GLP-1s are miracle drugs that (to my mind) seem one of the great accomplishments of medicine along side things like vaccines and antibiotics. They are a cure for all manner of metabolic conditions.
How are they a “gamble?” For patients, their efficacy rates are stunning. If you meant from an investing perspective, Eli Lilly and novo nordisk have very down to earth valuations when compared with AI companies.
I don't know what OP considers to be a gamble, but one thing that comes to mind is that from what I've read most people who succeed at significant weight loss while taking GLP-1 drugs regain most or all of the weight within a couple years if they stop taking the drugs.
I'm in the US and if my doctor had suggested such drugs before last year I'd have been reluctant because (1) they were expensive even with insurance, (2) just how expensive varied quit a bit from insurance provider to insurance provider and from plan to plan from a given provider, and (3) as I said I'm in the US, and so never knew for sure who my insurance provider would be next year and even if it was going to be the same provider I never knew what their plans would be like next year [1].
Starting a new drug that looked like it would be a "rest of your life" drug where the price could change year to year from reasonably affordable to painfully expensive would definitely feel like taking a gamble.
Now I'm old enough for Medicare, and they are something I would at least consider because Medicare seems to be less volatile. They are still expensive, if my understanding is correct, with the need to meet a deductible and with copays or coinsurance, but all that counts toward the part D annual cap of $2100 so there is at least a cap making it somewhat safer to make long term plans. (But Republicans in Congress want to eliminate or at least significantly raise that cap, so long term planning is still somewhat of a gamble).
[1] In the US around 80-85% of people under 65 who have health insurance that is not provided through the government get their health insurance via their employer's benefits package. Most of the rest get it through the ACA marketplace. Employers often renegotiate plans with their provider or switch providers when the old plans/provider prices go up. The ACA market is even more volatile.
> most people who succeed at significant weight loss while taking GLP-1 drugs regain most or all of the weight within a couple years if they stop taking the drugs.
Anecdata: I've gone from 260lb down to a minimum of 198ish, up to maybe 230, back down to 193, long slow climb up to 270 and now on a GLP-1 I'm under 230 and definitely look fat, but in the right light you can see my quad separation. The only people I know who've lost the kind of weight I've lost and kept it off (like a 5' man going from 250lb down to 145) went from logging every bite in My Fitness Pal (or similar) to keeping the log running in their head of what they're eating all day every day. Diabetics sometimes say they're making their prefrontal cortex do the work of their pancreas. That feels relatable.
So IDK if there's a weight loss solution that works that you don't have to do in perpetuity. "Eat less" yeah sure, but how? Magic Danish Gila monster potion that makes you want to eat less, or recording everything you eat and using that to tell yourself you're more full than you feel?
I managed some fairly significant weight loss and kept it off kind of by accident.
I was 326 lb when I took the physical that my college required incoming first year students to take. It slowly crept up over the years and by my mid 50s was generally in the 420-440 lb range. I had been diagnosed with type 2 diabetes about 10 years before that but responded spectacularly well to cheap diabetes drugs like metformin and Glucotrol. Same for cholesterol--it has been very high but Lipitor brought it down to normal. If you had showed my blood work to a doctor with no other information than my age and sex they would have not found any sign of anything wrong.
But then A1C started going up again, despite steady weight and no diet changes. I decided to try to lower carbs to see if that would help. Most low carb diets aim for a very low amount of carbs which require a lot of work to achieve (especially if like me at the time you don't mostly cook at home), so I decided to just try lower the percent of calories that came from carbs rather than worry about the absolute amount.
I picked 40% because (1) that is lower that average and definitely lower than what I was consuming, and (2) it is real easy to track (more on that below).
I was just trying to see if this change in balance would affect blood sugar and wasn't actually trying to lower calories. So rather than do things like give up most bread like many of the low carb diets require, I got the carb calorie percent down by adding non-carbs. For example if my normal ham and cheese sandwich with low calorie mayo was 60% calories from carbs, I'd switch that to regular mayo and/or double meat and/or double cheese. That would add a couple hundred or so calories which would lower the percent from carbs. The grams of carbs wouldn't change.
Two things happened then. First, my blood sugar did start going down. Second, and unexpectedly, I started losing weight. I had been keeping a simple food log for years at that point and it revealed that I in fact was consuming less calories.
Apparently what was going on is that things like the double meat double cheese regular mayo sandwich were keeping me satisfied longer, so I naturally snacked less, and naturally started eating smaller portions.
In two years I was down to 280 lb, and completely off diabetes and cholesterol. (I'd always had high blood pressure, and going from 420-440 lb to 280 lb had no effect whatsoever on that).
Over the next maybe 18 months it crept up to 320-325 lb (so basically my high school weight) and it has been steady in that range ever since (6 or 7 years so far).
I said earlier that 40% is easy to track. That's because 1 g of carbs has ~4 calories. That means all you have to do is look at the nutrition label and if numerically calories/10 <= carb grams the thing is not over 40% calories from carbs. (You can subtract grams of fiber from the carb grams).
For a meal with multiple items, say a fast food burger and fast food fries and a diet soda you could total the calories and total the carbs and do the calculation on that, but an easier way is to do the burger and fries separately and add the over/under amounts together.
For example let's say you are contemplating a Burger King Whopper (670 calories, 51 carbs) and large fries (440 calories 59 carbs). For the burger calculate 670/10-51=16, and for the fries 440/10-59=-16. 16 + -16 = 0, and your burger and fries together is 40% calories from carbs.
It is also fairly easy to keep a running net for the day, so just remember that say at breakfast you came out say at -8 because you decided to treat yourself to a donut for desert. Then at lunch you could change that Whopper to a Whopper with Cheese (770 calories 53 carbs) which is +24 instead of +16, nicely cancelling out your breakfast donut as far as carb balance goes.
> I had been keeping a simple food log for years at that point
> It is also fairly easy to keep a running net for the day
Right, so there it is: whatever you did to get to a calorie deficit you need to keep doing to be calorie neutral. If it's take a GLP-1 then that works. If it's using pen and paper or an app or even vibes-based reckoning to track everything you eat, then it's that. Regardless it just doesn't seem like a valid criticism of any given weight loss strategy when I have yet to hear of one that doesn't have that feature
I agree that their large scale rollout will be very beneficial on the whole. The US is absurdly overweight and obese.
But these are powerful medications that affect very highly conserved areas of tetrapod biology. We discovered GLPs in the mouths of gila monsters, after all. So you then can infer that that the mechanism is at least 300 million years old (our last common ancestor with lizards).
Actually, I tried looking this up, and glucagon is likely 5-600 million years old, back to all chordates, the Cambrian explosion essentially, though likely even before that. So, incredibly conserved. Like, if you are a multicellular animal, odds are you have some glucagon-like thing for digestion regulation.[0]
We're strongly messing with a system that is just tremendously old. Biology and evolution are ruthless about this stuff, it edits it out as fast as it possibly can. That it's been so closely held is a very big sign for us that we need to tread extremely carefully.
Like, clearly, other countries do not have these issues with weight. Yes, they are developing them, I know. But even the US didn't have these issues near as bad just two generations ago, a blink in biological terms. You and I both know that the solution is not a pill, but the root cause of the obesity epidemic itself. These injections and pill are just band-aids for a much deeper and more pernicious problem.
But then again, you and I both know that we're not going to get at the root cause anytime soon either.
[0] This is biology so you'll find exceptions everywhere though
The weight gain in the us compared to the rest of world is undoubtedly related to the callous disregard corporations posess for life in general, let alone the subtle things like microbiomes and fungi that shape our ecosystem
> Biology and evolution are ruthless about this stuff, it edits it out as fast as it possibly can. That it's been so closely held is a very big sign for us that we need to tread extremely carefully.
As long as you have descendants, biology and evolution don't care, once that's done it's game over for them.
> That it's been so closely held is a very big sign for us that we need to tread extremely carefully.
It's been tested for over 20 years, the weight loss bit is the recent one.
> other countries do not have these issues with weight.
It's part of the solution, is how you help existing people with the issue.
Doing a restrictive diet is not easy (I know, I've been dieting since october, lost 15 pounds, but I can go on autopilot for this, which is not the case for others), it requires a lot of discipline that most people don't have, and our bodies are optimized to store calories, as well as being very efficient in consuming them, because for most of history famines were common, last ~100 years being the exception to the rule for most of the world population.
Future generations can be helped by better food culture and education, and that's the other part of the solution, long term.
Yea you're right about that. I didn't mean to imply otherwise though it seems I did.
I guess what I meant to say was, to actually solve this problem we also need structural changes so that even driving one of these vehicles in our cities is a bit uncomfortable and so that it's less common precisely because of the reason you specified and many more.
As we build and design better cities, people will naturally not want to buy such vehicles except if they have actual needs for them. I mean, you should be able to buy whatever you want. If you want a giant truck by all means go for it, but society shouldn't cater to edge cases, especially when they cause hazards like the one you described.
What if a neighbor allowed homeless to camp in front of their house?
Seems like the issue is the store owner (i.e. the neighbor), not the fact that it is a store.
When I lived in Houston I used to jog past a house where the front yard was absolutely covered in garbage. Super nice neighborhood and all the houses in the neighborhood looked great, but just this one guy clearly had issues. It smelled horrendous.
>What if a neighbor allowed homeless to camp in front of their house?
People keep writing this, obviously, without thinking even for a minute.
A neighbor who allowed homeless camp in front of their house would:
1) have to live behind a homeless camp himself
2) be tanking his own house value
3) be open to sanctions from the code as there are way more restrictions on residential property use than there are on commercial.
>When I lived in Houston
Your experience in Houston, where there is no zoning, is not very irrelevant in discussion of zoning, don't you think? Unless you are actually making an example why zoning is important, of course.
1) the business owner has to operate a business behind the camp
2) the business owner tanks the value of their own property
3) what code? The building code? If we can apply a “code” to a home, then we can apply it to a business. So if there really is such a disparity where you live, the issue is that disparity in application of building codes, not zoning laws.
Re: Houston, what does zoning have to do with anything? My story could have happened i”anywhere. Zoning doesn’t control whether you are allowed to cover your property with trash. My point is that even in an area with nothing but houses, you can have horrendous neighbors.
Not at all. There are tons of businesses next to homeless camps in every American city, and the value of a business is not in the building but in the location and zoning, the code is the city code attached to zoning, the thing you don't have in Huston. The zoning for a residential and commercial is different thus you cannot apply residential zoning to commercial and vice versa.
There is no place in the world that is zoned for homeless encampments. Zoning is stuff like residential, commercial, industrial, mixed use, and so on. If you are talking about homeless encampments, it’s not a zoning discussion.
I don’t support homeless encampments. Out here where I live in California they tend to be on public land like parks. But wherever they are, there should be laws, enforcement mechanisms, and social support to deal with them. But none of those things have anything to do with zoning.
I think you are confused. Zoning is not words, zoning is a set of regulations. There is no zoning for an Indian restaurant yet you can open one in a commercial lot and can't in a residential or agricultural. Same with homeless camps: there is no specific zoning for a homeless camp only but they are much easier to keep in commercial lots than residential, where it will immediately run into occupancy limits, impervious cover, trash and other restrictions.
Where do you live? Where I live, the overnight occupancy limit for commercial zoning is 0 people, so (at least here) your comment makes no sense. I think commercial zoning that allows anyone to live on the property is basically rare. So if you live in a weird place where its ok for people to live on commercial zoned property, then I agree, that is super weird. But if not, then your issue is just enforcement. In which case, yea I agree, laws should be enforced, but again that has nothing to do with zoning.
I doubt very much there is any place in the US where overnight occupancy is 0 for a commercial property. Where I live you can have a 24 hour business. Living in commercial property is forbidden, but what exactly is living is up to the code officer. In my case the officer decided that homeless did not live there but just visited the business.
Ok by why does the code officer enforce the zoning code in residential zones but not the commercial ones? It’s not like anyone doing their job in good faith could confuse a business patron and someone camping out in a parking lot.
Seems like your code officer is obviously crooked. Not sure what that has to do with zoning though.
Camping in front of business is not against the code, people used to do that for big movie openings or for other commercial events some time ago. With the residential property there are actual overnight occupancy limits which are easy to show being violated. And the occupancy is just one of the codes which would be easy to prove violated by a camp on a residential property, there are tons of other codes. Where I live, you cannot replace an exterior door without a permit, while the commercial zoning is much more permissive.
Don't punish/restrict responsible people for a problem caused by an irresponsible person.
Fix the irresponsible behavior directly.
Most residential codes define minimum living standards, and as a result people camping/crashing on a property whose structure they don't live in, is prohibited.
Apparently your zone code needs to be corrected. Small businesses in residential areas need to be held to relevant/responsible residential zone code.
(You are proposing a zoning code fix too, but for reasons I don't understand, seem fixated on eliminating non-offending businesses, instead of directly addressing the problem.)
I am glad that going directly after illegal behavior is an option for you but I live in a blue city, where DA practices "restorative justice" and the mayor allowed homeless to camp everywhere by a decree (it took a referendum and numerous lawsuits to remove giant camps he created out of downtown, they are still free to camp in residential areas despite the referendum explicitly forbidding that on top of the city and state laws to the safe effect). Nobody gets ticketed for noise, the "defund police" campaign from 2020 ended with the police not even enforcing traffic anymore so nobody is holding small business responsible.
I mean define "work." Restaurants are a famously good way to light money on fire. IIRC something like half of restaurants go bust within the first five years.
So I don't think anyone is going to be celebrating if the message is "Don't worry guys, SaaS businesses are now like restaurants: low margin and high risk."
This is so dumb. Name literally any problem caused by AI generated content (there are dozens to choose from) and I will explain why this law will make absolutely no impact on that issue.
Now articles from organizations with legitimate journalists and fact checkers like the NYT, WSJ, or the economist will need an “AI generated” badge because they used an AI assistant and they have risk adverse legal departments. This will be gleefully pointed out by every brain dead Twitter conspiracy theorist, Breitbart columnist, 911 truther substack writer, and Russian spam bot as they happily spew unbadged drivel out into the world. Thanks so much New York!
AI doesn’t make bad news content. Complete disregard for objective reality does. I’ll take an ai assisted human that actually cares about truth over an unassisted partisan hooligan every time.
If this is the best our legislatures can come up with we are so utterly fucked…
I don’t know much about Matrix. Maybe in this case the key is money.
But having worked at various startups and enterprises, it is very common for lots of money and resources to thrown at projects and for little or no progress to be made.
Money might be a necessary condition but it’s definitely not a sufficient one. See Microsoft teams.
Again I know nothing about Matrix, but I found your comment about UX concerning. UX is a problem that is almost immune to money. An extremely clear vision is almost always the bottleneck. Money can always help with adding features or performance or scaling, but I feel like it doesn’t usually fix UX. Hope I’m wrong.
Oh I doubt it, unless you have that person with vision to interpret the results of the usability testing and turn them into a single cohesive design.
Good UX comes from someone that has deeply internalized the problems a piece of software is solving for users and the constraints on those users. Most startups do this without usability testing by doing things like sales or customer support. Anyway, IME usability testing is not the bottleneck to good UI.
I don't disagree with you that you need to have a singe cohesive design vision based on solving for users. But I think that certainly usability testing can lead to even better results and is mostly constrained by cost.
But on the other hand, I think it's reasonable to hope that the "clear vision" for Matrix can largely be cribbed from all the other nigh-indistinguishable team chat apps like Slack, Discord, Mattermost, et al. In that case money to actually make the obvious fixes might be enough.
Sometimes good enough is good enough. Slack, Teams, Matrix, whatever, as long as you're meeting most daily driving requirements, everything else is maintenance and long tail quality of life improvement (imho).
What else are Teams users going to get out of Microsoft chasing an ever increasing enterprise valuation and stock price target with regards to their user experience? Email just works, make teams comms that just works and is mostly stable. Get off the treadmill of companies chasing ever more returns (which will never be enough) at the expense of their customer base. We have the technology.
I think the PowerSync [1] team is missing out on an opportunity to showcase their impressive data sync technology by building a minimalist Slack clone.
Yea, if you have to waste an extra 15 minutes per day due to bad UX who cares, it’s much better that you get the self-satisfied feeling of sticking it to “the man” (American big tech).
I mean it only adds up to 90 days of your life wasted over a 30 year career. European peoples time has a lower salary value anyways. UX doesn’t even matter that much, the political meme of the day is much more important.
Microsoft Teams already is already terrible UX, we have nowhere to go but up. Perhaps you are unaware, and if so, you should be thankful you don’t have to lose time using it. There are objectively better solutions available.
I'm in several Slack teams for non profits and professional orgs, Teams for a client or two, IRC and Matrix servers for digital archiving ops, Signal/WhatsApp/GroupMe/Telegram groups, etc. I have been in tech for 25+ years, I am familiar with the extremes. You are right, things can be bad, that is the point of systems engineering: to drive directionally towards continual improvement. Success is never assured, but throwing our hands up and giving up is not reasonable. Make a plan, work the plan. Default to action. Work is hard.
I recommend "Thinking in Systems" by Donella H. Meadows (ISBN13 9781603580557) on this topic [1]. It's ~$10 on Amazon as of this comment, and the PDF is easy to find with a quick web search.
Care to give me an example to satisfy my morbid curiosity? I have used a lot of really bad chat clients over the year and Microsft's rewritten Skype is one of only a handful worse than Teams. Teams is not the worst but it is on my top 3 or 5 worst of the 30+ chat clients I have used. I have heard Lynk also was really bad but I never used it. Microsoft certainly has some of the worst.
Element is bad but it is way better than Teams from my experience.
Matrix is so much worse than Team it will make your head spin. It suffers from design by committee to an unbelievable extent, and its various end-to-end security features are wonderful from a privacy standpoint but make things much much more complicated.
I've used both and written code to integrate into both. You never have to worry about, for example, losing access to all previous messages in your Teams channels if you get a new phone.
I’m fine to share a car. I’m less keen on dying in one.
Riding in a car is easily the most dangerous thing I do in my daily life and my subjective impression of how well uber/lyft/taxi drivers drive is not great.
I also use it every day. It does its job, but it has many usability issues that make it less than ideal.
For example, copy and paste retains the text color (probably by design). So, sometimes I get black text on a black background, when the app is in dark mode.
The editing process to remove the formatting is pretty annoying.
It takes me time to find the edit button, which is buried in the menu but prominent in the desktop version. Then, I have to toggle the HTML mode and delete the retained tags, which on a phone takes time. The desktop version, instead, has a button to remove all formatting.
The App uses the Mac Text element rather than a custom one, so it'll have the same shortcuts as all of them; `⇧ Shift ⌥ Option ⌘ Command V` to paste and match the formatting of the current field (in the case of a blank field, remove formatting).
iOS one is fine, pretty good. I use it daily too. Ankidroid is much better, which I would attribute to being open source with lots of eyeballs on it and making improvements for the love of it.
I do too, and I hate it. Some of my pet peeves from the top of my head (there would be more most likely if I'd think a bit, but maybe later):
> I keep pressing the second button to OK a card, I rarely use the 3rd and 4th. But if I fail a card, that button becomes a NOK, and I keep pressing it out of reflex
> I can't help interpreting "card was a leech" notification other than "how dumb can you be". Fortunately there is no way to turn it off.
> It keeps phoning home for some reason, each time it gets into the foreground. It is really great when you are behind a proxy, and it keeps complaining that there is no network, every single time. Of course that call can't be turned off. Also, have no idea what it sends home. I try to trust that it's not some nefarious.
> Some years ago, for some reason Anki changed DB format, in a backwards incompatible way. There was a notification at the start of the app, that if I don't want it, I shouldn't update my app. I did turn off auto-update. A few weeks later it bricked my deck (my deck got updated to the new format, even though that old iOS app was the only way I accessed it), also trashing my 3 years long strike.
Well, presumably your business charges something to mail out job applications to companies? Like an application fee, that charge incurs a cost to applicant which will do something (presumably reduce applicant volume).
Plus by making that fee optionally replaced with time spent writing the letter, people who don't have the finances to pay a whole bunch of application fees can still apply for as many jobs as they're willing to put in the time.
How are they a “gamble?” For patients, their efficacy rates are stunning. If you meant from an investing perspective, Eli Lilly and novo nordisk have very down to earth valuations when compared with AI companies.
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