Published intermittently. Always cultural, never prescriptive. Subscribe to the monthly letter to get the next one in your inbox.
The cultural shorthand started in late 2024. Patients report blunted cravings — for food, alcohol, shopping, gambling, even Instagram. The mechanism is real: GLP-1 receptors are densely expressed in reward circuits. Here is the honest cultural read on what is signal and what is anecdote.
Read the essay →Everyone is watching the FDA. But the agency that could turn a gray-market vial into a felony is the DEA — and the reason it has stayed out is the most revealing fact in the whole story.
Analysis · Regulatory + policyIn 2023 the FDA opened an investigation into GLP-1 medications and suicidal ideation. In 2026 it's technically still open. What the data actually shows — and why "unresolved" is doing a lot of work.
Analysis · Regulatory + policyThe story has changed tense. A year ago the question was whether Lilly's oral GLP-1 pill would work. Now it's when it ships — gated by the FDA clock, the label sequence, and factory capacity, not by biology.
Analysis · Regulatory + policyNot a ban — the expiration of a temporary legal exception written into a 1997 statute. Who actually lost: not the drugmakers, but the telehealth layer and the patients paying $199 instead of $1,999.
Analysis · Regulatory + policyThe 2026 FDA action closed a grey market that was never technically open. Understanding what changed — and what was always illegal — matters for understanding where this goes next.
Analysis · Clinical dataSELECT showed a 20% relative risk reduction in serious cardiac events. But the trial only enrolled patients with established CVD and no diabetes. Here is what the numbers actually say — and for whom.
Analysis · Clinical dataThe pivotal trials ran 68 weeks. Real-world persistence data shows 23.7% of patients still filling prescriptions at 12 months. The gap between those two numbers is the whole story.
Analysis · Clinical data analysisBulls say it proves the drug keeps working; skeptics say you gain it all back. Both misread the same withdrawal design — and the truth in between is the whole point.
Analysis · Clinical data analysisEveryone quotes 20.9%. The body-composition substudy underneath it quietly settles the "muscle loss" panic — and I think almost everyone reads it backwards.
Analysis · Clinical data analysisEveryone repeats 24%. I think it is the least interesting figure in the Phase 2 data — and the five that matter are what the TRIUMPH readouts will decide.
Essay · NewFor a century the equation had two terms: diet and exercise. Then a generation woke up and the sentence had a third. An essay on what that third sentence does to a culture.
Cultural · EssayThe cultural phenomenon, the honest read on the neuroscience, and what it means for how we talk about pleasure and motivation in the medicated era.