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When patients start on the latest obesity drugs, they find that their food cravings drop away, and then the pounds do too. But when patients go off the drugs, the gears shift into reverse: The food cravings creep back, and then the pounds do too. Within a year of stopping semaglutide—better known by its brand names Wegovy or Ozempic—people regain, on average, two-thirds of the weight they lost. Tirzepatide, also known as Zepbound or Mounjaro, follows a similar pattern. And so the conventional medical wisdom now holds that these obesity drugs are meant to be taken indefinitely, possibly for a lifetime.
To pharmaceutical companies selling the blockbuster drugs—known collectively as GLP-1 drugs, after the natural hormone they mimic—that might be a pretty good proposition. To patients paying more than $1,000 a month out of pocket, not so much. Most Americans simply cannot afford the cost month after month after month.
This has forced some doctors to get creative, devising regimens to sub in cheaper, if less well-known, alternatives. GLP-1 drugs do work remarkably well, inducing more weight loss more quickly than any other obesity medication on the market, but some doctors now wonder whether patients need to be on GLP-1 drugs, specifically, forever. “What if we do a short-term investment, use it for six months to a year to get 50 pounds off?” asks Sarah Ro, an obesity-medicine doctor and the director of the University of North Carolina Physicians Network Weight Management Program. Then, as she and other doctors are now exploring, patients might transition to older, less expensive alternatives for long-term weight maintenance.
In fact, Ro has already helped patients—she estimates hundreds—make the switch out of financial necessity. Few of her patients in rural North Carolina have insurance that covers the new obesity drugs, and few can afford to continually pay out of pocket. In April, many also lost coverage when North Carolina’s health insurance for state employees abruptly cut off GLP-1 drugs for obesity. Ro switched her patients to older drugs such as topiramate, phentermine, metformin, and bupropion/naltrexone, plus lifestyle counseling. It’s not exactly an ideal solution, as these medications are generally considered less effective—they lead to about half as much weight loss as GLP-1 drugs do—but it is a far less expensive one. When prescribed as generics, Ro told me, a month’s supply of one of these drugs might cost as little as $10.
Jamy Ard, an obesity-medicine doctor at Wake Forest University, has also switched regimens for patients who lost coverage of GLP-1 drugs after retiring and getting on Medicare, which currently does not pay for any drugs to treat obesity. (Like many researchers in the field, Ard has received grants and consulting fees from companies behind obesity drugs.) Doctors I spoke with didn’t know of any studies about switching from GLP-1 drugs to older ones, but Ard says this research is a practical necessity in the United States. With GLP-1 medications exploding in popularity, more and more patients taking them will suddenly lose coverage when they hit retirement age and go on Medicare. “Now I’ve got to figure out, well, how do I treat them?” he told me.
Read the rest of this article at: The Atlantic
Kris Hansen had worked as a chemist at the 3M Corporation for about a year when her boss, an affable senior scientist named Jim Johnson, gave her a strange assignment. 3M had invented Scotch Tape and Post-it notes; it sold everything from sandpaper to kitchen sponges. But on this day, in 1997, Johnson wanted Hansen to test human blood for chemical contamination.
Several of 3M’s most successful products contained man-made compounds called fluorochemicals. In a spray called Scotchgard, fluorochemicals protected leather and fabric from stains. In a coating known as Scotchban, they prevented food packaging from getting soggy. In a soapy foam used by firefighters, they helped extinguish jet-fuel fires. Johnson explained to Hansen that one of the company’s fluorochemicals, PFOS—short for perfluorooctanesulfonic acid—often found its way into the bodies of 3M factory workers. Although he said that they were unharmed, he had recently hired an outside lab to measure the levels in their blood. The lab had just reported something odd, however. For the sake of comparison, it had tested blood samples from the American Red Cross, which came from the general population and should have been free of fluorochemicals. Instead, it kept finding a contaminant in the blood.
Johnson asked Hansen to figure out whether the lab had made a mistake. Detecting trace levels of chemicals was her specialty: she had recently written a doctoral dissertation about tiny particles in the atmosphere. Hansen’s team of lab technicians and junior scientists fetched a blood sample from a lab-supply company and prepped it for analysis. Then Hansen switched on an oven-size box known as a mass spectrometer, which weighs molecules so that scientists can identify them.
As the lab equipment hummed around her, Hansen loaded a sample into the machine. A graph appeared on the mass spectrometer’s display; it suggested that there was a compound in the blood that could be PFOS. That’s weird, Hansen thought. Why would a chemical produced by 3M show up in people who had never worked for the company?
Hansen didn’t want to share her results until she was certain that they were correct, so she and her team spent several weeks analyzing more blood, often in time-consuming overnight tests. All the samples appeared to be contaminated. When Hansen used a more precise method, liquid chromatography, the results left little doubt that the chemical in the Red Cross blood was PFOS.
Hansen now felt obligated to update her boss. Johnson was a towering, bearded man, and she liked him: he seemed to trust her expertise, and he found something to laugh about in most conversations. But, when she shared her findings, his response was cryptic. “This changes everything,” he said. Before she could ask him what he meant, he went into his office and closed the door.
Read the rest of this article at: The New Yorker
On May 13, OpenAI demonstrated a new model with a series of live conversations between its staffers and an AI voice assistant. The chatbot felt familiar in both senses of the word. Its responses were casual, agreeable, and sometimes uncomfortably flattering. There was also the way it sounded — like a voice you might have heard before in a related context. During the presentation, Sam Altman cleared up any doubts as to what his company was going for with a post on X:
AI companies have a funny relationship with sci-fi. On one hand, they’re in the rare and useful position of operating in a space that’s been explored in speculative fiction for years. Rather than explaining what they do, how they do it, or why they’re doing it, they have the option of simply referencing ideas and concepts that have existed in the popular imagination for generations as harmless cartoon robots, fearsome invisible superintelligences, and iconic disembodied voices. It’s a bit like saying you’re going to Mars or building a flying car. People know what you’re talking about. Some of them might feel like you’re fulfilling an overdue promise; others might point out that a lot of the thinking people have done about these things is complicated. On balance, though, it’s a pretty good deal for companies like OpenAI, unless of course they take it too far.
Read the rest of this article at: New York Magazine
“What editors do for writers is mysterious, and does not, contrary to general belief, have much to do with titles and sentences and ‘changes.’ The relationship between an editor and a writer is much subtler and deeper than that, at once so elusive and so radical that it seems almost parental.” Thus spake the venerable Joan Didion in a eulogistic essay about the late Henry Robbins, her editor first at Farrar, Straus and Giroux and then at Simon & Schuster. Didion proceeds to clarify her definition: For her, an editor gives the writer “the idea of himself, the idea of herself, the image of self that enable[s] the writer to sit down alone and do it. This is a tricky undertaking, and requires the editor not only to maintain a faith the writer shares only in intermittent flashes but also to like the writer, which is hard to do.”
That’s about as good a description as any writer or editor has been able to muster. Didion might even be giving editors too much credit. Said Robert Gottlieb, legendary editor and publisher, one of the hallowed deities of the 20th-century literary empire: “You never know what other editors do. Most of them do nothing.” That editors edit, which would seem to go without saying, turns out to be a pretty facile summary of a role whose essential ambiguities make it best suited to confidence men or obsessives. The most we can say is that the editor assists the writer in achieving what he or she has set out to achieve. Passive-aggression is almost built into the job.
But what else is built into it? Editor is a job title that feels deliberately obfuscating, like chief financial officer or art dealer. Within it lay multitudes of duties, predilections, sensibilities and manias. An editor can, should, or ideally will be: punctilious and attentive to detail, in grammar and in tone; personable with their authors, wide readers, fast readers; politically savvy, especially in the larger houses; sensitive to cultural shifts but loyal to the text; possessed of some degree of business nous. In other words, the editor is a kind of polymath. That professional managerial culture, in all its departmentalization and political quackery, no longer champions the polymath, renders the editor—a really, truly good editor—rare and invaluable.
It should come as no great shock, then, that one of the other more pernicious aspects of professional managerial culture—ubiquitous recognition for all—has bred a tendency to lionize the work of the editor, while eliminating the editorial function in real life. The latest installment in this trend, which perhaps reached its zenith with the 2022 documentary Turn Every Page about Bob Gottlieb and his relationship with Robert Caro, is a new book titled, forebodingly, The Editor. Its subject is Judith Jones, a “publishing legend” whose six-decade career—first at Doubleday, then at Knopf—had an “outsize influence on American culture,” or so says its author, Sara B. Franklin.
Read the rest of this article at: Tablet
When Otis Parrish was a kid in the 1940s, abalone were abundant. Each abalone grows in a single, beautiful opalescent shell, which can get as big as a dinner plate. Parrish’s father showed him how to pry the abalone off the rocky shoreline at low tide with an oak stick or the end of a sharpened leaf spring. Or, best of all, how to take the abalone unawares and grab them with his bare hands before they had time to fasten tight to the rocks. His mother’s village was called Dukašal, or “Abaloneville” in the Kashaya Pomo tribe’s language, notwithstanding its location five miles and two steep ridges inland from Stewarts Point on the California coast. The ocean gave the Kashaya people protein and ceremonial food. “We call [abalone] ‘Champion of the Sea,’” Parrish told me over coffee in nearby Windsor, California, one recent morning.
Newcomers to the state started eating abalone in far greater quantities in the mid-1800s. They went into deeper water with skiffs and long poles, and began free diving and subsequently diving from boats with air hoses to harvest the shellfish. Commercial capture passed 1 million pounds a year around 1920. Apart from a dip during World War II, abalone hauls totaled several million pounds a year for decades. When the pink-abalone population crashed in the early 1970s, people fished for more red abalone, whose decline, in turn, was compensated by increased pursuit of the green, white, and black species. They were all flatlining by the mid-1980s. In 1997, California banned commercial abalone fishing.
For years, red abalone was the only species sufficiently abundant to support even a limited recreational fishery. Tens of thousands of divers plucked nearly a quarter million abalone a year in Northern California. Then came 2017. Divers would pull abalone off the rocks only to find mostly empty shells. Scientists concluded that the abalone were starving because a record marine heat wave had weakened the kelp forest, and an epidemic, exacerbated by the hot water, killed more than 90 percent of sunflower sea stars from 2013 to 2017. Abalone and sunflower sea stars don’t have anything to do with each other directly, but the latter eat purple sea urchins, which eat kelp, which abalone also eat. When the sea-star population crashed, urchin numbers exploded, and a spiny purple horde clear-cut the remaining kelp. Biologists presumed that the abalone scooted around the rocks looking for their staple seaweed, found none, and perished. California’s last abalone fishery closed.
This story doesn’t involve extinction. Both abalone and sea stars still exist on this Earth. If we measure biodiversity as the number of species, nothing has changed. But red abalone, a species at least a few million years old that, during Otis Parrish’s youth and for at least eight millennia prior, required next to zero effort to gather, are now extraordinarily scarce. One California species, the pinto abalone, is “endangered,” according to the International Union for the Conservation of Nature (IUCN). The remaining six species in the state are “critically endangered.” Sunflower sea stars, kelp forests, and many other species that live in the rocky coves along the California coast are in similar straits. They’ve been displaced by hyperabundant purple urchins, which biologists are desperately trying to persuade humans, the predator of last resort, to eat.
Read the rest of this article at: The Atlantic
