Explainer//5 min
GLP-1s and cancer risk
The thyroid warning, the pancreatic scare and the colorectal signal are three different arguments with three different evidence bases, and the most consequential finding points the other way entirely.
The Business
Policy & Industry
Lilly, Novo, the FDA, and the money moving underneath it all.
24 pieces
Explainer//6 min
GLP-1s for teenagers
Wegovy has been licensed for twelve-year-olds since 2022 and the trial data is strong. The disagreement is not really about whether the drug works, which is why it has not resolved.
Deep Dive//5 min
The GLP-1 heart benefit
SELECT enrolled seventeen thousand people with heart disease and no diabetes, and found a twenty percent reduction in cardiovascular events. The label change that followed did more for access than any argument about obesity ever has.
Explainer//5 min
Every GLP-1 medication
There are more of these than the two everyone talks about, several are considerably older, and a few are still widely prescribed for reasons that have nothing to do with weight.
Deep Dive//6 min
GLP-1s versus bariatric surgery
Surgery still produces more weight loss than any injection, and it is now being declined by people who would have accepted it three years ago. Both of those facts deserve more scrutiny than they usually get.
Guide//6 min
Ozempic alternatives, compared
There are more approved weight-loss drugs than most people realise, and they are not close to each other in effect. Knowing the order matters, because plenty of plans will only cover the bottom of it.
Explainer//5 min
Semaglutide, explained
Ozempic, Wegovy and Rybelsus contain the same active ingredient. Almost every argument about which one you should be on is an argument about indications and insurance rather than about chemistry.
Explainer//5 min
The thyroid cancer warning
Every box in this class carries a boxed warning about thyroid tumours in rodents. Fifteen years of human data have not confirmed it, and the warning is still there — for reasons worth understanding.
Explainer//5 min
Tirzepatide, explained
Eli Lilly added a second hormone receptor to the design, largely as a bet. It produced the largest average weight loss of any approved drug, and nobody can yet fully explain why.
Guide//6 min
Do you qualify for a GLP-1?
Clinical eligibility is a short, public, unambiguous rule. Whether anyone will pay for it is a completely separate question, and conflating the two is why so many people believe they were turned down for being too healthy.
News//4 min
The federal GLP-1 pricing deal
A negotiated price, a direct-purchase channel and a Medicare pilot. It is the largest change to GLP-1 access in America since the drugs arrived — and the fine print decides whether any of it reaches you.
News//3 min
Semaglutide, MASH, and a new coverage route
Fatty liver disease is common, largely undiagnosed, and now has a GLP-1 approved to treat it. For patients whose plans exclude weight-loss drugs, that is not a footnote — it is a different prescription.
News//3 min
The compounding question, after the shortages
Compounded semaglutide filled a real gap during a genuine shortage. The regulatory basis for that gap has narrowed — and the market has not gone anywhere. Here is how to reason about it.
News//3 min
The kidney indication
A trial stopped early for efficacy, a label expanded, and a benefit that has almost nothing to do with weight. If you have type 2 diabetes and chronic kidney disease, this is the most important thing in your file.
Deep Dive//5 min
Zepbound, sleep apnea, and the coverage door it opened
When Zepbound was approved for obstructive sleep apnea, it stopped being a weight-loss drug in the eyes of a large part of the American payment system. That distinction is worth thousands of dollars a year to some people.
Deep Dive//5 min
The oral GLP-1 is coming
An effective GLP-1 in tablet form is not mainly a convenience story. It is a manufacturing story — and manufacturing is what has rationed these drugs since the day they arrived.
Explainer//4 min
The race past 20 percent
Retatrutide, CagriSema and the triple agonists are aiming at weight reduction that used to require surgery. The interesting question is no longer whether they can get there, but what breaks first.
News//3 min
Generic semaglutide, elsewhere
Patent expiry in several countries has produced generic semaglutide at a fraction of the American price. The US patent runs years longer, which is already driving people toward routes that carry real risk.
Explainer//5 min
Semaglutide and the eye question
A 2024 study reported a higher rate of a rare optic nerve condition in semaglutide patients. Here is how to read a finding like that without either dismissing it or panicking.
News//4 min
Employers and states are pulling back
Having your GLP-1 covered today tells you very little about January. Employers are narrowing benefits, states are dropping them, and the people affected usually find out at the pharmacy counter.
Guide//6 min
Winning a prior authorization appeal
Most denials are not clinical judgments. They are documentation failures, and documentation failures are the kind you can fix — if you know what the reviewer on the other end is actually reading.
Deep Dive//5 min
Medicare and the obesity drug exclusion
A single clause written in 2003, before anyone had a weight-loss drug worth arguing about, now shapes the entire American market. It is the most expensive sentence in obesity medicine.
Guide//4 min
What these drugs cost in America
List price, negotiated price, coupon price, cash price, compounded price. Five numbers, none of which is the price, and only one of which you will ever be quoted.
Deep Dive//5 min
Inside the telehealth GLP-1 boom
A monthly fee, a fifteen-question form, and a prescription in under ten minutes. Some of these services provide genuinely good care. Distinguishing them from the ones selling access is harder than it should be.
Also in The Business
On The Jab
The
GLP‑1
Handbook
Dr. Nick Robertson
MD
The book · 14 chapters
The GLP-1 Handbook
Everything I tell my own patients before their first injection. 214 pages of what actually matters in the first year — dosing, side effects, food, muscle, cost, and the part nobody prepares you for: maintenance.
$4Less than your morning coffee.
Priced at four dollars because it should be affordable to everyone taking these drugs — not because it's worth four dollars. No upsell, no course, no supplement line.