Statins and Seniors

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 defaulthttps://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

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 Drugshttps://pearhealthcareplaybook.substack.com/p/mark-cuban-on-breaking-the-drug-pricing

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

Yikes.

GLP-1 Just $50 a Month!!!

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.

The Dangers of Self-Diagnosis and AUD (Alcohol Use Disorder)

Using naltrexone to cut back on drinking isn’t new, says Sarah Wakeman, a senior medical director for substance use disorder at Mass General Brigham. The approach dates back to the 1980s with the Sinclair method, which pairs drinking with naltrexone to blunt alcohol’s pleasurable effects. In parts of Europe, Wakeman adds, people have long used a “pill-in-the-pocket” strategy, taking the medication only when they anticipate drinking. A decades-old drug is helping people drink less alcohol—without giving it up completelyhttps://www.nationalgeographic.com/health/article/naltrexone-drink-less-alcohol? (Paywall article)

The Provider Individual who is not a doctor will see you after you answer the questionnaire (this is the self-diagnosis part).

Oar Health is an online service offering naltrexone subscriptions to those with alcohol use disorder (AUD). Users can fill out a brief assessment which is reviewed by a medical professional, then be given a naltrexone prescription if appropriate. After a one-time $50 fee, subscriptions cost $297 for three months of medication, which comes out to $99 monthly. It’s currently available in 42 US states. Beyond the naltrexone prescription, Oar Health offers ongoing access to the support of a medication prescriber, a health coach, a Facebook group for community support, and extras like educational articles and guided reflections.Oar Health Review: Pros & Cons, Cost, & My Experiencehttps://www.choosingtherapy.com/oar-health-review/

Health coaches who are “naltrexone experts”! And The Sinclair Method might not work for everyone. https://drugfree.org/article/sinclair-method/

Depending upon the online service you choose you may get naltrexone prescribed when trying to get your doctor prescribed GLP-1 filled out even when you don’t have alcohol use disorder.

Telehealth companies such as Vida Health and its rivals offer lifestyle support so people taking drugs like Wegovy and Zepbound can have the most success on the drugs. But the companies often have another job: limiting obesity drug costs for employers.

The Vida Health nurse said he was a good candidate for Zepbound but insisted he try two generic drugs first: naltrexone, a drug used to curb alcohol and opioid use, and bupropion, an antidepressant. Neither drug is approved for obstructive sleep apnea. Primary care doctors raise alarm as telehealth companies get involved in obesity drugshttps://www.npr.org/2026/06/14/nx-s1-5805984/glp1-telehealth-weight-loss-drugs

Yikes.

Medscape on Obesity – 04.26.26

Medscape on Obesity  
  Latest Stories  
  Study Exposes Risks in Compounded GLP-1s  
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  Can Weight Loss Cut Cancer Risk? New Data  
  A Looming Crisis in Diabetes  
  Non-Medicinal Satiety Tips for Weight Loss  
  Trending  
  New Obesity Medication Guidance: Will It Reduce Stigma?  
  Why GLP-1 Results Vary: New Genetic Data  
  Is Tallow Shallow? The Skinny on Unsaturated Fats  

GLP-1s (it’s kind of a mess)

“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.

Medscape on Obesity – 02.08.26

  Prescribing GLP-1s After 65? Read This First  
  Beyond BMI: New Tool Flags Hidden Metabolic Risk  
  Is Fat Loss Overrated for Metabolic Health?  
  Digital Tool + Meds Delivered 10%+ Weight Loss  
  Sleep Patterns Tied to Post-Bariatric Surgery Outcomes  
  Discussing Pathways for Patients With Obesity and Depression  
  Trending  
  Do GLP-1s Damage Muscle?  
  What Your Glutes Say About Diabetes Risk  
  Scary Risk That Can Sneak Up on GLP-1 Users  

GLP-1s and the Risk for Malnutrition

“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 Drugshttps://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)