The arithmetic of a step: what doubling a dose actually asks of you
We work the arithmetic out in full, because it is arithmetic and it is short.
Semaglutide
Page 5 of 18 of this archive, newest first.
Thiamine and the vomiting patient
What the trials measured, which in the case of micronutrients is very little.
The out-of-range flag is a statistical convention with a printer attached
A flag is a probability statement about a population. It is not a statement about the person holding the printout.
Reading the semaglutide titration schedule as a regulatory artefact
The published ladder exists because a protocol needed a single number. Practice has never followed it exactly, and the regulatory file never assumed it would.
Falling ferritin is not always falling iron
A substantial proportion of the abnormal results generated during rapid weight loss are consequences of the weight loss rather than findings about the person.
Why people actually stop, in the order they actually stop
Why the reason for stopping changes what happens afterwards.
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 dose is.
HbA1c and its lag: what a result three months old is telling you
The assay is not the problem. The interpretation of a lagging integral as a current measurement is the problem.
Do you need the top of the ladder?
The dose-response curve in this class flattens near its top. That has direct consequences for whether the final rung is worth climbing.
How much of retatrutide weight loss can any instrument actually attribute?
The instrument determines the answer more than the drug does, and the trade quotes the answer without naming the instrument.
Why the bone question is harder than the muscle question
A plausible mechanism, a measurable change, and no outcome data. This is what an open question looks like.
Percentage of loss, absolute kilograms, and the sleight of hand between them
What was pre-specified, what was exploratory, and what was calculated afterwards by people who did not run the trial.
The dose that got you here and the dose that keeps you here
What the labels permit, what clinicians do, and the size of the gap between them.
Load, not cardio: the distinction the general advice keeps losing
Mass and function are different endpoints and training affects them differently. Most coverage treats them as one.
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.
Why the fifth week of a semaglutide dose feels different from the first
An accumulation model, drawn from published parameters, with its assumptions stated.
What a low result means when intake has halved
Reduced intake is a plausible mechanism for deficiency. Reduced absorption is not, and the two are conflated in most of the advice.
Why receptor selectivity is the least discussed number in incretin pharmacology
The class is described as though every molecule in it did the same thing. At the receptor, they demonstrably do not.
Percentage of loss, absolute kilograms, and the sleight of hand between them
A substudy powered to describe a mean is not a substudy powered to detect a clinically meaningful individual change.
Randomised withdrawal is the cleanest design in this field and the least discussed
The evidence on stopping is better than the evidence on almost anything else in this field, because somebody deliberately randomised it.