Care?
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On the presidential campaign trail, former President Donald Trump is, once again, promising to repeal and replace the Affordable Care Act — a nebulous goal that became one of his administration’s splashiest policy failures.
“We’re going to fight for much better health care than Obamacare. Obamacare is a catastrophe,” Trump said at a campaign stop in Iowa on Jan. 6.
The perplexing revival of one of Trump’s most politically damaging crusades comes at a time when the Obama-era health law is even more popular and widely used than it was in 2017, when Trump and congressional Republicans proved unable to pass their own plan to replace it. That failed effort was a big part of why Republicans lost control of the House of Representatives in the 2018 midterms.
Despite repeated promises, Trump never presented his own Obamacare replacement. And much of what Trump’s administration actually accomplished in health care has been reversed by the Biden administration.
Still, Trump secured some significant policy changes that remain in place today, including efforts to bring more transparency to prices charged by hospitals and paid by health insurers.
Trying to predict Trump’s priorities in a second term is even more difficult given that he frequently changes his positions on issues, sometimes multiple times.
The Trump campaign did not respond to a request for comment.
Perhaps Trump’s biggest achievement is something he rarely talks about on the campaign trail. His administration’s “Operation Warp Speed” managed to create, test, and bring to market a covid-19 vaccine in less than a year, far faster than even the most optimistic predictions.
Many of Trump’s supporters, though, don’t support — and some even vehemently oppose — covid vaccines.
Here is a recap of Trump’s health care record:
Public Health
Trump’s pandemic response dominates his overall record on health care.
More than 400,000 Americans died from covid over Trump’s last year in office. His travel bans and other efforts to prevent the global spread of the virus were ineffective, his administration was slower than other countries’ governments to develop a diagnostic test, and he publicly clashed with his own government’s health officials over the response.
Ahead of the 2020 election, Trump resumed large rallies and other public campaign events that many public health experts regarded as reckless in the face of a highly contagious, deadly virus. He personally flouted public health guidance after contracting covid himself and ending up hospitalized.
At the same time, despite what many saw as a politicization of public health by the White House, Trump signed a massive covid relief bill (after first threatening to veto it). He also presided over some of the largest boosts for the National Institutes of Health’s budget since the turn of the century. And the mRNA-based vaccines Operation Warp Speed helped develop were an astounding scientific breakthrough credited with helping save millions of lives while laying the groundwork for future shots to fight other diseases including cancer.
Abortion
Trump’s biggest contribution to abortion policy was indirect: He appointed three Supreme Court justices, who were instrumental in overturning the constitutional right to an abortion.
During his 2024 campaign, Trump has been all over the place on the red-hot issue. Since the Supreme Court overturned Roe v. Wade in 2022, Trump has bemoaned the issue as politically bad for Republicans; criticized one of his rivals, Florida Gov. Ron DeSantis, for signing a six-week abortion ban; and vowed to broker a compromise with “both sides” on abortion, promising that “for the first time in 52 years, you’ll have an issue that we can put behind us.”
He has so far avoided spelling out how he’d do that, or whether he’d support a national abortion ban after any number of weeks.
More recently, however, Trump appears to have mended fences over his criticism of Florida’s six-week ban and more with key abortion opponents, whose support helped him get elected in 2016 — and whom he repaid with a long list of policy changes during his presidency.
Among the anti-abortion actions taken by the Trump administration were a reinstatement of the “Mexico City Policy” that bars giving federal funds to international organizations that support abortion rights; a regulation to bar Planned Parenthood and other organizations that provide abortions from the federal family planning program, Title X; regulatory changes designed to make it easier for health care providers and employers to decline to participate in activities that violate their religious and moral beliefs; and other changes that made it harder for NIH scientists to conduct research using fetal tissue from elective abortions.
All of those policies have since been overturned by the Biden administration.
Health Insurance
Unlike Trump’s policies on reproductive health, many of his administration’s moves related to health insurance still stand.
For example, in 2020, Trump signed into law the No Surprises Act, a bipartisan measure aimed at protecting patients from unexpected medical bills stemming from payment disputes between health care providers and insurers. The bill was included in the $900 billion covid relief package he opposed before signing, though Trump had expressed support for ending surprise medical bills.
His administration also pushed — over the vehement objections of health industry officials — price transparency regulations that require hospitals to post prices and insurers to provide estimated costs for procedures. Those requirements also remain in place, although hospitals in particular have been slow to comply.
Medicaid
While first-time candidate Trump vowed not to cut popular entitlement programs like Medicare, Medicaid, and Social Security, his administration did not stick to that promise. The Affordable Care Act repeal legislation Trump supported in 2017 would have imposed major cuts to Medicaid, and his Department of Health and Human Services later encouraged states to require Medicaid recipients to prove they work in order to receive health insurance.
Drug Prices
One of the issues the Trump administration was most active on was reducing the price of prescription drugs for consumers — a top priority for both Democratic and Republican voters. But many of those proposals were blocked by the courts.
One Trump-era plan that never took effect would have pegged the price of some expensive drugs covered by Medicare to prices in other countries. Another would have required drug companies to include prices in their television advertisements.
A regulation allowing states to import cheaper drugs from Canada did take effect, in November 2020. However, it took until January 2024 for the FDA, under Trump’s successor, to approve the first importation plan, from Florida. Canada has said it won’t allow exports that risk causing drug shortages in that country, leaving unclear whether the policy is workable.
Trump also signed into law measures allowing pharmacists to disclose to patients when the cash price of a drug is lower than the cost using their insurance. Previously pharmacists could be barred from doing so under their contracts with insurers and pharmacy benefit managers.
Veterans’ Health
Trump is credited by some advocates for overhauling Department of Veterans Affairs health care. However, while he did sign a major bill allowing veterans to obtain care outside VA facilities, White House officials also tried to scuttle passage of the spending needed to pay for the initiative.
Medical Freedom
Trump scored a big win for the libertarian wing of the Republican Party when he signed into law the “Right to Try Act,” intended to make it easier for patients with terminal diseases to access drugs or treatments not yet approved by the FDA.
But it is not clear how many patients have managed to obtain treatment using the law because it is aimed at the FDA, which has traditionally granted requests for “compassionate use” of not-yet-approved drugs anyway. The stumbling block, which the law does not address, is getting drug companies to release doses of medicines that are still being tested and may be in short supply.
Trump said in a Jan. 10 Fox News town hall that the law had “saved thousands and thousands” of lives. There’s no evidence for the claim.
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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Genetic Risk Factors For Long COVID
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Some people, after getting COVID, go on to have Long COVID. There are various contributing factors to this, including:
- Lifestyle factors that impact general disease-proneness
- Immune-specific factors such as being immunocompromised already
- Genetic factors
We looked at some modifiable factors to improve one’s disease-resistance, yesterday:
And we’ve taken a more big-picture look previously:
Beyond Supplements: The Real Immune-Boosters!
Along with some more systemic issues:
Why Some People Get Sick More (And How To Not Be One Of Them)
But, for when the “don’t get COVID” ship has sailed, one of the big remaining deciding factors with regard to whether one gets Long COVID or not, is genetic
The Long COVID Genes
For those with their 23andMe genetic data to hand…
❝Study findings revealed that three specific genetic loci, HLA-DQA1–HLA-DQB1, ABO, and BPTF–KPAN2–C17orf58, and three phenotypes were at significantly heightened risk, highlighting high-priority populations for interventions against this poorly understood disease.❞
For those who don’t, then first: you might consider getting that! Here’s why:
Genetic Testing: Health Benefits & Methods
But also, all is not lost meanwhile:
The same study also found that individuals with genetic predispositions to chronic fatigue, depression, and fibromyalgia, as well as other phenotypes such as autoimmune conditions and cardiometabolic conditions, are at significantly higher risk of long-COVID than individuals without these conditions.
Good news, bad news
Another finding was that women and non-smokers were more likely to get Long COVID, than men and smokers, respectively.
Does that mean that those things are protective against Long COVID, which would be very counterintuitive in the case of smoking?
Well, yes and no; it depends on whether you count “less likely to get Long COVID because of being more likely to just die” as protective against Long COVID.
(Incidentally, estrogen is moderately immune-enhancing, while testosterone is moderately immune-suppressing, so the sex thing was not too surprising. It’s also at least contributory to why women get more autoimmune disorders, while men get more respiratory infections such as colds and the like)
Want to know more?
You can read the paper itself, here:
*GWAS = Genome-Wide Association Study
Take care!
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Atomic Habits – by James Clear
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James Clear’s Atomic Habits has become “the” go-to book about the power of habit-forming. And, there’s no shortage of competition out there, so that’s quite a statement. What makes this book stand out?
A lot of books start by assuming you want to build habits. That can seem a fair assumption; after all, we picked up the book! But an introductory chapter really hammers home the idea in a way that makes it a lot more motivational:
- Habits are the compound interest of productivity
- This means that progress is not linear, but exponential
- Habits can also be stacked, and thus become synergistic
- The more positive habits you add incrementally, the easier they become because each thing is making your life easier/better
For example:
- It’s easier to save money if you’re in good health
- It’s easier to sleep better if you do not have financial worries
- It’s easier to build your relationship with your loved ones if you’re not tired
…and so on.
For many people this presents a Catch-22 problem! Clear instead presents it as an opportunity… Start wherever you like, but just start small, with some two-minute thing, and build from there.
A lot of the book is given over to:
- how to form effective habits (using his “Four Laws”)
- how to build them into your life
- how to handle mishaps
- how to make sure your habits are working for you
- how to see habits as part of your identity, and not just a goal to be checked off
The last one is perhaps key—goals cease to be motivating once accomplished. Habits, on the other hand, keep spiralling upwards (if you guide them appropriately).
There’s lots more we could say, but it’s a one-minute book review, so we’ll just close by saying:
This book can help you to become the kind of person who genuinely gets a little better each day, and reaps the benefits over time.
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How To Reduce Cortisol Levels Naturally
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Cortisol is a hormone that is important for us (we’d struggle to get up in the morning without it, for a start), but in this modern world we often have too much of it, too much of the time. How can we rebalance it? Dr. Mindy Pelz explains:
Lifestyle adjustments
A note in advance: the video makes frequent reference to things that “spike cortisol levels”, but this is probably intended as a stand-in for “raise cortisol levels”. Because, unlike for some things, in the case of cortisol, spikes aren’t usually a problem (indeed, they can be beneficial, and this is a large part of why cold showers and ice baths can be healthy; it’s an artificially induced cortisol spike, and this hormesis has an assortment of healthy benefits, each related to improving our body’s ability to switch quickly between states as appropriate); rather, it’s chronically high cortisol levels that are the problem. However, the video discusses things that can increase resting cortisol levels, so where she says “spike”, we suggest to read “raise”.
Dr. Pelz, an advocate of intermittent fasting, mentions that done incorrectly and/or for the same way for too long, fasting can raise cortisol levels and thus sabotage our efforts—so varying our fasting style can help avoid that. For example, 16:8, 5:2, longer fasts less frequently, etc.
On the topic of food, she also warns us of the dangers of ultra-processed food, harmful oils, and foods with added sugar, as these can all raise cortisol levels.
When it comes to exercise, she notes that intense exercise without adequate recovery can raise cortisol levels, so again it’s good to mix up one’s methods, vary one’s exercise routine, and allow each well-worked muscle-group adequate rest afterwards.
Dr. Pelz also talks mindset, and has her own interesting way of framing the well-established science that chronic stress means chronically high stress hormone (cortisol) levels; Dr. Pelz prefers to see it as negative vs positive thoughts, environments, etc.
Any discussion of cortisol management would be incomplete without discussing the importance of good quality sleep. Dr. Pelz doesn’t mention this at all in her video, but it’s important to bear in mind too!
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
Lower Your Cortisol! (Here’s Why & How)
Take care!
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Lost for words? Research shows art therapy brings benefits for mental health
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Creating art for healing purposes dates back tens of thousands of years, to the practices of First Nations people around the world. Art therapy uses creative processes, primarily visual art such as painting, drawing or sculpture, with a view to improving physical health and emotional wellbeing.
When people face significant physical or mental ill-health, it can be challenging to put their experiences into words. Art therapists support people to explore and process overwhelming thoughts, feelings and experiences through a reflective art-making process. This is distinct from art classes, which often focus on technical aspects of the artwork, or the aesthetics of the final product.
Art therapy can be used to support treatment for a wide range of physical and mental health conditions. It has been linked to benefits including improved self-awareness, social connection and emotional regulation, while lowering levels of distress, anxiety and even pain scores.
In a study published this week in the Journal of Mental Health, we found art therapy was associated with positive outcomes for children and adolescents in a hospital-based mental health unit.
An option for those who can’t find the words
While a person’s engagement in talk therapies may sometimes be affected by the nature of their illness, verbal reflection is optional in art therapy.
Where possible, after finishing an artwork, a person can explore the meaning of their work with the art therapist, translating unspoken symbolic material into verbal reflection.
However, as the talking component is less central to the therapeutic process, art therapy is an accessible option for people who may not be able to find the words to describe their experiences.
Art therapy has supported improved mental health outcomes for people who have experienced trauma, people with eating disorders, schizophrenia and dementia, as well as children with autism.
Art therapy has also been linked to improved outcomes for people with a range of physical health conditions. These include lower levels of anxiety, depression and fatigue among people with cancer, enhanced psychological stability for patients with heart disease, and improved social connection among people who have experienced a traumatic brain injury.
Art therapy has been associated with improved mood and anxiety levels for patients in hospital, and lower pain, tiredness and depression among palliative care patients.
Studies suggest art therapy could support people with a range of health conditions. mojo cp/Shutterstock Our research
Mental ill-health, including among children and young people, presents a major challenge for our society. While most care takes place in the community, a small proportion of young people require care in hospital to ensure their safety.
In this environment, practices that place even greater restriction, such as seclusion or physical restraint, may be used briefly as a last resort to ensure immediate physical safety. However, these “restrictive practices” are associated with negative effects such as post-traumatic stress for patients and health professionals.
Worryingly, staff report a lack of alternatives to keep patients safe. However, the elimination of restrictive practices is a major aim of mental health services in Australia and internationally.
Our research looked at more than six years of data from a child and adolescent mental health hospital ward in Australia. We sought to determine whether there was a reduction in restrictive practices during the periods when art therapy was offered on the unit, compared to times when it was absent.
We found a clear association between the provision of art therapy and reduced frequency of seclusion, physical restraint and injection of sedatives on the unit.
We don’t know the precise reason for this. However, art therapy may have lessened levels of severe distress among patients, thereby reducing the risk they would harm themselves or others, and the likelihood of staff using restrictive practices to prevent this.
This artwork was described by the young person who made it as a dead tree with new growth, representing a sense of hope emerging as they started to move towards their recovery. Author provided That said, hospital admission involves multiple therapeutic interventions including talk-based therapies and medications. Confirming the effect of a therapeutic intervention requires controlled clinical trials where people are randomly assigned one treatment or another.
Although ours was an observational study, randomised controlled trials support the benefits of art therapy in youth mental health services. For instance, a 2011 hospital-based study showed reduced symptoms of post-traumatic stress disorder among adolescents randomised to trauma-focussed art therapy compared to a “control” arts and crafts group.
Artwork made by a young person during an art therapy session in an in-patient mental health unit. Author provided What do young people think?
In previous research we found art therapy was considered by adolescents in hospital-based mental health care to be the most helpful group therapy intervention compared to other talk-based therapy groups and creative activities.
In research not yet published, we’re speaking with young people to better understand their experiences of art therapy, and why it might reduce distress. One young person accessing art therapy in an acute mental health service shared:
[Art therapy] is a way of sort of letting out your emotions in a way that doesn’t involve being judged […] It let me release a lot of stuff that was bottling up and stuff that I couldn’t explain through words.
A promising area
The burgeoning research showing the benefits of art therapy for both physical and especially mental health highlights the value of creative and innovative approaches to treatment in health care.
There are opportunities to expand art therapy services in a range of health-care settings. Doing so would enable greater access to art therapy for people with a variety of physical and mental health conditions.
Sarah Versitano, Academic, Master of Art Therapy Program, Western Sydney University and Iain Perkes, Senior Lecturer, Child and Adolescent Psychiatry, UNSW Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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How To Gain Weight (Healthily!)
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What Do You Have To Gain?
We have previously promised a three-part series about changing one’s weight:
- Losing weight (specifically, losing fat)
- Gaining weight (specifically, gaining muscle)
- Gaining weight (specifically, gaining fat)
There will be, however, no need for a “losing muscle” article, because (even though sometimes a person might have some reason to want to do this), it’s really just a case of “those things we said for gaining muscle? Don’t do those and the muscle will atrophy naturally”.
Here’s our first article: How To Lose Weight (Healthily!)
While some people will want to lose fat, please do be aware that the association between weight loss and good health is not nearly so strong as the weight loss industry would have you believe:
And, while BMI is not a useful measure of health in general, it’s worth noting that over the age of 65, a BMI of 27 (which is in the high end of “overweight”, without being obese) is associated with the lowest all-cause mortality:
BMI and all-cause mortality in older adults: a meta-analysis
Here was our second article: How To Build Muscle (Healthily!)
And now, it’s time for the last part, which yes, is also something that some people want/need to do (healthily!), and want/need help with that.
How to gain fat, healthily
Fat gets a bad press, but when it comes to health, we would die without it.
Even in the case of having excess fat, the fat itself is not generally the problem, so much as comorbid metabolic issues that are often caused by the same things as the excess fat.
So, how to gain fat healthily?
- Obvious but potentially dangerously misleading answer: “in moderation”
- More useful answer: “carefully”
Because, you can “in moderation” put on less than one pound per week for a few years and be in very bad health by the end of it. So how does this “carefully” work any differently to “in moderation”?
The key is in how we store the fat
Not merely where we store it (though that’ll follow from the “how”), but specifically: how we store it.
- When we consume energy from food in excess of our immediate survival needs, our body stores what it can. This is good!
- When our body is receiving energy from food faster than it can physically process it to store it healthily, it will start shoving it wherever it can instead. This is bad!
This is the physiological equivalent of the difference between tidying a room carefully, and cramming everything into one cupboard in 30 seconds just to get it out of sight.
So, you do need to consume calories yes, but you need to consume them in a way your body can take its time about storing them.
We’ve written before about the science of this, so we’ll share some links to that in a moment, but first, here are the practical tips:
- Do not drink your calories. Drinking calories tends to be the equivalent of injecting sugars directly into your veins, in terms of how quickly it gets received.
- See also: How To Unfatty A Fatty Liver ← this is highly relevant, because the same process that results in unhealthy weight gain, results in liver disease, by the same mechanism (the liver gets overwhelmed).
- Eat your greens. No, they won’t provide many calories, but they are critical to your body not being overwhelmed by the arrival of sugars.
- See also: 10 Ways To Balance Blood Sugars ← the other 9 things are also helpful for not putting on fat unhealthily, so using these alongside a calorie-dense diet can result in healthy fat gain as needed
- Get more of your calories from fats than carbs. Fats will not overwhelm your body’s glycemic response in the same way that carbs will.
- Again this is about getting calories while not getting metabolic disease. See also: How To Prevent And Reverse Type Two Diabetes as the advice is the same for that, for the same reason!
- Consider going low-carb, but even if you choose not to, go for carbs with a low glycemic index instead of a high glycemic index.
- For reference, see: Glycemic Index Chart: Glycemic index and glycemic load ratings for 500+ foods
- Need healthy fats in a snack? Enjoy nuts (unless you have an allergy); they will be your best friend in this regard. As an example, a mere 1oz portion of cashew nuts has 157 calories.
- See also: Why You Should Diversify Your Nuts
- Need health fats for cooking? Enjoy olive oil, as it has one of the healthiest lipids profiles available, and is a great way to increase the calorific content of many meals.
Lastly…
Be patient, enjoy your food, and stick as best you can to the above considerations. All strength to you.
Take care!
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