Yesterday a friend told me that the head of a respected statistics/labour agency in the U.S. had been fired by you-know-who because he didn’t like the numbers she was reporting. This got me to thinking about the role numbers – and data – play in our increasingly  digitalized world. (I have of course ranted on about this before.) Also the extent to which medicine has fallen into this numbers-driven discourse.

Think about it. There you are, wandering about, dancing merrily amid the daffodils, a la Wordsworth, when for some reason it is decreed (by some aspiring vampire) that you need “blood work”. Whereupon you are told, in grave accents, that your cholesterol is somehow off or that you are “pre” diabetic. (There is, incidentally, no such thing. You may as well walk around saying you are pre-ankle fracture or pre-stomach upset since who knows when you might tumble down a staircase, breaking said ankle, or eat a bad oyster.)

At this point you are prey to what some observers call numbers-created disease.

You’re doing fine but your “numbers” don’t match some Utopian ideal. And nowhere are those numbers more quelling than in the dreaded BMI or Body Mass Index measures, telling you that you, your body type, your rounded post-menopausal tummy and pretty much all of you is, well, wrong.

For thousands of years food shortage and malnutrition stalked the human condition and those better able to store calories had a survival advantage. Alas, the fickle finger of fashion moved on and with it our notions of beauty. Old portrait galleries ably demonstrate just how bizarre previous generations defined the fashionable (usually) lady: Elizabethans plucked their hair to give themselves a higher forehead, my grandmother had weird little curls stuck to the side of her face making her look like some kind of demented Clara Bow. Now young women inject poisons into their faces and lips and opt for surgery to look better in selfies.

Never mind that people come in all shapes and sizes, always have, always will.  

So when did it become a federal crime to carry around a few extra kilos?

Thin is in

So far has the pendulum swung away from the older, more zaftig ideal that now it threatens to fall off and hurt something. Being a touch plump now would appear to signal a visible sign of evil intent, with the medical profession (egged on by social media) leading the charge. God help you if you’re fit and fat – une belle fille as my grandmother would have said; the general feeling is that that’s impossible. You simply must have something wrong, even if your numbers are fine. Here, bias trumps evidence.

Frankly, to my way of thinking, as we age, carrying some extra weight is A Good Thing: it gives one some reserve. Just like those earlier humans who had an evolutionary advantage. Especially should one have the misfortune to suffer some kind of health problem. (Trust me, the food in most hospitals, not to mention the gulag like care, will peel the pounds faster than you can say Viva Ozempic. And who came up with this diabolical notion to wake you up at 6 .m. to give you drugs? Atilla the Hun?)

This ridiculous obsession with body size has had some dire medical consequences over the years. I recall, back in the days when I was writing my dissertation, the excitement over fenfluoramine a drug which the FDA fast-tracked because it purportedly quickened weight loss. Turned out it also quickened cardiac problems and early death. Oops. It was taken off the market post-haste.

Today the big news on the crazy diet front is Ozempic (semaglutide) and its ilk, magical drugs – or so we’re told – with zero down sides. Say what now?

Abra-cadabra

Back in the 19^th century Nobel laureate Paul Ehrlich spoke of our burning desire for a “magic bullet”, a drug that could magically cure disease without side effects. At the time the magic elixirs on hand were hawked by con artists in fairs and carnivals, usually a mix of alcohol and some kind of bitters (we tend to believe more in things that taste bad), said to cure ague (chills and fever), boils, inflammation of the lungs (pneumonia) and so on. Of course in the absence of antibiotics and routine vaccines, most people still died of infectious disease.

Now it’s white-coated pseudo-doctors on Tik-Tok promising their version of magic.

And then there’s Ozempic et al. The potion you’re exhorted to ask your overworked, underpaid, impatient doctor about. Touted as solutions to everything from reversing cardiac disease to Alzheimer’s and addiction, the popular press has jumped on the bandwagon full tilt. The bonus? You could be a size 4 by next Tuesday. What could possibly go wrong?

G-u-LP One

This class of drugs is, I grant you, interesting. They’re what’s called glucogen-like peptides (GLP-1), a substance which the cells in your stomach, pancreas, liver, kidneys and pretty much everywhere else secrete when “nutrients are absorbed”. When you eat, in other words. This process converts food into glucose which is the only “fuel” cells can use. (Fat is the only exception.) The problem is that the naturally occurring GLP lasts only minutes then poof, it’s gone. So, drug companies, notably Novo-Nordisk which has been futzing with diabetes drugs for years, have tirelessly worked at making GLP linger in the system. With semaglutide (circa 2005) they finally succeeded, as a once-a-week injection that the FDA approved in 2017 or thereabouts for Type 2 diabetes (T2D). It is now, conveniently, also available as a pill.

In the abstract, for people with T2D this could be useful as in these folks the uptake of glucose is impaired. Often, people with T2D do make insulin but for some reason it’s ineffective so there’s a lot of free-floating glucose on board. Which is why their glucose levels tend to be high. This class of drugs assist in the uptake of that glucose, so, for people with T2D in whom older treatments like Metformin have not worked, a trial of one of these drugs could help. Of course that’s assuming they can tolerate the damn thing. So at least here one can see the FDA’s point.

Where this gets seriously muddled is in the weight loss arena. As it turned out, people who took these drugs lost weight. Huzzah cried the peasants. More dancing in the streets.

Of course the reason people lost weight was that they ate less.

GLP slows digestion, which makes you feel full. Rather head-bangingly obvious. It also causes gas, bloating and diarrhea. But, between celebrity endorsements and clever marketing, Ozempic became a household word and around 2021 I think, the FDA approved these meds for weight loss.

The trouble is that people who don’t have T2D probably don’t need all those extra glucogen like peptides floating around since they affect pretty much every major organ. Side effects may include pancreatitis and pancreatic cancer, (fairly major) digestive problems, gall bladder issues and more. In lab studies neck or thyroid tumours have developed. Weirdly, other side effects include depression and suicidal ideation. No matter. According to a breathless article I read in the staid Economist, these drugs are just awesome, probably the most important medical discovery ever. (The author of this piece appears to have forgotten about antibiotics.) Frankly, reading this article rather shocked me – it sounded like a teenager who had just met Taylor Swift.

A big selling point is that GLP-1 is, after all, natural. True, in minute quantities, but in the quantities used, it’s about as natural as purple KoolAid.

Just a reminder, moreover, that snake venom and cyanide are also “natural”. Natural does not equal safe. I’m old enough to remember when interferon (also a naturally occurring immune substance, a cytokine, that helps white blood cells fight infection) made the cover of TIME. Similarly breathless comments were made about interferon’s potential to cure cancer and all other dire diseases. (Maybe even my bad mood.) Then, gosh, it turned out that in high quantities interferon destroyed vital organs and could kill the patient. Anyone hear about the magical properties of those interferons recently? Or the equally “natural” interleukins which followed some years later? Didn’t think so. 

But we love magic, especially a one-size-fits-all diet aid, and drug companies are only too happy to encourage us in our delusions. I had the devil of a time, researching this, finding any journal articles that were not drug company funded or drug company adjacent. “Funded by an unrestricted grant from company X” was pretty much everywhere. I did find bits of evidence on side effects and people relating their issues with pancreatitis, serious gastric disorders, even psychiatric problems but very little in the literature. That alone makes me suspicious. Besides, I don’t tend to like new drugs; call me cynical but I prefer older drugs that you know aren’t going to kill you, at least not straight away.

As with health in general, there are complex and overlapping factors affecting body shape and size. Genetics, hormones, metabolism, age, lifestyle, muscle mass, activity level, etc., etc. And it’s not as clear-cut as calories in/calories out, that lovely mechanistic algorithm we’ve created because it’s idiot proof.

Frankly, I’d rather be a tad rounder and healthy than skinny and sick.

Everything from our impoverished food supply and poverty itself along with pollution, plastics and factory food also play a part but getting a handle on these overlapping, interdisciplinary issues is difficult. Much more amusing to believe Ozempic is the answer.

Except now, as always, I’ve forgotten the question.