May 2026

Antiemetics, laxatives and the thin literature underneath them

We separate what is supported, what is reasonable, and what is folklore, and we do not pretend the boundaries are crisp.

The eighteenth month, and the conversation that should have happened in the third

Two withdrawal-design trials tell us what happens when treatment stops. Neither tells us what the lowest effective maintenance…

What the GIP receptor adds: reading cagrilintide as two drugs in one sequence

Head-to-head data exists for some of these comparisons and not for others. This piece says which.

Forty-four per cent: reading the nausea figure properly

Almost every figure in circulation about tolerability comes from six publications. This is what they say.

The area postrema, and the anatomy of an unwanted effect

What scintigraphy and breath-test studies established about emptying rate, and what they did not.

The upper rungs, ranked by evidence

Where the curve flattens, what flattens with it, and what does not.

Beta-arrestin, cAMP, and the part of cagrilintide’s mechanism nobody quotes

Selectivity, potency and efficacy are three different measurements. The trade routinely reports none of them.

What twenty companies say about storage, and what they have measured

A stability programme needs a protocol, defined conditions, a stability-indicating method and time. Time is the ingredient no…

Sterility is not a percentage, which is the whole difficulty

Purity, content, identity, sterility and endotoxin are five separate determinations. A single sheet of paper carrying one of…

How a claim degrades between the bench and the listing

Lot-level verification with a public report is a real and achievable thing. It exists in this market, on a minority of listings.

How a claim degrades between the bench and the listing

Every step between the laboratory report and the product page removes information, and the badge is the last step.

The pyrogen question has a price, and it is not the price of a purity run

The absence of microbiological capability in this market is a commercial fact with a straightforward explanation, and it is…

A certificate is a snapshot, and peptides do not stand still

A document is only as good as the chain that connects it to the material, and most chains here are two or three links longer…

Aggregation: the impurity your chromatogram dissolved before it looked

We describe each pathway in enough chemical detail to explain why it is invisible to the method the trade uses, because that is…

Side effects, cost, supply, target: four reasons with four trajectories

The trials studied planned withdrawal. Almost nobody stops that way.

Load, not cardio: the distinction the general advice keeps losing

The older-adult diet-and-exercise trials are the closest analogue to rapid pharmacological weight loss, and they are twenty…

Reading HbA1c in the presence of anaemia

The alternatives with shorter windows, what they measure, and why they are rarely ordered.

What SELECT reported for HbA1c, and from which baseline

A robust, cheap, standardised assay with a specific and well-catalogued set of failure modes, several of which are common in…

Why your laboratory interval differs from the one in the textbook

A twelve-analyte panel in a perfectly healthy person has roughly even odds of producing at least one flagged result.

What the trials monitored, and what that implies about routine practice

Timing is the whole of the post-cessation panel: draw it too early and it measures the treatment period.

Side effects, cost, supply, target: four reasons with four trajectories

Why the reason for stopping changes what happens afterwards.

The retest date and the expiry date are not the same document

We asked twenty companies three questions about stability data and print every answer, refusal and non-response.

Why a dead-clean sterile filter can pass pyrogen straight through

The masking phenomenon known as low endotoxin recovery means a formulation can return a clean result while containing endotoxin…

LAL, kinetic chromogenic, recombinant factor C: three ways to the same figure

The limit for a parenteral product is calculable from the dose and the body weight in two lines. Almost nobody in this trade…

When a better instrument changes the answer rather than the confidence

Calibration drift is real, unremarkable, and the reason serious laboratories run internal standards.

What we asked twenty suppliers about stability data

We asked twenty companies three questions about stability data and print every answer, refusal and non-response.

Janoshik, Medutest, PeptideMeter, VendorInvestigate: a capability audit

Endotoxin is the more tractable of the two questions, and a kinetic chromogenic determination is neither slow nor exotic. It is…

Five things a purity figure cannot tell you

Aggregates dissociate in the mobile phase and are recorded as monomer. Only a size-based separation reports them.

Why people actually stop, in the order they actually stop

A supply interruption is a discontinuation with no notice, no taper and no plan. That is a distinct clinical situation.

Tolerability is the ceiling, and the ceiling is personal

An effect is dose-limiting when it prevents adequate intake, prevents normal activity, or produces a risk of its own. Discomfort…

Escalating past the approved maximum, examined honestly

We looked at what the dose-ranging data supports about going higher, and it is thinner and less flattering than the market…

What the placebo arms of the withdrawal trials actually tell us

The evidence on stopping is better than the evidence on almost anything else in this field, because somebody deliberately…

What the trials adjudicated, and how

We give background rates alongside trial rates, because an event occurring during treatment is not thereby caused by it.

A reference interval is not a target, and a result outside one is not a diagnosis

The arithmetic of the reference change value, worked for the analytes that matter here.

The mechanism behind the mechanism

The clinical effect profile is almost fully predictable from where the receptor is expressed, which is unusual and useful.

Why people actually stop, in the order they actually stop

A supply interruption is a discontinuation with no notice, no taper and no plan. That is a distinct clinical situation.

From vial to bench: what is recorded and what is assumed

The condition on arrival is recorded by some services and not others, and it is one of the more informative lines in a report.

The supply gap as a clinical event

Real-world persistence figures, with their definitions stated, because the definitions are doing most of the work.

Continued treatment against continued placebo: the comparison that settled it

The evidence on stopping is better than the evidence on almost anything else in this field, because somebody deliberately…

Six words a verification badge would need to mean anything

A badge asserts that something was tested. It does not assert what, when, on whose sample, by what method, or whether the lot on…

What STEP 2 tells us about maintenance, and what it does not

What the labels permit, what clinicians do, and the size of the gap between them.

The badge economy, and what it is actually certifying

Every step between the laboratory report and the product page removes information, and the badge is the last step.

The supply gap as a clinical event

Why the reason for stopping changes what happens afterwards.

Same material, different gradients, different answers

Two years ago we ran an anonymised version of this comparison and promised a named one. This is it, with every method printed in…

Vitamin D, adiposity, and a volume-of-distribution problem

Reduced intake is a plausible mechanism for deficiency. Reduced absorption is not, and the two are conflated in most of the…

The skeleton responds to load, and load is falling

The evidence base is one secondary analysis, several small studies and a large amount of extrapolation from bariatric surgery.

The word “confirmed” is doing an enormous amount of work on this certificate

The Journal’s standing position: a mass that matches is necessary evidence of identity and nowhere near sufficient.

Aseptic technique for people who were never taught it

A needle blunts on first use. Reuse is uncomfortable, and it is a documented contributor to lipohypertrophy.

Five things a purity figure cannot tell you

An orthogonal method separates on a different physical principle, so that species co-eluting in the first are likely to resolve…

An error taxonomy for a market without a pharmacist

The recurring errors in this market are not exotic. They are a small set of arithmetic and reading failures, each capable of…

Carbon-13, and the reason a peptide has more than one mass

A peptide has a monoisotopic mass and an average mass, they differ by several daltons at this molecular size, and a certificate…

We asked four laboratories for a sterility test. Here is what came back.

We asked all four services what they can determine, on what timescale, at what price, and under what accreditation. The answers…

Peak capacity, and the honest measure of a separation

Gradient slope is the single most consequential method parameter for a reported purity figure, and it is the one most often…

The eighteenth month, and the conversation that should have happened in the third

What the trials measured was continuation against withdrawal. What patients want to know is continuation at a lower dose, and…

The specification sheet says 500,000. The report says conforms.

Every instrument specification quoted in an advertisement is a best case obtained on a calibration mixture, not on a submitted…

What orthogonal actually means, and what it does not

Aggregates dissociate in the mobile phase and are recorded as monomer. Only a size-based separation reports them.

Adverse events by dose, adverse events by week

Trial adverse-event tables count episodes reported to a study nurse. They are the best data we have and they systematically…

Where the receptor is: a tissue-by-tissue account of liraglutide’s reach

The central effects are not a bonus. On the current evidence they are the principal mechanism of weight loss.

Choosing a needle for a subcutaneous peptide

Skin thickness at the standard injection sites is approximately two millimetres in adults and varies remarkably little with body…

What STEP 4 and SURMOUNT-4 actually established

What the trials measured was continuation against withdrawal. What patients want to know is continuation at a lower dose, and…