We kind of do know the long term side effects. Exenatide has been in use since around since 2005. They can include pancreatitis and thyroid cancer in a small percentage of the population. Modern GLP-1 agonists exhibit essentially the same threat profile.
EDIT - Just wanted to note that the cancer thing has only been seen in rats. Not humans. After 20 years we'd probably have seen it by now.
Thyroid cancer sounds more scary than it actually is. It's one of the weakest forms of cancer, and it's extremely easy to treat if caught early enough. Also, living without a thyroid is no big deal.
Somebody very near and dear to me was diagnosed with thyroid cancer ten years ago, and now has no thyroid. She's hardly inconvenienced by it & hasn't even gained any weight since then. Just gotta remember to take those T4 tablets in the morning, is all.
Point is: If you weigh in the balance [lives saved or QALY gained due to GLP agonist administration] vs. [lives lost or QALY lost due to thyroid cancer secondary to GLP agonist administration], it's not even going to be remotely close. "Lives saved" will probably win by an enormous margin, maybe a factor of twenty or so.
People hear the word "cancer" and think "death sentence." (Or, at the very least, an extremely difficult ordeal.) It's a scary word. Yet thyroid cancer is generally a mild disease -- especially mild as cancer goes -- and almost invariably nonfatal if caught early enough.
If GLP-1 inhibitors get people screened for thyroid cancers more frequently, or lead to improved treatments for thyroid cancer, they will almost certainly lead to a reduction in thyroid cancer deaths -- even if, as some surmise, they are responsible for an increase in thyroid cancer cases. Even without this effect, if you balance [QALY lost] versus [QALY gained] GLP-1 agonists should come out so far ahead that it's almost laughable.
In any case, I believe it is wise to talk about these things openly and without fear.
> Also, not all thyroid cancers are created equally (like papillary vs medullary)
Granted, but how is this relevant? I've heard that those drugs may -- this is still, as yet, uncertain -- increase the likelihood of follicular thyroid cancer, which is a very weak type. I have not heard that they increase one's likelihood of coming down with the anaplastic variant. (The only truly deadly one, but quite rare.) If caught early enough, papillary, follicular, and medullary are all easily treatable and indeed curable.
> not every one taking GLP-1 RAs are morbidly obese
Thanks for this. I hadn't seen that it had been verified in humans.
I suppose it helps to emphasize that there are trade offs with all drugs, and that you'll need to work with your doctor to adapt a program suited to your own risk tolerance.
Shouldn’t we have a non-negligible prior on possible cancer risks at all timescales? That doesn’t mean we don’t approve drugs without 80-year clinical trials, but I think it’s a non-negligible risk that has to be accepted.
For instance, my impression is that lung cancer rates only really become strongly pronounced — in the sense of being statistically detectable in the small population sizes you find in clinical studies, rather than the entire US population — after like 15 years of smoking. (Correct me if I’m wrong.)
EDIT - Just wanted to note that the cancer thing has only been seen in rats. Not humans. After 20 years we'd probably have seen it by now.