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Are you getting the GLP-1 you were expecting?
The promise of weight loss can make starting a GLP-1 sound straightforward. Michael Blyumin wants patients to understand what they’re taking, what they can realistically expect, and what happens when they stop.
A clinical pharmacist at Stanford Health Care, Michael works with patients managing diabetes and other long-term conditions. He has also co-authored research on medication costs and access.
He joins Richard Skaife to discuss the business behind compounded GLP-1s, his concerns about untested formulations, and why successful treatment involves more than the number on the scales.
He explains:
■ Compounded GLP-1s versus FDA-approved medicines
■ The costs and incentives behind the market
■ Muscle loss, protein and resistance training
■ Weight regain after stopping treatment
■ What newer dual and triple agonists could offer
■ The costs and incentives behind the market
■ Muscle loss, protein and resistance training
■ Weight regain after stopping treatment
■ What newer dual and triple agonists could offer
Chapters
- (00:00) - Intro
- (01:42) - Compounded vs. approved GLP-1s
- (03:35) - Cost, access and profit
- (07:08) - Marketing and untested formulations
- (09:18) - What the media gets wrong
- (13:16) - What happens when you stop?
- (14:09) - Protecting muscle on GLP-1s
- (16:41) - Dual and triple agonists
- (20:42) - The future of GLP-1s
- (22:46) - Changing lives with diabetes
Further reading
FDA: Information on compounded GLP-1 products, dosing errors and unapproved formulations: FDA’s Concerns with Unapproved GLP-1 Drugs Used for Weight Loss
PubMed Central: Conference abstract examining changes in fat and lean mass in a 140-person STEP 1 substudy. Lean mass includes more than skeletal muscle: Impact of Semaglutide on Body Composition in Adults With Overweight or Obesity: Exploratory Analysis of the STEP 1 Study
PubMed: The STEP 1 extension, following participants for a year after semaglutide and the trial’s lifestyle intervention ended: Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension
PubMed: Research co-authored by Michael Blyumin examining changes to Medicare prescription coverage and the cost of GLP-1 medicines: Assessing the impact of the Inflation Reduction Act on Medicare prescription drug coverage
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This podcast is for informational and educational purposes only and does not constitute medical advice. Some compounds discussed in this episode are investigational, unapproved for the uses discussed, or subject to changing regulatory requirements.
Creators and Guests
Host
Guest
Michael Blyumin
Michael Blyumin, PharmD, is a clinical pharmacist and certified diabetes care and education specialist at Stanford Health Care. He works with patients managing chronic conditions, helps train pharmacists, and has co-authored research on medication affordability and access, including GLP-1 therapies.
What is Peptide Show?
Welcome to the world of Peptides. New episodes every Tuesday.
That you may have lost muscle,
or you may lose muscle on the GLP-1,
and when you discontinue,
and if you have weight regain,
it's not like you just magically
gain back muscle, right?
They are just as profit-motivated
as any pharma company.
They're not here
for the good of the people.
They're here to exploit an opportunity.
It's hard to describe, really,
how revolutionary some of these drugs are
for people's blood sugar management.
If you wanna lose, you know,
just 5% of your body weight,
take the medicine for two months and stop,
yeah, it might help you achieve that.
But you have to ask yourself:
Is the risk worth the benefit?
Whether this is your first episode
or we've become part of your week,
it's lovely to have you here.
If you enjoy the conversation,
please do subscribe and join
us for the next one.
Michael Blyumin
is a clinical pharmacist
at Stanford Health Care.
He works with patients managing diabetes
and has seen firsthand how
GLP-1s can change lives.
He's also concerned
about the way these
medicines are being marketed,
and whether people really understand
what they're signing up for.
So, are you actually
getting the same medicine
that was tested in the clinical trials?
And how would you know?
In this conversation,
we explore the business
behind compounded GLP-1s,
how to protect muscle during weight loss,
and why the decision to start treatment
should include a conversation
about stopping.
My guest today is Michael Blyumin.
Welcome to Peptide Show.
Welcome to Peptide Show from Longr.
My name is Richard Skaife.
I'm a venture capitalist and entrepreneur,
exploring the business of peptides.
Great pleasure to welcome my guest,
Michael Blyumin.
Good evening, Michael.
Good evening. Thanks for having me.
What are you seeing is the,
the most common sort of mistake
that people are making
with, with peptides?
I guess it depends on what. Peptides is a,
is a large term.
I guess what... Absolutely.
I mean, let's, let's home into,
you know, GLP-1s.
You know, compounding versus
market access approved.
And for those who are not familiar,
maybe we'll give a little
bit of an explanation
in terms of what a market access
approved therapeutic is versus a compound.
And I guess we could,
we could explore that even further as to:
why can that happen? Right, right.
We talk about compounding
versus market access, right?
So in... I can speak for the US.
I guess in the US, you know,
a drug comes to market,
it has five years of exclusivity
if it's a small-molecule drug,
and after that potentially
goes off of patents.
That patent can last a lot longer.
There's a lot of strategies
to extend the patent.
Once it goes off of patent,
biosimilars or generics,
depending on the type of drug, come out,
and things get a lot cheaper.
During the patent period,
you cannot compound that medicine unless
it's on shortage. So what's
the whole thing
that happened with GLP-1s is,
GLP-1s had been out for a long time,
but some of the newer versions of GLP-1s
are more potent versions of GLP-1s,
or specifically
weight-loss-indicated GLP-1s,
which are often the same as
the diabetes-indicated ones,
were on shortage
for a long period of time.
Like, for maybe a year or two years,
three years,
you could not get them at the pharmacy.
They were backordered.
They could not make enough of them.
And when that happens,
even if the drug is patented,
there is exemptions made
where you can compound,
or a compounding pharmacy can compound it,
to alleviate the shortage.
When the shortage ends, though,
that is no longer, no longer legal,
which is why a lot of those
processes have winded down.
That's the short of it in terms of how...
That's... Absolutely.
So why do you think we
still see so many compounded
GLP-1s, you know,
being made available? Is, uh,
is there a, is there a,
a cost difference? Uh,
is it an access issue? Insurance?
What is the, what is
the reason why this is,
is still happening, apart from capitalism?
Yeah, I'm glad you
brought up the last point.
That was definitely part of it.
I think it's a confluence
of all of those things.
So historically,
people feel that these medications
are very unaffordable.
The reality is they also are
very expensive in the US.
This is very true. Historically,
they've been hard to get,
though that's eased now,
especially with supply
sort of catching up somewhat to demand.
So all of that access component is true.
That's what led to the formation
of these companies,
right? There was a huge demand.
There's no supply.
There's a legal way to do
it outside of, you know,
paying Eli Lilly or Novo Nordisk
for their compounds.
And so naturally, with capitalism,
you form a company:
"We're gonna compound GLP-1s,
and we'll give it to you."
Because you're compounding,
you probably can do it
at a more affordable rate
than paying, you know,
the, the drug manufacturers.
And so also,
you could potentially,
depends on the company,
offer someone a good price for it.
I would say recently,
that's not really
the same equation anymore.
They've hung on because, you know,
they've been able
to accumulate a customer base.
People feel like they can trust them. Why?
I don't know.
More than, like,
a drug company or a pharmacy.
And so they hang on. In reality,
most of these compounding
pharmacies, companies,
whatever you want to call them,
have actually winded down
offering compounded products.
Most of them are now offering commercially
available products. I think
Hims & Hers is what it's called,
is probably the only one still fighting
for compounding GLP-1s.
And the reason they've wound down
is because the FDA is sending cease
and desist letters. It's,
it's not legal to compound
a patented drug.
The reason drugs are patented
is so that there is an incentive
to spend billions of dollars
to research the drugs,
to bring them to market.
If there's no incentive,
then no one's gonna do it.
And so the theory is innovation will stop.
Now, obviously,
we know that pharma
companies make a lot of money
with this. So,
you know, that's not a reason
to charge people more
than they should,
but that is a reason why
these things are expensive
and why patent exclusivity exists.
Now, in terms of cost,
because the manufacturers
are offering self-pay
cash options directly to consumers,
you can basically get
the same thing with the FDA
approved medication without a middleman,
without using, like, Ro, for example,
or something like that.
Those prices are becoming pretty equal,
especially
because those other companies
can't compound anymore.
And they actually may
charge you more in the end,
'cause you might have
to pay for a membership fee,
et cetera. And people also
have this innate trust in that:
"Oh, this is an alternative.
I think, you know,
it's, it's expanding market access.
This is a good thing." The reality is,
these companies are after the same thing
everybody's after. They're after profit.
They are just as profit-motivated
as any pharma company.
They're not here
for the good of the people.
They're here to exploit an opportunity.
That's what capitalism is. So,
I, I don't place any more sort of
good faith in any of those
companies than I do
like a drug manufacturer. And,
in fact, it becomes a little
bit the opposite way
when you're compounding illegally,
because then there's a whole question on:
Who's overseeing the process?
Is the product clean?
Is it being introduced
with other compounds
to make them novel? But those
style of compounds have
never been truly validated
to be absorbed properly or effective.
It leads to a whole separate discussion.
Absolutely. And,
and you must have, you know,
you must have seen some
sort of horror stories.
What, what are some of the sort of
most egregious things
that you've seen happening in,
in that space?
Yeah, for one,
it's, the, the marketing
is a little bit predatory,
in my opinion, right?
We're marketing people's health,
and promises are made without sort of
fully having that benefit
risk discussion that you
have at the doctor's office,
or you should have at the doctor's office.
Like, with my patients,
when we start new medicines,
whether it's weight loss
or diabetes or something else,
you know, there is a lot
of discussion that happens
about why we should do it.
And if we do it,
what are the risks we're incurring?
And these companies,
they're, they're marketing.
They're not doctors' offices.
Like, they're pharmacy,
compounding pharmacies,
or whatever you want to call them.
They're marketing to get people in there.
So that marketing, in my opinion,
is a bit predatory.
The formulations that they
are promising people
may not necessarily be
approved formulations.
Novel formulations give
me particular pause,
because if you haven't ran sort of
a larger trial
to understand if they're
absorbed the same way,
if the doses are equivalent,
if they aren't absorbed at all,
and you're
making people pay for something
that doesn't work,
that's a potential problem.
The other problem
that exists is essentially,
to get around the compounding law,
you would have to claim
you are making a totally
new compound, right?
Like, some people can't
take an oral medicine,
and so you have to compound, like, a,
like a big tablet,
but there's no other product available.
You have to compound a liquid.
That makes sense.
That person needs the medicine.
They can't swallow the tablet,
or they have a G-tube,
et cetera. They need an alternate form.
What compounding GLP-1
companies are doing is saying,
"Let's make a whole
different formulation,"
but it may not be equivalent.
Peptides are hard to absorb.
And when they do make
a similar formulation,
like an injectable subcutaneously,
they say, "Oh,
we'll put other things in it.
Maybe vitamin B12,
or maybe something else."
Things can affect absorbability.
Compatibility between different products
is not always guaranteed.
And if you're just willy-nilly
making a new compound
so that you can say that it's
a new compound and legal,
but not testing
the true efficacy and safety
of that combination,
that gives me pause.
I can't tell my patients anything about
the safety of that because
it's not been studied, right?
Absolutely. I mean,
and, and not a day goes by,
I mean, well,
not a second goes
by on social media without,
you know, somebody talking
about peptides and GLP-1s.
But let's just home in on the media
and sort of mainstream media.
What do you think they
could possibly cover?
So we need an entire series.
What, what do you think are the sort of,
the main things that mainstream media
get wrong about GLP-1s? And, you know,
we've obviously seen, uh,
you know, the adoption of the term GLP-1s.
I think, you know,
really didn't even pop into,
you know, sort of conversation until, oh,
well, a couple of years ago.
It was very much Ozempic
and an "Ozempic face." And,
you know, what,
what are the, what are the common
sort of media mistakes that you see?
Yeah, I,
I think it's just not
treating this medication
like a medication. I mean,
we really don't talk
about any other medication
this way, right?
We're treating it, like,
on one hand, like a miracle drug,
on the other hand,
like something you can just easily take
to get a few little benefits out of.
And I would just say we need
to treat it with the same
sort of a caution that we treat any
public discussion about
the use of medication
and its effects and safety. You know,
if you're not someone that has
credentials to do that,
you, you might want to be careful about
how you speak about it,
to not give people the false
impression about what
and what not the drug is.
So, like, more concretely,
I think it needs to...
People that really,
truly need the medication,
or fit the profile
of getting benefit from the medication,
are the people that should be taking it.
We should not be posing this as an option
for just anybody.
That, that's one thing to consider.
Second thing,
there's a lot of discussion
from my patients, like, "Oh,
I heard this new side effect.
I heard there's this new
issue with the medicine."
Treating this medicine like it's new.
I mean, a lot of the newer
formulations are new.
Mounjaro is new. Zepbound is new,
relatively speaking.
It's like four years now.
But this class of medications
has been around like 20 years or so,
studied since the '90s,
initially used for diabetes.
It wasn't popular because
they weren't potent.
They didn't have a lot of weight loss.
They had a little bit, but not a lot.
But as we got more potent
and potent versions,
or higher doses were approved,
people noticed the weight loss.
That got into sort of the use
of it for weight loss.
The weight loss versions got more potent,
and that's how we ended up here today.
And so, so you,
you've seen a sort
of a gradual increasing,
I guess, then,
of the sort of the dosing
and the strength in the,
in the time that you've
been working in the space.
What does that sort of look like?
So, you know,
for the people who are
not familiar with where,
where it started and kind
of where it's at now, and,
and is that something
that somebody needs to do?
And, and also, just to sort of,
to sort of wrap that up in a little bow,
what happens when somebody says,
"I don't want to take this anymore.
I don't think I need
to take this anymore"?
What, what should they be looking at,
or what should their medical
provider be looking at?
Yeah, yeah.
So the, the point of that is
that these are not new
miracle drugs.
These are drugs that have
been sort of long available,
long studied.
They're just newer versions of it.
And so people need not
to think this is some new,
unproven thing.
We've known about this for a long time,
and it's been studied
for a decent amount of time.
So when people say, "Oh,
I have some new side effects," or they're
reporting these new things,
I mean, it's always a possibility
we learn something new
as we gain more time
with a certain medicine.
But a lot of these things
are things we knew about,
and it's seeming new because
people may be getting medication
from people that are not explaining
the full benefits and risks.
These medications started,
like, early 2000s.
They were, potency-wise,
which is basically, you can say, like,
how much sugar can they lower?
How much weight loss can they cause?
Those go hand in hand, typically.
They were not as strong as they are today.
For, like, an A1C result,
maybe 1% or so in reduction,
versus, like, high-dose
Mounjaro now is 2.3%.
Weight loss, maybe 5 to 10%.
Now it's, on some of them, like 15 to 20%.
And before, they were daily injectables,
another reason they weren't super popular.
People don't love injecting every day.
And then they became weekly injectables.
Now we even have oral versions.
So that's sort of been the progression.
And the point is that this
development has been take,
taken a long time. Certainly,
they've gotten better.
In terms of getting off of the medicine,
it depends on what you're using it for.
If you're someone who's
using it for blood sugar,
for example,
it's unlikely you will
fully get off the medicine,
because we don't cure diabetes.
We can only manage it.
We can't reverse insulin
resistance in 99% of the cases,
right? So that's a whole
different discussion.
From a weight loss perspective,
when you're on the medicine,
you will lose weight.
A lot of the weight loss
mechanism is related to caloric deficits,
because you have appetite suppression.
Those caloric deficits are
very difficult to maintain
without the medicine because
of things like food noise,
because of the, you know,
sort of the taking off of that mask
of getting full faster.
Your old appetite will return.
So that's what makes it
difficult to keep weight off
after discontinuing the medicine.
So that is something you
should think about as a,
definitely a possibility
when you stop the medicine.
And not only are you losing
fat when you're on a GLP-1,
most studies point to about
25% loss of lean muscle.
That was gonna be my next question.
So, in terms of, you know,
diet changes, lifestyle changes,
what would you be saying to somebody
that they need to do from a
sort of an augmentation perspective?
Yeah, if you're on a GLP-1,
it's very important
to be physically active,
use your muscles,
both cardio-type activities,
but also resistance training.
That obviously helps
not atrophy our muscles
if we're going to use them,
and they're already at risk
of that with the GLP-1.
And then protein intake is important.
That's a bit of a tough one
when you're feeling full
all the time, 'cause
protein makes us full.
But protein has a number of benefits,
in the sense that you'll
need it for muscle retention
or growth, depending
what you're looking for.
And it keeps you full, so that it helps,
if you're lowering the dose
or coming off of it completely, to again
curb the food noise while
being able to maintain
some level of calorie deficit.
Fats and carbs are more calorically dense.
So, you know,
the more we have of those,
the higher calories intake,
the less weight loss you get,
or more weight gain upon
discontinuation you'll get.
So people need to be aware of that,
that you may have lost muscle,
or you may lose muscle on the GLP-1,
and when you discontinue,
and if you have weight regain,
it's not like you just magically
gain back muscle, right?
Most of that... So,
so looking, yeah,
looking at it as a, as a,
as a wonder pill or a wonder
jab in a standalone,
in a standalone way is,
is not particularly helpful for,
for the patient. Yeah.
I mean, there are no,
there's no magic in, in this world.
It's, it's science.
It's, everything has a risk and benefit.
Everything we put in our mouths,
food-wise, has a risk and benefit.
Supplements,
vitamins, medicines,
everything has a risk and benefit.
It is certainly very good,
and much better at what it does
than anything we had before.
You know,
if you think about weight
loss medications from before,
largely based on stimulants,
that has a,
not a great profile from
a cardiovascular standpoint,
which is
a lot of the reason why
you want to lose weight,
to improve your cardiovascular health.
So, in that context,
these have certainly
changed the game
and are very helpful for a lot of people.
They've changed the lives
of my diabetes patients.
They lower cardiovascular risk,
fatty liver, sleep
apnea. But there's contexts for them.
There are certain people
that are better fits for them,
certain people that are not.
If you wanna lose, you know,
just 5% of your body weight,
take the medicine for two months and stop,
yeah, it might help you achieve that.
But you have to ask yourself:
Is the risk worth the benefit
for such a small benefit,
potentially,
or if that's all you're looking for?
And as we sort of look towards the future,
you know, we started off with,
with GLP-1s. GLP-2's
now a thing.
A lot of speculation of the first,
or one of the very first
trillion-dollar drugs.
And GLP-3s. For our audience,
what is the sort of the,
what is the difference between the,
the, the GLP family? And,
you know, when will we get to GLP-49?
Yeah, yeah.
That's a good question.
So they're all GLP-1s.
Just some of them hit multiple pathways.
So some of them are built as a GLP-1.
Some of them are,
are built as a dual-agonist
GLP-1. Some are built, will,
will be triple agonists,
meaning they hit three
different receptor pathways.
So GLP-1 is the main one.
The current one that's dual,
the only one of them exists,
it's Mounjaro or Zepbound.
Generic name is tirzepatide.
And that's a GLP/GIP, so dual agonism.
Same pathway, though, so,
like, same areas of process.
The difference, we,
I don't think we fully
understand. Certainly,
I'm not, I don't have any
literature
showing that we fully
understand what happened
when we hit only one
pathway or both pathways.
I think
we're still learning about
the potential effects,
because these receptors are
located all over our body,
meaning there can be effects
in lots of different ways.
Right now, what it looks
like is the dual mechanism,
like Mounjaro and tirzepatide,
tend to be stronger in their effect.
Like the max approved effect,
max approved dose has
a larger effect on weight loss
and, and blood sugar.
Maybe a little bit improvement
in how well people tolerate,
from a nausea perspective,
though hard evidence,
in terms of statistics
in a clinical trial,
don't prove that. Anecdotally, practicing,
we do see a lot of people
seem to tolerate Mounjaro better.
There is thoughts about that extra pathway
being a little antiemetic,
anti-nausea.
There may be effects on bone health
that come out of this. The retatrutide,
which is in studies right now,
is the triple agonist soon to be.
Again, I,
I can't sit here and speculate on,
on exactly what difference
that will cause.
We will have to see,
'cause there is also a theory, right?
In theory, these pathways do X,
Y, Z,
but is this drug strong
enough in each pathway
to actually produce those results?
That's the point
of the clinical trial. Indeed.
And I think
we're so well conditioned
to Apple's marketing
with iPhone 14 and 15 and 16,
there's this presumption
that every time a number goes on it,
then surely it's just getting better.
So, you know,
we joked about, I think it was GLP-46,
but do you actually have people now
coming forward and saying,
"You know, I've,
I've tried GLP-1s, but, you know,"
is it, is,
"Can you get me some GLP-6?
Will that work better for me?"
We do have people that want
maybe more effect than
what they're able to get.
Certainly,
there's an individuality to that.
Some people are better
responders than others.
That's true of almost any drug.
But yeah, we do have people that
have heard certain things about
certain GLP-1 medications.
Maybe they'll feel like they didn't,
they plateaued very
early on their medicine.
They didn't get that blood
sugar control or weight loss
they wanted.
They want to try something else.
And I guess, from our perspective,
we look to see if, if,
if that's reasonable or not.
It's definitely reasonable
to change between GLP-1s.
Again, what these other GLP-1s promise,
I wouldn't, as a practitioner,
I wouldn't speculate.
I would want to see hard evidence.
If I'm gonna sit here
and recommend something to you,
I need to know
that in amongst 10,000 people,
there's a certain
likelihood that certain
things will happen.
Like, the triple agonist has supposedly,
for current data
that we have,
a lot more effect on blood sugar
control and weight loss
than what we have currently approved,
which is the single and dual
agonists. If that's what you're
looking for, then that's good.
But not everybody is, right?
So it, it's like another
tool in your tool belt.
As more and more come out,
it depends on, like,
what's the benefit you're looking for?
Do I want more weight loss?
Some people actually
want less weight loss.
Some people don't want to inject.
They want an oral option. So,
it's more like a certain
tool in your tool belt
that will fit a certain patient,
not necessarily it's always better,
better, better.
Thank you.
And the final question
before we come to a close:
Next 10 years,
what do you think it's gonna look like?
This could be in your own practice.
This could be the, the sector.
This could be the advancements
in, in science.
You, you could do a bit
of cosmic ordering if you like.
Yeah, it doesn't have to be
wholly grounded in science.
But what would Michael like to see,
you know, come to fruition
in the, in the peptide space?
Yeah, from a GLP-1 perspective,
I, I do think more,
more compounds is always beneficial.
Like I said,
more tools in your tool belt to,
to help patients that have
different preferences
or different circumstances.
I think the biggest barrier to GLP-1s
often is access/cost,
and then tolerability.
So it would be nice to see
better insurance coverage
and market prices
for these GLP-1s, because they are truly,
really beneficial for patients that,
they truly, you know,
that would benefit for, from them.
And if there were ways
to improve the tolerability,
you know, reduce nausea,
constipation, diarrhea,
those are the most common,
reduce that muscle wasting,
that would even enhance further the,
you know,
the amount of people
that would be able to tolerate
these medications and get
the pros out of it
and avoid some of the cons.
In the future, what will happen?
I think for sure people will
target multiple pathways.
They will bring new effects
that will bring new FDA indications,
novel FDA indications.
That's good for business
for these companies.
It's also good for people
that will now have therapies
for things before they
did not have therapies,
or an additional therapy.
And there will be more oral GLP-1s.
Foundayo, or orforglipron, just came out.
It's the first non-peptide
small-molecule GLP-1,
which means easier to take,
easy to manufacture, much cheaper.
So I assume a lot of that will
start coming out too, and,
and this will be like
the statins of our time.
You know, statins,
when they came out in the '70s,
huge blockbuster drugs.
And this,
this sort of feels like
one of those moments again.
Absolutely. And that kind of... I have
a final question. A final,
final question. What's been the,
the most positive
unexpected outcome that you've seen from,
from, from your work with GLP-1s?
Yeah, I,
I would have to point
to the diabetes space.
It's hard to describe, really,
how revolutionary some of these drugs are
for people's blood sugar management,
for a number of reasons.
One, their effects on,
on the pathway,
pathophysiology of diabetes,
but also the appetite suppression,
food noise control that they have.
The amount of people that we've
been able to get off of,
like, insulin, for example,
which, there's nothing wrong with insulin,
but it's difficult.
It's difficult to manage.
It's multiple injections a day.
It has risks like low
sugar that can be serious.
The improvement in people's
quality of lives,
to gain a stable sugar
for the first time in their life,
with a once-weekly medicine
they don't have to think
about all day long,
they don't have to think
about every time they eat,
about injecting,
checking their sugar, et cetera,
it's hard to understand
how much that improves people's lives.
And we see it a lot because
diabetes is so pervasive in,
in society. And so that is, I,
I don't know how unexpected it is,
but it certainly really
highlights the power
of some of these medications
in improving people's health
and just in general, you know,
their quality of life. And,
and to be determined
on other places it does that.
I think there are some thoughts about it
in the space of, like,
alcohol use disorder and cravings
and addiction. Again,
if, if that ever comes to fruition,
that would change a space
that is very difficult to treat
and very detrimental
to people's quality of life.
Michael,
thank you very much
for joining us on Peptide Show
today. Of course. Thank you for having me.