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.
I see this error on HN a lot, but the overwhelming majority of people will not do that, because the overwhelming majority of people take the path of least resistance and neither have the ___domain knowledge nor the drive to figure out how to do things outside the easily packaged path. Your example class of peptide-using bodybuilders are probably in the top 1% of both drive and ___domain knowledge to have gotten there (probably higher, even - less than 1 in 100 people on the street are that jacked).
A lot of HN users are extremely high-agency people with a significantly-above-average ability to understand how systems work and how to take advantage of that. A lot of said users make the understandable mistake that most people are like them. This is not the case.
It is extremely important if you are in charge of designing a system (as many of us are) that you understand and internalize that any claim of "people will just" that requires more than a few steps will only bear out for a very small minority (which are important edge cases, but should not be your expectation of the average user)
You're right not most. The thing is the barrier to entry is so low now, people don't need "___domain knowledge" because there is an "easily packaged path" now a days. These black/gray market peptides are directly advertised on social media not only directly from companies selling them but it has given rise to a whole crop of influencers known as "peptide educators". They lower the barrier to entry, simplify how to do it all and offer servicing essentially coaching people to take peptides.
There is Facebook groups with thousands of 50 year old moms taking gray market peptides, not just top 1% peptide-using bodybuilders. My example of peptide using bodybuilders was about the anecdotal safety of peptides. The barrier to entry previously was ALOT higher, you practically had to either contact a middleman in China and wire money to a random bank account overseas or buy it from a steroid drug dealer, now a days there is thousands of online storefronts that accept credit card and ship domestically that come with visual graphic instructions on how to do everything.
I'm sure when the New York Times writes a big piece about how gray market peptides have become a huge thing in the Fitness social media space, others will recognize it is growing and growing fast.
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.
Actual regulated drugs are also not that great either. Sometimes these grey market peptides might be tested better than actual FDA-regulated medications. Just dig into Aurobindo and how they literally destroy records and more. An aurobindo-manufactured generic medication I take is significantly worse than any other manufacturer of that generic medication, and I've taken them from about 5 at this point. "Bottle of lies" is a good book to look into.
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.
This is certainly a problem, but there just isn't much that many can do about the laws as they are written (and the whole incentives of the pharmaceutical industry as we know it).
That said, there is some hope on the horizon, some patent expirations have already happened (i.e. liraglutide which is less effective) and some are coming:
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?
I heard a story once about a research chemist who decided to synthesise LSD for his own use, miscalculated and gave himself a massive overdose-it didn’t kill him, but it rendered him non compos mentis for an extended period. Even ___domain experts can make dumb mistakes, especially when you separate them from formalised quality control systems aimed at catching those mistakes before anyone is harmed.
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.
The first generation drug Exenatide's patent was filed in 1992, but got approved in 2005. The latest one is Tirzepatide, a dual agonist, approved in 2022. Expect soon for Retaglutide, a triple agnonist, in the market.
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.
Sure, but gross labor share of GDP is 60% in the US (salaried employees earn 60% of GDP in total) so it doesn't change the consideration that much.
The US is spending roughly 15% of the GDP on health. If 1% of GDP is due to obesity then this is 'just' 1/15th of the overall health spending. If 3% of GDP is due to obesity then this is 20% (3/15th) of the overall health cost in the US.
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!
I've tried prompting once, but to be honest, just saving the .html and opening it got the full thing in my browser, so no prompt really needed. Prompts always worked... just was always worried about hallucinations, even when I said not to do those.
Have the government step in and say, “if you want to sell your drugs in America, you can only sell them to me.”
Then the government hammers that price down as low as it can go, and buys in bulk. A small rider is added to everyone’s federal taxes - a few dollars at most - to pay for it all, and the drugs are provided for free with any prescription.
It’s called single-payer healthcare, and most any advanced country uses that method to turn a $2,000/mo drug that the end user would pay either directly or through income-reducing insurance, into a $50/mo drug that is paid indirectly through federal taxes at less than 1/100 the cost.
But nooooooo… America can’t do this because “socialism is evil”.
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.
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