What we got wrong about GLP-1s
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What are GLP-1s and why have they been controversial?
Okay, so here's something. Our show's motto, no question too big, no question too small, but there's some questions that I have on this show avoided. I'll give you an example, GLP-1s. Surge Engine has barely acknowledged their existence, which is fine, except I read a lot about them, I think a lot about them, and in my private life, I talk a lot about them. But when they cannonballed into American culture, I had a lot of questions that I didn't want to ask in public. In 2022 and 2023, GLP-1s were just, for me, too hot a topic. Going online felt like walking into a crazy shootout at an old Western saloon, except instead of gunslingers, it was all fast draw scolders. There were scolders out there scolding celebrities for taking GLP-1s, but then they were getting scolded by other scolders for scolding celebrities.
How did Dr. Bedard first become aware of GLP-1s?
Some people got scolded because they were taking the drugs despite not being fat enough, scolded for wanting to lose 15 pounds. Rich people, of course, were getting scolded all over the place, accused of ripping GLP-1s out of the hands of the people who actually needed them. It was scolding mayhem. Meanwhile, offline, in real life, 20% of the people I knew just lost 15 to 40 pounds. They seemed happy, and I had questions. What did we really know about these drugs? Were they helping people the way they claimed to? What were the side effects? I had questions, but I hate getting scolded, so I kept my mouth shut. Meanwhile, in 2026, the scolders have moved on to other topics, topics I'll cover in 2029.
But today, we can finally get some answers on these fascinating drugs, which it turns out are much weirder than we ever knew. So this week, we're going to talk to a doctor who's going to tell us the story of GLP-1s from her perspective, which is a very unique one, because she's a doctor to a particular patient population that we don't hear from much in the media, almost never, and who were very absent from the entire early discourse around these drugs.
What unique patient population does Dr. Bedard serve?
Can you say your name and what you do?
Sure. I'm Rachel Bedard. I'm a physician and I'm a writer. I'm a contributing writer to the New York Times Opinion. And as a doctor, I am an internist and my subspecialties are geriatrics and palliative care. But I've had this sort of unusual career where for six years I was a physician on Rikers Island and I now work in a homeless clinic a couple days a week.
Can you tell me about your work at that homeless clinic? Like, where's the clinic? What's it like? What's your work like?
So the clinic is, it's a safety net clinic run by the city. The city has a network of these safety net clinics that are embedded in the public hospital system. And so my clinic is at Woodhull Hospital in Brooklyn. So the clinic's in the hospital, but it's an outpatient clinic. It's primary care. We serve people who are either... unhoused or sort of in precarious housing situations. They were recently, you know, housed or they are staying on friends' couches or something like that. But the majority of the people that we take care of are living in shelter or people who are sleeping on the streets. So we do sort of all of their primary care. That population has a very high rate of comorbid mental health issues, very high rate of comorbid addiction issues.
but also is just very medically sick. So the majority of folks that I take care of have at least one chronic medical comorbidity, like high blood pressure, diabetes, or other diseases like that for which they're taking daily medications.
I have a bunch of questions in a bunch of different directions. One is, your work puts you... I think a lot of people who live in New York City, the weird thing about New York, maybe more than other places in America, is that it's both incredibly class-stratified. You have very elite, very wealthy people, and you have working people, and you have very poor people. But the people in those worlds don't always really run into each other, besides maybe on the subway or literally on the street. You have this unusual life where you're moving between highly elite worlds, like the New York Times, and then working with populations that are so far removed from it.
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Chapters
8 chapters
1
What are GLP-1s and why have they been controversial?
0:24–1:16
2
How did Dr. Bedard first become aware of GLP-1s?
1:16–2:31
3
What unique patient population does Dr. Bedard serve?
2:31–4:40
4
What are the primary benefits of GLP-1s for patients?
4:40–7:26
5
What unexpected effects have been observed with GLP-1s?
7:26–9:54
6
What are the potential side effects of GLP-1 medications?
9:54–13:17
7
How are GLP-1s changing the landscape of primary care?
13:17–17:42
8
What ethical concerns arise from off-label use of GLP-1s?
17:42–47:28