A 2 year supply of Ozempic (Semaglutide) lyophilized in sterile vials is ~$120USD (300mg of Semaglutide, 2.4mg a week at max dose so 125 weeks) on the black/gray market and that's with at least 2 middlemen making a profit so realistically the cost might be closer to $70USD?. Anyone can pay to get it HPLC tested to confirm the quantity, purity, sterility etc not to mention people (bodybuilders) have been using gray market peptides for 10+years and you never hear any stories about something going wrong (Things go wrong with oil based steroids for bodybuilders commonly not peptides in BAC water).
Meanwhile that same ~$120USD 2 year supply of Ozempic is $8400 in Europe, $9600 in Canada and $24000 in the USA.
While you might be able to get the purity of the compound itself tested, the user buying it ready for injection or even homebrewing it themselves can still have serious sterility issues, heavy metals contaminates and other nasty leftovers in the batch itself from shady companies that sell these "peptides" and etc.
When a low quality lab in China is producing something that normally costs such a high amount there are always corners cut, quality issues and people manufacturing it that are not using the same quality control and standards you would even get from a compounding pharmacy.
Author William Llewellyn's talk on how the black market of anabolic steroids evolved over the years explains how things like this are made and what sort of contaminates get into gray/black market injectables (regardless of oil or water based).
> When a low quality lab in China is producing something that normally costs such a high amount there are always corners cut, quality issues and people manufacturing it that are not using the same quality control and standards you would even get from a compounding pharmacy.
The cost of GLP-1 drugs doesn't come from production costs or complexity, it is purely a function of being on patent.
A month's supply of Ozempic costs less than a dollar to produce. It costs $25k in the US because of patents.
People regularly test black/gray market peptides in labs for both heavy metals and sterility (USP 61 or 71 I believe). The production of something like Testosterone/anabolic steroids is completely different has higher risks of contamination than peptides which use recombinant DNA or solid phase peptide synthesis.
That video is literally about anabolic steroids not peptides. Not to mention there was 0 testing labs in 2012 that users could send their items to, to get tested while there is many now a days. Back then in 2012 unless you had a friend at a University lab that knew analytical chemistry you were out of luck to get anything tested.
You aren't wrong about a lab in China cutting corners, having quality issues and low quality control standards but people don't care if they see 10,000+ people using peptides for decades without a single complaint about infection or real problems.
"is producing something that normally costs such a high amount" the cost has very little to do with the chemicals themself, the cost is about recouping R&D costs and having a 90% profit margin.
I suspect medical tourism is going to get a big boost from this. You can travel to someplace like Thailand or Taiwan and bring back a 90 day supply, and the savings covers your airfare with some leftovers. If you were going to take a vacation anyhow, it's a win-win.
You can order all this stuff on the internet. There are now three extremely popular medical drugs that are illegal or out of reach due to price here. Steroids, abortions, and GLP-1s are more than enough to set up clear net sites that deliver these drugs from Europe or China.
Become a compounded pharmacist yourself: get lyophilized powder of glp-1 drugs, bacteriostatic water, Leur Lock syringe with a needle, gloves and alcohol pads; make your own glp-1 compound in your home.
1. Test it for mass, purity, endotoxins, whether it is the real deal or not; this can be easily mitigated if one joins some testing group to share costs.
2. Calculate the dosage units properly, as it depends on how much bacteriostatic water is mixed with the powder. Here, many peptide calculators help. Some will end up making mistakes here; instead of taking 5 units, one will take 50 units--this leads to ER visits.
Most people's understanding of basic math, and ability to precisely follow directions, is terrible. What's to prevent you from ending up with a concentration that's 10x or 100x what you intended?
Risks, there are risks everywhere. Late Philosopher of Science, Larry Laudan wrote a little book--The Book of Risks: Fascinating Facts About the Chances We Take Every Day
Who is doing testing of these powders for toxins/heavy metals/purity/etc etc and what does that cost? Can you trust the results of said places performing these tests?
It costs from $600 to $1000 if one wants full suite of tests. There are at least two popular third party testing labs. Since testing is expensive, buyers pool together to share costs. In large groups, one ends up spending $10.
It isn’t a choice. Compounding is only legal when there is a federal shortage of the drug. When the shortage ends so does compounding. If the fda declares a shortage when there isn’t one they get sued.
No one says companies should lose money. The government can cover the price for everyone just like they did for covid vaccines. Considering obesity adds between $147 billion and $210 billion to annual U.S. health-care expenses[0], it would cost much less.
My mathematical intuition says this isn't really much considering US annual GDP is 27 trillion (27,000 billions) USD. So less than 1% of GDP.
Your linked article says: Obesity adds between $147 billion and $210 billion to annual U.S. health-care expenses, increasing an average adult's medical costs by 42 percent — an estimated $200,000 over a lifetime.
Since annual GDP per person in the US is roughly 80k USD and average life expectancy is also roughly 80 so roughly 6.4m USD GDP per person lifetime. 200,000 USD over 6.4m would imply over 3% of GDP, which seems more reasonable.
I’m regularly shown ads on Instagram for a company called “Willow”, which openly markets itself as a source of GLP-1’s for people who don’t meet the medical criteria. “I just want to lose 15 pounds before my beach vacation!” That type of thing. I’m not that upset to see the compounded GLP-1 market reigned in a bit.
$350 a month is already almost as much as we pay in EU. It won't get any cheaper than that. Compounded GLP-1 drugs were an intellectual property theft - and not against some evil megacorporation, but impacting a company that actually already saved millions of lives and has capacity to improve lives of billions of people so much more. It could have been probably justified for a short while because of shortages (a logic of "as long as you are unable to satisfy our demand, we will copycat your product ourselves" is cynical, but with some moral stretch, acceptable), but not anymore.
It's no moral stretch to say that if society pays tax to provide police and courts to enforce intellectual property rights for pharmaceuticals to encourage production of pharmaceuticals (note: not because of some "moral right" of a chemist), and you the pharma co don't hold up your end of the bargain (producing the pharmaceuticals), then we as a society need not hold up ours (enforcing the limited rights we granted you with our courts and police).
That seems like a straightforward deal. You provide us benefits, we provide you benefits. A one sided deal like you propose (we protect "your" medicine and yet get none ourselves) is the real moral stretch.
The same goes for anything that provides value right? If you make some useful software, by that logic I should be allowed to copy it and use it in whatever way I see fit (including commercially), no matter what license you used?
If I refuse to make it available (commercially or otherwise)? Absolutely. Copyright exists to incentivize production and distribution.
I can see it argued that, being less critical than medicine, perhaps a book or software could be "out of print" for longer than medicine being out of production before the copyright protection ceases, but ultimately the only reason we have copyright to begin with is too encourage people to create and make available.
So yes, by all means. Make orphaned and out of production works publicly available.
You mean - on a permanent basis? Everyone knows that poor availability of GLP-1 medicines in the past were because of difficulties scaling production to match demand that unexpectedly proved insane. No one was ever intentionally withholding them. It was a temporary problem and it is now solved.
I do think medicine is a special category because people need it, whereas if there is a 36 month gap between a novel's first printing and second, I (being the radical copyright reform advocate I consider myself) wouldn't think we need an exception to allow other publishers to publish it during that window, as with medicine.
I do think that at some point that window is long enough that the author and publisher lose any logical justification for keeping something unavailable while the rest of us subsidize their ability (via courts, laws, and police) to do so. After all, if we're paying for that stuff, what are we getting in return?
Maybe we should look at it differently. If there was no patenting, only way to create drugs will be know-how: just keep contents secret and there will be no copy-catting. But that's not allowed: they can't sell drugs without telling the public what's in them, and assuring that the content and the effects of it have been thoroughly tested.
True (to some extent, there's always the other side), but now there's no longer a shortage. The drugs are there in the pharmacies. That's why compounding is outlawed.
And honestly if you do a proper diet to lose serious weight, you are going to save much of that in food. If you are not doing a diet, then you have no business taking those products.
Click "View Tested Page" and you'll have the raw HTML at the right to copy into an html file and open (or drop the text heavy parts into an AI to remove the formatting). If you selected the Desktop view, open the image in a new tab.
Interesting! There is a link to access that in the Bypass Paywalls Clean extension, but I wasn't sure what that was for.
Can you suggest a prompt that would quickly strip all the HTML formatting from a file? There's a lot of broken characters for quotation marks and etc, but I was able to read it. Thanks!
Most will simply go to the gray/black market.
A 2 year supply of Ozempic (Semaglutide) lyophilized in sterile vials is ~$120USD (300mg of Semaglutide, 2.4mg a week at max dose so 125 weeks) on the black/gray market and that's with at least 2 middlemen making a profit so realistically the cost might be closer to $70USD?. Anyone can pay to get it HPLC tested to confirm the quantity, purity, sterility etc not to mention people (bodybuilders) have been using gray market peptides for 10+years and you never hear any stories about something going wrong (Things go wrong with oil based steroids for bodybuilders commonly not peptides in BAC water).
Meanwhile that same ~$120USD 2 year supply of Ozempic is $8400 in Europe, $9600 in Canada and $24000 in the USA.
While you might be able to get the purity of the compound itself tested, the user buying it ready for injection or even homebrewing it themselves can still have serious sterility issues, heavy metals contaminates and other nasty leftovers in the batch itself from shady companies that sell these "peptides" and etc.
When a low quality lab in China is producing something that normally costs such a high amount there are always corners cut, quality issues and people manufacturing it that are not using the same quality control and standards you would even get from a compounding pharmacy.
Author William Llewellyn's talk on how the black market of anabolic steroids evolved over the years explains how things like this are made and what sort of contaminates get into gray/black market injectables (regardless of oil or water based).
Anabolic Steroids: an evolving black market (28mins) https://youtu.be/0LL7bL4F9G4
> When a low quality lab in China is producing something that normally costs such a high amount there are always corners cut, quality issues and people manufacturing it that are not using the same quality control and standards you would even get from a compounding pharmacy.
The cost of GLP-1 drugs doesn't come from production costs or complexity, it is purely a function of being on patent.
A month's supply of Ozempic costs less than a dollar to produce. It costs $25k in the US because of patents.
People regularly test black/gray market peptides in labs for both heavy metals and sterility (USP 61 or 71 I believe). The production of something like Testosterone/anabolic steroids is completely different has higher risks of contamination than peptides which use recombinant DNA or solid phase peptide synthesis.
That video is literally about anabolic steroids not peptides. Not to mention there was 0 testing labs in 2012 that users could send their items to, to get tested while there is many now a days. Back then in 2012 unless you had a friend at a University lab that knew analytical chemistry you were out of luck to get anything tested.
You aren't wrong about a lab in China cutting corners, having quality issues and low quality control standards but people don't care if they see 10,000+ people using peptides for decades without a single complaint about infection or real problems.
"is producing something that normally costs such a high amount" the cost has very little to do with the chemicals themself, the cost is about recouping R&D costs and having a 90% profit margin.
I suspect medical tourism is going to get a big boost from this. You can travel to someplace like Thailand or Taiwan and bring back a 90 day supply, and the savings covers your airfare with some leftovers. If you were going to take a vacation anyhow, it's a win-win.
You can order all this stuff on the internet. There are now three extremely popular medical drugs that are illegal or out of reach due to price here. Steroids, abortions, and GLP-1s are more than enough to set up clear net sites that deliver these drugs from Europe or China.
Become a compounded pharmacist yourself: get lyophilized powder of glp-1 drugs, bacteriostatic water, Leur Lock syringe with a needle, gloves and alcohol pads; make your own glp-1 compound in your home.
I'm concerned about what would happen if everyone started trying to do this. How many would put themselves in the emergency room, or worse?
I see at least three sources of problems.
1. Test it for mass, purity, endotoxins, whether it is the real deal or not; this can be easily mitigated if one joins some testing group to share costs.
2. Calculate the dosage units properly, as it depends on how much bacteriostatic water is mixed with the powder. Here, many peptide calculators help. Some will end up making mistakes here; instead of taking 5 units, one will take 50 units--this leads to ER visits.
3. Hygiene: use gloves and alcohol wipes.
Most people's understanding of basic math, and ability to precisely follow directions, is terrible. What's to prevent you from ending up with a concentration that's 10x or 100x what you intended?
Risks, there are risks everywhere. Late Philosopher of Science, Larry Laudan wrote a little book--The Book of Risks: Fascinating Facts About the Chances We Take Every Day
How do you source powdered GLP-1 safely?
Sourcing is easy if you are adventurous. Many third party testing labs help you deal with safety: purity, toxins, whether it is legit.
Who is doing testing of these powders for toxins/heavy metals/purity/etc etc and what does that cost? Can you trust the results of said places performing these tests?
It costs from $600 to $1000 if one wants full suite of tests. There are at least two popular third party testing labs. Since testing is expensive, buyers pool together to share costs. In large groups, one ends up spending $10.
If you pool together doesn't this increase the risk of you being prosecuted for dealing these compounds?
Yes, if you sell to others; no, if you join with others who buy from the same batch from the same source.
The same way we solve all of our problems: websites on the internet.
half the pharmaceutical companies here in hyderabad seem to have shifted their production to glp drugs
Why would FDA do that? Obesity is the biggest public health disaster in US. They should make it as cheap as ibuprofen.
It isn’t a choice. Compounding is only legal when there is a federal shortage of the drug. When the shortage ends so does compounding. If the fda declares a shortage when there isn’t one they get sued.
Do you want them to keep spending money on drug R&D to solve all the other problems that still exist?
No one says companies should lose money. The government can cover the price for everyone just like they did for covid vaccines. Considering obesity adds between $147 billion and $210 billion to annual U.S. health-care expenses[0], it would cost much less.
[0]: https://theweek.com/articles/870872/americas-deadly-obesity-...
My mathematical intuition says this isn't really much considering US annual GDP is 27 trillion (27,000 billions) USD. So less than 1% of GDP.
Your linked article says: Obesity adds between $147 billion and $210 billion to annual U.S. health-care expenses, increasing an average adult's medical costs by 42 percent — an estimated $200,000 over a lifetime.
Since annual GDP per person in the US is roughly 80k USD and average life expectancy is also roughly 80 so roughly 6.4m USD GDP per person lifetime. 200,000 USD over 6.4m would imply over 3% of GDP, which seems more reasonable.
GDP isn't actual income. It's just a number.
Careful, if you start framing the problem like that you might end up with socialized healthcare!
Because it’s under patent.
There was a temporary allowance for compounding it due to sustained manufacturer shortages but that is in the process of expiring.
Wasn’t GLP-1 discovered in 1984?
Not the newer ones that have lower risks of lifetime digestive issues.
hopefully to protect my investment in lily
Compounded: 200 USD month; Lilly/Novo Discounted: 350 USD month
Seems alright?
The article and, indeed, its title, talk about "The end of compounded GLP-1 drugs".
I’m regularly shown ads on Instagram for a company called “Willow”, which openly markets itself as a source of GLP-1’s for people who don’t meet the medical criteria. “I just want to lose 15 pounds before my beach vacation!” That type of thing. I’m not that upset to see the compounded GLP-1 market reigned in a bit.
FYI, it's "lose/lose."
$350 a month is already almost as much as we pay in EU. It won't get any cheaper than that. Compounded GLP-1 drugs were an intellectual property theft - and not against some evil megacorporation, but impacting a company that actually already saved millions of lives and has capacity to improve lives of billions of people so much more. It could have been probably justified for a short while because of shortages (a logic of "as long as you are unable to satisfy our demand, we will copycat your product ourselves" is cynical, but with some moral stretch, acceptable), but not anymore.
It is $500 a month after the first month, as El Lilly charges $350 during the first month for a starter dosage.
500 US$ = 442 euro. Does that include the higher doses? Than it is actually cheaper than in Europe.
15mg Zepbound is 489 euro in Germany for a month (4 shots).
$499 per month "[f]or the Zepbound 5 mg, 7.5 mg, and 10 mg vial" [1]. So, I don't know how much they charge for 15 mg.
[1] https://zepbound.lilly.com/coverage-savings
Similar prices in AU$ here in Australia too. So around AU$300 to AU$400 for a months supply, or thereabouts. It varies - just going off my experience.
Hopefully the market will correct the pricing situation once the goldrush calms down.
Even my local pharmacist ranted about what a rort it is last time I asked LOL
You wouldn’t download an injection that makes you not fat…
I doubt you will find many here who agree with your usage of “theft” here.
Saxenda (from Novo Nordisk) is 180€ in Hungary for 36 days dosage
Saxenda is a previous generation drug with efficiency below that of lifestyle changes/diets... Not at all what's being discussed here.
It's no moral stretch to say that if society pays tax to provide police and courts to enforce intellectual property rights for pharmaceuticals to encourage production of pharmaceuticals (note: not because of some "moral right" of a chemist), and you the pharma co don't hold up your end of the bargain (producing the pharmaceuticals), then we as a society need not hold up ours (enforcing the limited rights we granted you with our courts and police).
That seems like a straightforward deal. You provide us benefits, we provide you benefits. A one sided deal like you propose (we protect "your" medicine and yet get none ourselves) is the real moral stretch.
The same goes for anything that provides value right? If you make some useful software, by that logic I should be allowed to copy it and use it in whatever way I see fit (including commercially), no matter what license you used?
If I refuse to make it available (commercially or otherwise)? Absolutely. Copyright exists to incentivize production and distribution.
I can see it argued that, being less critical than medicine, perhaps a book or software could be "out of print" for longer than medicine being out of production before the copyright protection ceases, but ultimately the only reason we have copyright to begin with is too encourage people to create and make available.
So yes, by all means. Make orphaned and out of production works publicly available.
You mean - on a permanent basis? Everyone knows that poor availability of GLP-1 medicines in the past were because of difficulties scaling production to match demand that unexpectedly proved insane. No one was ever intentionally withholding them. It was a temporary problem and it is now solved.
I do think medicine is a special category because people need it, whereas if there is a 36 month gap between a novel's first printing and second, I (being the radical copyright reform advocate I consider myself) wouldn't think we need an exception to allow other publishers to publish it during that window, as with medicine.
I do think that at some point that window is long enough that the author and publisher lose any logical justification for keeping something unavailable while the rest of us subsidize their ability (via courts, laws, and police) to do so. After all, if we're paying for that stuff, what are we getting in return?
Maybe we should look at it differently. If there was no patenting, only way to create drugs will be know-how: just keep contents secret and there will be no copy-catting. But that's not allowed: they can't sell drugs without telling the public what's in them, and assuring that the content and the effects of it have been thoroughly tested.
True (to some extent, there's always the other side), but now there's no longer a shortage. The drugs are there in the pharmacies. That's why compounding is outlawed.
And honestly if you do a proper diet to lose serious weight, you are going to save much of that in food. If you are not doing a diet, then you have no business taking those products.
Anyone have the full article? It's paywalled with no easy bypass.
drop the URL in here: https://search.google.com/test/rich-results
Click "View Tested Page" and you'll have the raw HTML at the right to copy into an html file and open (or drop the text heavy parts into an AI to remove the formatting). If you selected the Desktop view, open the image in a new tab.
Interesting! There is a link to access that in the Bypass Paywalls Clean extension, but I wasn't sure what that was for.
Can you suggest a prompt that would quickly strip all the HTML formatting from a file? There's a lot of broken characters for quotation marks and etc, but I was able to read it. Thanks!
https://archive.ph/VFJ9b