14 Comments
May 8Liked by Check the Facts!

Holy heck! Your stuff is so good, thank you for doing all this analysis!

As a non-science guy, I think I fundamentally agree with Michael and Aubrey's project and their message, that the media, the weightloss- and wellness industry, and even the medical field, are unfortunately very anti-fat.

That being said, I've often found weird inconsistencies listening to Maintenance Phase. Like in the "Is Being Fat Bad For You" episode, they criticise that there is much more attention on the direct health effects of obesity than the negative health effects of anti-fat bias. Which is true, and it is a massive media issue, but then they get into the studies, and it almost sounds like they criticise the studies for how the media portray their findings, which is kind of nuts.

But I would never have caught or have a reason to suspect that stuff like the gallbladder cancer thing is wrong, that's a wild oversight to me. I also fully believed Aubrey saying that there are no evidence-based methods of weight-loss, and only now realise that they've never fully explained what that means.

The wildest thing to me is in the "Forks Over Knives" episode about vegans and vegetarians. They talk about Forks Over Knives, essentially a propaganda film that promotes veganism by wildly exaggerating the beneficial health effects of a vegan diet.

Michael and Aubrey repeatedly point out that they think that veganism and vegetarianism are good, but that the film is harmful because it overstates its claims and spreads misinformation.

And, like, that's exactly what Maintenance Phase is doing with regards to anti-fat bias. It's a real issue that deserves to be talked about, but there is no need to disparage all studies into obesity or adipose tissue. Dieting can definitely be harmful, and it doesn't have to cause cancer for that to be true.

You mention media criticisms a couple of times in your posts here, and I think it's best to view Maintenance Phase primarily as media criticism. It's a real issue when Michael and Aubrey do not draw a clear line between media criticism and science communication, and essentially do their own science communication without (as far as I know) any background in science.

Anyway, great job!

Expand full comment
author

Wow, thank you for the kind words! I, too, fundamentally agree with the MP message. And that's what makes me want them to have higher standards for this podcast! They have such a great platform and they are (in my opinion) failing to use it appropriately.

Everything you said is spot on. They so often fall prey to hypocrisy and they have very different standards for studies that confirm vs. don't confirm their world view. And you are totally right that what they are really doing is criticizing the media, but they conflate that with the science itself! And of course, the irony is that they are the media and they are butchering the science, too. It's bizarre to me that they don't recognize this, but they are also making a lot of money doing it, so perhaps that's enough to put on blinders!!

Anyway, thank you for reading and for the thoughtful comment!

Expand full comment

An amazing piece, as always.

1. I like your initial criticism on journalism, though I do think it is quite calm. We need to be held accountable more for the mistakes, the poor research we are conducting and for the lack of expertise in some areas. It is sad, because very specialized journalists in niche topics are slowly disappearing, especially as a result of media closures. Try to find a Romanian journalist that understands semaglutides - maybe there is 1 or two.

2. I cannot wait for the Maintenance Phase to respond to this newsletter series. They better accept their mistakes and seek guidance on how to research better. If they go the opposite route, then they are a bunch of fools.

3. A lot of misinformation around the drug.

3.1. What I am worried about is whether or not this will prompt changes in our diet culture or will continue the same but having a drug as a backup to cover for "the bad food". The equity aspect is important, because not everyone has access to it.

Just some thoughts.

Expand full comment
author

Hi Radu! Fantastic comment, as per usual. :)

1. I agree, my criticism of journalism is pretty tame. I think we are at a crisis point with media and misinformation, and I'm not sure how we fix it. It doesn't seem to me like society places enough value on high quality journalism - and as our mainstream news sources are failing us, there are fewer and fewer other places to turn.

2. I would love for MP to respond to this. I've reached out to them in the past and they have not responded. But I do hope that at some point they will change their minds!

3. and 3.1 This is a really interesting consequence that I hadn't really considered. In general, I think preventive medicine is the best - instead of slapping a drug on a problem, we should prevent the problem in the first place! And that means promoting healthy lifestyles and nutrition and physical activity (including making these things accessible to systematically underserved communities). I really believe we can do that without moralizing health seeking behaviors. I've been going down some rabbit holes about the role of big food corporations in our food environment. I think climate change is an interesting parallel, because society has recently come to understand that corporations have worked very hard to shift the onus to the individual to save the planet, when really the individual has very little power compared to the giant companies. For some reason, that same reckoning hasn't happened yet with the food industry. But these huge food companies are absolutely complicit in causing many of the public health problems we face today. And I wish there was more awareness of that among the general public!

Expand full comment
Feb 3Liked by Check the Facts!

Thanks. I am on Semaglutide for weight loss, and it’s frustrating how much misinformation is out there. Anecdotally, it’s worked very well for me.

Expand full comment
author

I am so glad it is working well for you, Sara! And I'm sorry that so many people are spreading misinformation about it and judging people for taking it.

Expand full comment

another great post! I hope to respond more substantively at some point, but here’s one thing that left me bit confused:

In your post, you say: “This is consistent with an Epic Research report that CNN covered which found that more than 70% of semaglutide prescriptions have gone to White patients and a Komodo analysis which reported that 65% of prescriptions for Ozempic, Mounjaro, Wegovy, and Rybelsus went to non-Hispanic White people. Obviously, we have a lot of work to do to address healthcare inequities in this country, and this is just one example."

Now, just off the top of my head, it wasn’t clear to me why the quoted statistics were an example of healthcare inequity, since I figured that something like 60-70% of Americans were White, so those numbers seemed about proportional.

I couldn’t trace the data in the CNN article back to a study, and the CNN article says the Epic Data was “shared exclusively”, so I’m not sure how to assess the >70% claim in the CNN piece.

Also, the CNN article says “White people are about four times more likely than Black people to have a prescription for a semaglutide medication, despite having nearly a 40% lower prevalence of diabetes and a 17% lower prevalence of obesity.” [Emphasis mine] Not being able to see the data they were referring to, I couldn’t tell whether this means “a White person is 4x more likely than a Black person to have an Rx” or “4x as many White people have Rxs than Black people”. I think the correct usage of the phrase “__ times more likely” implies the first interpretation, but I’ve also seen journalists get this wrong before. And again, no way to look at the actual numbers and verify which one it is.

Okay, so, moving on to the Komodo analysis:

“Among patients prescribed any of the top four drugs (Ozempic, Mounjaro, Wegovy, Rybelsus) between 2021 and 2022, 65% were non-Hispanic White and 14% were Hispanic or Latino. For comparison, only 59% of the U.S. population is White, and just over 19% of the U.S. population identifies as Hispanic or Latino. Prescriptions were proportional with population sizes for other racial groups: Black patients made up 12% of both the population and prescriptions received, 3% were Asian, and 7% were ‘Other.’”

Now, what is obviously missing here is information on what percentage of Americans with an indication for semaglutide (i.e. type 2 diabetes or obesity) belong to which racial groups. As an example, Black Americans making up 12% of the U.S. population as well as 12% of semaglutide prescriptions, but 15% of Americans with an indication for semaglutide (to be clear I just made up the 15% figure to illustrate my point), would definitely suggest that Black Americans have disproportionately lower access to these drugs. But without the racial demographics on diabetes and obesity, it’s not clear to me how the provided data can be taken an example of healthcare inequity.

Anyhow, thanks for writing this post! Since tone can often get lost online, I hope it’s clear that I intend my comment as serious engagement with what you’ve written, and not (ill-intentioned) criticism.

Expand full comment
author

Hey! Thanks for the comment. Sorry for the delay - I sometimes forget to check Substack! First of all, I welcome criticism, and I appreciate you engaging with the content. You raise good questions and also I agree it's annoying that CNN isn't releasing that report but my guess it they paid $$$ for it and want to be able to report on it exclusively. All of the sources that want to cite that now have to cite CNN which gives them traffic. Frustrating for those of us that want to see the data. it highlights where I did not provide enough context - there is quite a bit of research that shows that rates of "obesity" and diabetes, etc. are higher among non-White population and a few recent studies have looked at eligibility for semaglutide and found that eligibility is higher among non-White populations (https://www.ahajournals.org/doi/10.1161/JAHA.121.025545). The difference isn't HUGE, but it's still there. That being said, your point about proportionality stands.

It's possible that I'm misunderstanding the next section of your comment, but in this context, the two different statements that you put forth mean the same thing to me (if this came from some sort of statistical modeling, that would be different, but this is just them describing data). What do you see as the difference between those two that seeing the data would help with? This is such a good example of why word choice matters in science communication!!

As to your last piece, I think I may have addressed it in the first part of my comment, but let me know if not. I agree that the way these data are presented makes it seem like there is a HUGE gap but that's not really the case (at least, as far according to these data).

Expand full comment
Apr 18·edited Apr 18

I have a very poor impression of Michael Hobbes and his journalistic integrity, and upon finding this substack I was pretty excited for some satisfying takedown. That is to say, I'm predisposed to agree with you here.

After the first section of this essay though, I frankly... do not. Your very first point is ridiculous, as far as I can tell! So ridiculous, in fact, that I immediately stopped reading to dispute your correction, and offer my feedback on including it.

> A basic example of the knowledge gap pops up frequently: semaglutide is a GLP-1 receptor agonist, but throughout the podcast, Aubrey and Michael continue to say "GLP-1 agonist." The “receptor” is important: an agonist is a chemical that activates a receptor to produce a biological response

So in other words, the phrase 'GLP-1 agonist' can only logically refer to a GLP-1 receptor agonist, because agonists, by definition, are receptor agonists?

So remind me: why exactly is the word 'receptor' important? What exactly is being miscommunicated here? What possible misunderstanding could arise? At best, this objection is incredibly nitpicky, and at worst it's just wrong.

I would suggest that's why the Mayo and Cleveland Clinics both omit the word 'receptor', and why the term 'GLP-1 agonist' has double the google results of its longer synonym. Because it's an abbreviated way of saying the same thing!

If a term refers unmistakably to its correct referent, is semantically identical to its more literally-correct term, and is vastly more widely used, including by relevant authorities and most people, then you're on very shaky ground to insist that it's incorrect.

You immediately come across not as a disinterested defender of accurate reporting, but as an ideological enemy searching desperately for corrections to make. You do sort of disclaim it in advance before defending its inclusion, but I'm on the side of your pre-empted detractors- that correction is pure semantics, and for the credibility of the following objections you should have left it out. I will continue to read the essay, but I hope the rest of the corrections are more substantive.

Expand full comment
author

Hi Jack! I'm sorry you were frustrated by my inclusion of that! I take that to heart and in future posts, I do stick to the more substantive things. I firmly believe that it's important to use the correct terminology for things, and I think the reason I included that piece is because it was indicative of how poor their understanding of these concepts is. That is, I think it is telling that they can't get a basic terminology piece right. But I definitely hear you about nitpicking and I've done my best to respond to criticisms like yours in later posts. I do receive a lot of positive feedback and I think most people would disagree with you about seeming like an ideological enemy, especially since I explicitly state up front that I agree with much of the intended messages of the podcast. That being said, I appreciate the feedback - it's helpful for me to hear constructive criticism!

Expand full comment
Apr 19·edited Apr 19Liked by Check the Facts!

Well I appreciate your friendly and positive response to my criticism, which may have been quite harsh in tone.

I went on to read the rest of the post, and I do think it contains many substantive corrections that are worth making. And I'd like to emphasise that I don't actually believe that you ARE just a partisan ideological enemy looking to score points. And I think that makes it even more important not to discredit those criticisms with (ironically) spurious ones. Especially when they're right at the start of the essay! I think some people would close the tab at this point, (wrongly) dismissing you as just an axe-grinder, and that would be a shame precisely because you have some legitimate points to make.

And I do have to insist that the objection in question is spurious. You write above:

> I firmly believe that it's important to use the correct terminology for things, and I think the reason I included that piece is because it was indicative of how poor their understanding of these concepts is. That is, I think it is telling that they can't get a basic terminology piece right.

I strongly disagree that their phrasing was indicative of poor understanding, and I (less strongly) disagree that they got anything wrong at all.

I could be missing something, as I am not an expert here, but based on your explanation and my understanding, 'GLP-1 agonist' means the exact same thing as 'GLP-1 receptor agonist', because an agonist is by definition a receptor agonist. There's no other possible kind of GLP-1 agonist. Which makes dropping the word 'receptor' equivalent to, say, saying 'glaucoma drops' instead of 'glaucoma eye drops'. Of course they're eye drops, and of course the agonist is a receptor agonist. Where else does one drop/agonise?

You say that you "firmly believe that laypeople are more than capable of understanding ... nuances and details"- so why insist on using every word of the phrase? What misunderstanding could possibly arise?

I just fundamentally disagree that it is at all misleading, or "indicative of poor understanding", to drop a functionally redundant word from the technical term for something, any more than it would mislead or indicate poor understanding of glaucoma drops not to specify that they're glaucoma eye drops.

I'm sorry to continue arguing when you've received the initial criticism so graciously, but it did seem important to emphasise the substance of my object-level objection, which is that this correction is not merely overly nitpicky, but positively misguided, and that its inclusion at the beginning of this essay is likely to reduce the impact of the more substantive points proceeding it.

Expand full comment
author

Hi Jack! That's fair - and I don't think you need to apologize for continuing to argue! I think having discourse like this is important and I enjoy it. Sometimes arguing is constructive! Your points are very well-taken and I appreciate you reiterating them, especially with good examples. I will edit the post to remove that piece. As you so importantly point out, I don't want people to instantly close the tab because they feel like I'm just an axe-grinder. :)

I do really appreciate your thoughts and feedback! Keep it coming!

Expand full comment
Apr 24Liked by Check the Facts!

Well one further piece of feedback, then: I'm hugely impressed by your gracious response, and your scout mindset in the face of disagreement.

You've earned an (unfortunately free) subscription from me, and I'll be sure to let you know my thoughts on further posts.

Expand full comment
author

Thanks, Jack! I appreciate it! :)

Expand full comment