STAT readers on biotech and national security, liquid-only diets before colonoscopy, and the value of weight loss drugs

STAT now publishes selected Letters to the Editor received in response to First Opinion essays to encourage robust, good-faith discussion about difficult issues. Submit a Letter to the Editor here, or find the submission form at the end of any First Opinion essay.

“For national security, the U.S. must maintain its biotech dominance,” by John Crowley

I think corporations and business interest groups operating in the health care system should leave the national security rhetoric out of their investment messaging strategies. The topical arguments for investing in biotechnology made in this article were entirely gratuitous. They were based upon projections that are guaranteed to be worthless by (to be as charitable as I can manage) next Wednesday. (China controlling the biotech research sector by 2035??? — (10 years and approximately 9 months from today) ???? — please show me the hat these numbers were pulled out of.)

I’m all for investing in research and development of promising medical treatments and products. But I’m sick of this rote Cold War era rhetoric being cynically used to “leverage” the fear response.

It doesn’t make the biotech industry less threatening to people who have legitimate qualms about corporations engaging in genetic manipulation. Just the opposite.

— Michael Doran, Springfield, Mass.

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I am shocked to see STAT publishing a piece that is effectively anti-China propaganda and skirts the line of espousing conspiracy theories. I would not expect a publication for scientific journalism to endorse such a non-scientific opinion rife with slippery slope arguments. I understand the author is a relatively famous and influential person, but this op-ed crossed a line.

— Kassi Stein

“Oprah kicked off a national conversation on obesity. Let’s have it,” by Lisa Shah

As a therapist, someone who has been maintained for years on antidepressants, and a patient now on Ozempic, I was so pleased to see this thoughtful discussion taking place. I have some additional thoughts for consideration:

I suspect that increased suicidality could also be related to the disappointment that weight loss brings. That is, being in a smaller body may solve specific problems (e.g. knee pain), but we have been led to believe by social conditioning (especially for those raised as girls) that it is a key to overall happiness. When you arrive in your smaller body and you find that the challenges of your life basically the same: oof, what a let down. Clearly we know intellectually that this will be the case, but emotionally we are often holding onto a belief like, “If I could just get this weight off, everything would be okay.”

I’ve noticed since starting Ozempic that my dream intensity has ramped up significantly, even on a low dose. I wonder if this is a common side effect, and what this can tell us about how semaglutide is interacting with the brain.

— Tara McGrath, LMFT

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I couldn’t disagree more with Lisa Shah. I have been obese for my whole life and come from a family of obese people. I have tried every diet under the sun and have lost up to 50 pounds before gaining it all back again. The whole time I felt hungry and deprived.

I have been on GLP-1s for about two years now and have lost 29% of my body weight seemingly effortlessly. Lisa Shah says, “Everyone deserves to be able to sit down and share a meal with the people they care about. Food plays a central role in cultural identity and social health; it’s a focal point for connection, for belonging, and for happiness.” I couldn’t agree more. Shah writes,” To take food off the table is to remove an element of joy from life.” While diets did indeed “take food off the table”, GLP-1s have done the exact opposite. None of the joys associated with eating, as she claims, have been “robbed” from me. On the contrary, I am able to share food with loved ones for the first time; instead of bring my own “diet” food to the restaurant, I can order off the menu. I now see food as nourishment instead of a collection of calories and fats that must be meticulously recorded and tallied. The guilt I associated with food has disappeared. I still eat, I just need much smaller amounts of food to feel satisfied.

Most importantly, she is completely ignoring the psychological benefits of weight loss on people who have experienced the stigma of obesity their whole lives. If she had ever been obese, she would know that it takes just as much of a toll mentally as physically. Studies have shown that obese people are less likely to be hired and promoted. They have also shown that children would rather be friends with a child missing an arm than a child who is obese. Since my weight loss my self-esteem has soared and for the first time in my adult life, I no longer need antidepressants.

I recognize that everyone’s experience is different, but I felt the need to give the perspective of someone who knows what it is like to obese, knows what is like to be on this medication, and whose life has literally been transformed by GLP-1s.

— Noelle Teagno

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As I read this article, I found myself thinking of blood pressure medications. My understanding is that people who have not been able to reduce their blood pressure through lifestyle changes will be on blood pressure medication for the rest of their lives. While no one wants to be dependent on medications and there are compliance problems for that reason, I don’t hear medical professionals being concerned that people who are on blood pressure medications have to remain on them for the rest of their lives. This makes me suspect that in spite of everything, many still erroneously believe that weight loss rests on will power.

— Nora Staffanell

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I consider myself lucky! I have lost weight on Ozempic as planned. What I didn’t expect was the tremendous improvement in my A1C which decreased by 8 points and my HDL decreased by 73 points — in itself a miracle. When we acknowledge obesity as a disease and not a lack of willpower we then can have real conversations on curing the epidemic of weight.

— Karen Bailey

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Thank you for being the voice of reason! Everyone out here is on the bandwagon with these drugs and I’ve been thinking how unhealthy it is to disrupt your body and mind to lose weight when most would benefit from behavioral changes that slowly get them to a lower weight.

— Karen Mulhern

“The evidence is clear: A liquid-only diet before a colonoscopy is unnecessary,” by Benjamin Lebwohl

The clear liquid is the easy part, my guy makes me follow the day before diet suggested here for 10 days! Conversely, the guy I used prior to my move, placed no diet restrictions at all on me instead relied on the gallon of laxative I drank the day before to do the trick, which it did every time. Yes indeed, these guys need to follow the science and not their gut, especially when it’s my gut they’re messing with.

— Dana Autenrieth

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I have been allowing my patients a diet consisting of rice, noodles, and white meat but advise them to avoid dairy, leafy vegetables and fruit especially beet root, red dragon fruit one day before the procedure. My bowel prep has been fairly effective 90% of the time.

— Andy Easwaren Vasudevan

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Great article. However, the author misses the true hurdle to colonoscopy prep: the massive amount of gross liquid a patient is required to drink. I can handle a liquid diet for a day, but drinking that nasty, cold stuff? Not so much! I’ve made the mistake of chugging it, just to get it over with, which resulted in chills and vomiting. It would be nice if doctors worked on finding a way to purge that does not involve drinking a gallon of cold grossness.

— Gertrud Jeffries

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Evidence-based health care… what a concept! Dr. Lebwohl nails the criticism of his colleagues, who withhold the choice of low residue diet because, “My patients may have difficulty understanding the nuances of the low-residue diet.”

Let me get this straight, physicians lie to us about medical practices, so we will respect and follow their advice? That sounds more like dialogue from a situation comedy, “Parents gotta lie to their children to get them to respect and believe us.”

Whether the medical community chooses to require the unnecessary clear liquid diet or the more nuanced low residue diet, colonoscopy efficacy will be compromised by patients who fail to follow instructions. When either choice is going to make one side unhappy, make sure the right side is unhappy.

I would slightly modify the last sentence of this good article. Instead of, “… let our patients eat…” I would suggest, “… let our patients decide…”

— Michael Brown