Drugs

Statins and Seniors

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For clinicians, these findings reinforce the importance of individualised decision making rather than a single preferred approach. For older adults who are tolerating statin therapy and wish to continue treatment, evidence from SAGA/SITE provides little reason to recommend routine discontinuation. Conversely, for patients who prioritise reducing medication burden, have limited life expectancy, have substantial polypharmacy, or whose goals of care have changed, discontinuation might be a reasonable option. Rather than supporting a default strategy, the trial broadens the evidence available for treatment decisions that reflect each patient’s individual clinical circumstances and preferences.2,3 Statin discontinuation in older adults: changing the conversation, not the default – https://www.thelancet.com/journals/lanhl/article/PIIS2666-7568(26)00072-3/fulltext

Discontinuation of statins for primary prevention of atherosclerotic cardiovascular disease in adults aged 75 years or older (SAGA/SITE): a multicentre, open-label, pragmatic, non-inferiority randomised trial Bonnet et al.

The Lancet Healthy Longevity August 11, 2026

WOO HOO (maybe).

Life is short and science takes too long.

Scary Charts (Prescription Drug edition) – 08.02.26

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Today, three PBMs, CVS Caremark (34% market share), Express Scripts (23%, owned by Cigna’s Evernorth), and Optum Rx (22%, owned by UnitedHealth Group), control nearly 80% of all U.S. prescription claims. In exchange for placing a manufacturer’s drug on the formulary, or giving it preferred status over competing therapies, the PBM negotiates rebates, administrative fees, and performance payments from the manufacturer. A portion of those payments flows back to the health plan, while the PBM retains part of the negotiated revenue.

One feature of today’s market that surprises many people is how vertically integrated it has become. The largest PBMs are no longer independent middlemen. They sit inside healthcare conglomerates that also own insurers, pharmacies, physician groups, specialty pharmacies, and mail-order pharmacies. For example, CVS Health owns Aetna, CVS Caremark, CVS Pharmacy, MinuteClinic, and Signify Health. UnitedHealth Group owns UnitedHealthcare, Optum Rx, and Optum Health. Cigna owns Express Scripts through Evernorth. This consolidation has fueled ongoing debate about whether these organizations can optimize each part of the supply chain independently or whether incentives increasingly favor the parent company as a whole. Mark Cuban on Breaking the Drug Pricing Cartel: Inside Cost Plus Drugs – https://pearhealthcareplaybook.substack.com/p/mark-cuban-on-breaking-the-drug-pricing

Hat Tip – https://ritholtz.com/2026/08/10-sunday-reads-239/

Yikes.

This Is Not Your Grandfather’s Weed

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So let me be the doctor who says it plainly. This is not the mild plant of the 1970s. Then, cannabis was 1-3% THC. Today’s products run 15-25%, and concentrates — dabs, vapes, wax — hit 70-90%+. When people say “it’s natural, it’s harmless,” they’re defending a product that no longer exists. We didn’t legalize the old plant. We industrialized a far more potent one.

A Danish registry study followed 6,788 people diagnosed with substance-induced psychosis. Overall, 32.2 percent later developed schizophrenia-spectrum or bipolar disorder. Among those with cannabis-induced psychosis, 47.4 percent later received one of those diagnoses.

A large Ontario cohort found that approximately 26 percent of people who presented to an emergency department with cannabis-induced psychosis were diagnosed with a schizophrenia-spectrum disorder within three years. The corresponding rate after alcohol-induced psychosis was approximately 8.9 percent. Among the substances studied, cannabis-induced psychosis carried the highest risk of later transition to schizophrenia-spectrum illness. Is it cannabis-induced psychosis or bipolar disorder? https://kevinmd.com/2026/07/is-it-cannabis-induced-psychosis-or-bipolar-disorder.html

YIKES.

GLP-1 Just $50 a Month!!!

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Starting July 1, 2026 Medicare covers certain GLP-1 drugs under the Medicare GLP-1 Bridge program. This temporary program is available nationwide (including all states and U.S. territories) to certain people with Medicare drug coverage (Part D). https://www.medicare.gov/coverage/weight-loss-drugs

You must be 18 or older and meet one of these requirements when you start GLP-1 therapy:


You have a body mass index (BMI) of 35 or more.


You have a BMI between 30-34.99 and have at least one of these conditions:
Diastolic heart failure (also called heart failure with preserved ejection fraction)
Uncontrolled high blood pressure (also called hypertension)
Chronic kidney disease at stage 3a or higher
Prediabetes
A previous heart attack (also called myocardial infarction) or stroke
Blocked arteries in your legs or arms (also called peripheral artery disease) with symptoms


You have a BMI between 27-29.99 and have at least one of these conditions:
Prediabetes
A previous heart attack (also called myocardial infarction) or stroke
Blocked arteries in your legs or arms (also called peripheral artery disease) with symptoms

Yes, I loved writing the click bait title to this post.

GLP-1s (it’s kind of a mess)

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“But the real question is what is the quality of the weight regain and what is the shift in people’s metabolism, and it seems to be very bad,” she said. “Ongoing studies that haven’t been published yet suggest that hypertension comes back. All the inflammatory markers come back, and lipids go up. And if you have diabetes, it gets worse. Overall, it’s kind of a mess…As these studies and others showed, most people regain the weight. Whether or not they regain all the weight depends in part on diabetes and insulin and many other factors, but people will likely regain most of their weight.”

“But the message isn’t that you regain the weight. The message is that you may be less healthy when you regain the weight. That’s why we need to couple the drugs with lifestyle interventions. And it’s why people who just want to lose 5 or 10 pounds really need to consider that lifestyle change, hard as it is, is the better way to do it.”

Anne Peters, MD, professor Keck School of Medicine of the University of Southern California

Less Weight Regain, More Health Loss after Stopping GLP-1s? – Medscape – March 05, 2026 – https://www.medscape.com/viewarticle/less-weight-regain-more-health-loss-after-stopping-glp-1s-2026a10006rv?

I never envisioned developing an obsession with pharmaceuticals. And after many years of endless blogging into the void I learned I could link to previous posts like this: https://lifeunderwriter.net/tag/glp-1-receptor-agonist/

The learning never stops.

GLP-1s and the Risk for Malnutrition

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“We see cases where people take a GLP-1 medication and become so severely malnourished that they need to be hospitalized,” said Rebecca Boswell, PhD, director of Penn Medicine Princeton Center for Eating Disorders, in Philadelphia. “It’s not uncommon.” The Scary Health Risk That Can Sneak Up on GLP-1 Users – Medscape – January 19, 2026. https://www.medscape.com/viewarticle/scary-health-risk-can-sneak-glp-1-users-2026a10001pi

Yikes.

People return to their baseline weight and lose all cardiometabolic benefits in less than 2 years after stopping semaglutide or tirzepatide, a new meta-analysis found. Weight Regain, Health Benefit Loss Rapid When GLP-1s Stopped – Medscape – January 08, 2026. https://www.medscape.com/viewarticle/weight-regain-health-benefit-loss-rapid-when-glp-1s-stopped-2026a10000kr?

YIKES.

You see, cures are passée. Cures kill markets. Getting the population properly hooked on a pharmaceutical treatment for a ‘chronic’ condition is where the serious money is. “Our core insight was simple and grim: it’s far easier—and infinitely more profitable—to convince healthy people that they’re sick than to develop genuine cures for the truly ill.“

Twenty years later, the hustle is bigger, slicker, and more dangerous than ever. Watching that hustle unfold with weight loss drugs feels weirdly ominous, like watching a slow-moving train wreck you can’t peel your eyes off of. You know there’ll be carnage and bodies, vast fortunes won and lost, and humanity left just a little bit poorer. We have often documented the pharmaceutical industry’s proven ability to create enormously lucrative markets overnight, by inventing and selling diseases. Now watch as all that ingenuity and energy gets pointed at one of the biggest problems bewitching humanity: human fatness. The Seven Deadly Sins of Weight Loss Drugs – https://brownstone.org/articles/the-seven-deadly-sins-of-weight-loss-drugs/

YIKES!

This will not end well.

Complications? What Complications? (just another GLP-1 receptor agonist post)

My Statin Comes From India

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According to the USP, the bulk of the APIs come from India. That country is responsible for 50% of the active pharmaceutic ingredients. China is not far behind at 32%. The European Union supplies 10%. That’s a big change since 2000. Back then, European countries like France, Germany, Switzerland and Denmark supplied 42% of the APIs. Drug Recalls From India – Can You Trust Foreign-Made Generics? – https://www.peoplespharmacy.com/articles/more-drug-recalls-from-india-do-you-trust-foreign-made-generics

Dozens of companies received approval from the FDA over the years to sell metoprolol and bupropion in the U.S. Yet from 2018 to 2024, the agency reported running only 2 tests on metoprolol and 7 on bupropion through its quality surveillance program — in each case, by pulling a sample from a single drug maker. In many of those years, the drugs weren’t tested at all, FDA records show. Those that were assessed received passing results. The FDA Often Doesn’t Test Generic Drugs for Quality Concerns, So ProPublica Did – https://www.propublica.org/article/fda-generic-drug-testing

ClinCalc DrugStats Database – https://clincalc.com/DrugStats/

Both articles are long reads but worth your time.

Yikes.

Antidepressant Prescriptions Increase 130% for Teenage Girls

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The increasing rate of mental health disorders among children and adolescents is a concerning trend that has been observed for several decades, with survey studies revealing dramatic increases in anxiety, depression, and suicidal ideation.1 In the United States, suicide ranks as the second leading cause of death for those aged 10 to 19 years and the third leading cause of death for those aged 15 to 24 years.2 Antidepressant Prescriptions and Mental Health – https://publications.aap.org/pediatrics/article/153/3/e2023064677/196661/Antidepressant-Prescriptions-and-Mental-Health

Between January 2016 and December 2022, the monthly antidepressant dispensing rate increased 66.3%, from 2575.9 to 4284.8. Before March 2020, this rate increased by 17.0 per month (95% confidence interval: 15.2 to 18.8). The COVID-19 outbreak was not associated with a level change but was associated with a slope increase of 10.8 per month (95% confidence interval: 4.9 to 16.7). The monthly antidepressant dispensing rate increased 63.5% faster from March 2020 onwards compared with beforehand. In subgroup analyses, this rate increased 129.6% and 56.5% faster from March 2020 onwards compared with beforehand among females aged 12 to 17 years and 18 to 25 years, respectively. In contrast, the outbreak was associated with a level decrease among males aged 12 to 17 years and was not associated with a level or slope change among males aged 18 to 25 years. Antidepressant Dispensing to US Adolescents and Young Adults: 2016–2022 – https://publications.aap.org/pediatrics/article/153/3/e2023064245/196655/Antidepressant-Dispensing-to-US-Adolescents-and?autologincheck=redirected

Between 2020 and 2022, antidepressant prescriptions for girls aged 12-17 skyrocketed by 130%. Antidepressants Increase 130% for Teen Girls, Drop 7% For Boys – https://brownstone.org/articles/antidepressants-increase-130-for-teen-girls-drop-7-for-boys/

Yikes.