Brain stimulation might be more invasive than we think
But is it? In Bluhm and colleagues’ survey, responses varied. Some thought treatments that involve multiple trips to the doctor’s office are invasive because they impinge on a person’s time. Others thought treatments that rely on devices are less invasive than traditional talking-based therapies, because they don’t require regaling a stranger with one’s life story. But others said that what made TMS invasive was its impact on the brain.
The effects can spread throughout the brain. In theory, noninvasive forms of brain stimulation are designed to target specific regions, such as those involved with mood. But it’s impossible to pinpoint tiny areas when you’re stimulating the brain through the skull, as Nick Davis at Manchester Metropolitan University points out.
And if TMS can help treat the symptoms of chronic pain, depression, or Parkinson’s disease, then it must be eliciting some sort of change in the brain. This might be in the way signaling molecules are produced, or the way brain circuits connect or fire, or perhaps some other mechanism.
And given that we still don’t really understand how TMS works, it’s difficult to know how, if at all, these changes might affect the brain in the long term.
Is a treatment invasive if it changes the way a person’s brain works? Perhaps it depends on the impact of those changes. We know that “noninvasive” forms of brain stimulation can cause headaches, twitches, and potentially seizures. Electroconvulsive therapy, which delivers a higher dose of electrical stimulation, is designed to trigger a seizure and can cause memory loss.
This can be extremely distressing for some people. After all, our memories make us who we are. And this gets at one of the other concerns about brain-modifying technologies—the potential to change our personalities. Doctors have noticed that some people who have DBS for Parkinson’s disease do experience temporary changes in their behavior. They might become more impulsive or more irritable, for example.
It’s unlikely that the effects of noninvasive stimulation will be anywhere near as dramatic as that. But where do we draw the line—what counts as “invasive”?
It is an important question. Treatments that are considered invasive are generally reserved for people who have no other options. They are seen as riskier. And treatments that are considered too invasive might not ever be used, or even researched, according to Nir Lipsman, a neurosurgeon based at the University of Toronto, and his colleagues.
The Download: weight loss drugs, and a new abortion fight frontier
Over the course of the last year, so-called “miracle” weight-loss drugs have blown up across the internet. Although celebrity users have boosted their standing, they owe much of their fame to social media and discussion boards, where they are promoted by influencers and everyday people alike.
Yet not everyone who wants them goes to a doctor. Throughout 2022, rising demand for weight-loss injections caused global shortages. As a result, some people began seeking these drugs illegally, crossing borders or buying them under the counter without a prescription.
Do the hype and the hashtags tell the full story? What are the physical, social, and psychological side effects of a miracle? And can all the publicity lead people to do things they definitely shouldn’t? Read the full story.
Texas is trying out new tactics to restrict access to abortion pills online
There’s been a quiet shift in the abortion fight in the US. Since the reversal of Roe v. Wade last June, laws that make most abortions illegal have passed in 13 states. Efforts to restrict abortion care have, so far, focused mostly on criminalizing medical providers. But increasingly, the battleground is moving online.
Texas is currently in the process of trying to limit access to abortion pills by cracking down on internet service providers and credit card processing companies. Earlier this month, Republicans in the state legislature introduced two bills to that effect.
Texas is trying out new tactics to restrict access to abortion pills online
Texas is trying to limit access to abortion pills by cracking down on internet service providers and credit card processing companies. These tactics reflect the reality that, post-Roe, the internet is a critical channel for people seeking information about abortion or trying to buy pills to terminate a pregnancy—especially in states where they can no longer access these things in physical pharmacies or medical centers.
Texas has long been a laboratory for anti-abortion political tactics, and on March 15, a US District Judge heard arguments in a case that’s seeking to reverse the FDA approval of mifepristone, a drug that can be used to terminate an early pregnancy. The case would limit online-facilitated abortions and would have far-reaching consequences even in states that are not trying to restrict abortion.
Earlier this month, Republicans in the Texas state legislature introduced two bills to restrict access to abortion pills. The first bill, HB 2690, would require internet service providers (ISPs) to ban sites that provide access to the pills or information about obtaining them. Companies like AT&T and Spectrum would have to “make every reasonable and technologically feasible effort to block Internet access to information or material intended to assist or facilitate efforts to obtain an elective abortion or an abortion-inducing drug.” The bill would also forbid both publishers and ordinary people from providing information about access to abortion-inducing drugs.
The second bill, SB 1440, would make it a felony for credit card companies to process transactions for abortion pills, and would also make them liable to lawsuits from the public.
Blair Wallace, a policy and advocacy strategist at the ACLU of Texas, a nonprofit that advocates for civil liberties and reproductive choice, said the recent developments mark “a new frontier for the ways in which they’re coming for [abortion access],” adding: “It is really terrifying.”
Wallace sees it as a continuation of a strategy that seeks to criminalize whole abortion care networks with the aim of isolating people seeking abortions. More broadly, this strategy of censoring information and language has become a popular tactic in US culture wars in the last several years, and the proposed bill could incentivize platforms to aggressively remove information about abortion access out of concern for legal risk. Some sites, like Meta’s Instagram and Facebook, have reportedly removed information about abortion pills in the past.
So what might the outcome of all the Texas action be? Both the bill that targets ISPs and the misteprone case this week are unprecedented, which means neither is likely to be successful. That said, the tactics are likely to stay. “Will we see it again next session? Will we see parts of this bill stripped down and put into amendments? There’s like a million ways that this can play out,” says Wallace. Anti-abortion political strategy is coordinated nationally even though the fights are playing out at a state level, and it’s likely that other states will target online spaces going forward.
Online abortion resources can pose risks to privacy. But there are lots of ways to access them more safely. Here are some resources I recommend.
Weight-loss injections have taken over the internet. But what does this mean for people IRL?
Good side effects, bad side effects
In the beginning, weight loss was just a side effect. GLP-1 RAs were first developed to treat type 2 diabetes; their hormone-mimicking action provokes insulin production. In 2005, the US Food and Drug Administration approved the first drug of this kind, Exenatide, for diabetics. Throughout the 2000s, more and more GLP-1 RAs came onto the market. Right away, patients noticed that these drugs didn’t just treat their diabetes—they also helped them lose weight.
Ozempic and Wegovy, the brand names of a GLP-1 RA known as semaglutide, are both made by Novo Nordisk, a Danish pharmaceutical company. Though they both contain the same active ingredient, the drugs have different indications, dosages, prescribing information, titration schedules, and delivery devices. In 2017, Ozempic was first approved as a diabetes treatment, and doctors soon began to prescribe it off-label to overweight patients. Subsequently, Novo Nordisk developed Wegovy specifically for weight loss. In June 2021, it became the first new treatment for chronic obesity approved by the FDA since 2014.
Then, in May 2022, the FDA approved Mounjaro as a diabetes treatment; now the agency is officially “fast-tracking” the investigation of its active ingredient, tirzepatide, for obesity. A spokesperson for the drug’s manufacturer, Eli Lilly, said it is presently only approved for glycemic control in adults with type 2 diabetes and the company “does not promote or encourage use of Mounjaro outside of its FDA-approved indication.” Nonetheless, since the drug came to market, doctors have been prescribing it off-label for weight loss—there are almost 100,000 members in a Facebook group called “Mounjaro Weight Loss Success.”
Clinical trials have shown that tirzepatide patients lose at least 20% of their weight in 72 weeks, while overweight adults on Wegovy lose an average of 15% of their body weight in 68 weeks.
Edenfield is one such success story. Unable to work at the height of the pandemic, he had stayed at home “eating a lot and eating very unhealthy.” He compares his diet to a teenager’s: regular consumption of fast food sandwiches, cheese steaks, and burgers accompanied a “crippling addiction” to Coca-Cola. When his weight crept up to 357 pounds (he is 6 feet 3 inches tall), he sought gastric sleeve surgery because his employer would cover the cost. Yet the doctor he met with suggested Ozempic instead. He lost 15 pounds in his first month on the drug and switched to Wegovy in February 2022. He now weighs 228.
“It’s changed every aspect of my life,” Edenfield says—he no longer feels “hijacked” by hunger and doesn’t get out of breath walking to work. “I feel like I’m in my 20s again,” he says.
The results may be enviable, but the day-to-day reality of weight-loss injections is not always pleasant. The most common side effects are gastrointestinal, including nausea, diarrhea, and constipation. Edenfield consulted Reddit for tips on alleviating “brutal” nausea. A number of subreddits dedicated to semaglutide have sprung up or grown in popularity over the last year—the one Edenfield posted on was created in 2021 and has almost 22,000 members today. Meanwhile, countless Facebook groups have also been created during the weight-loss injection boom. Here, people report experiencing vomiting, headaches, fatigue, “sulfur burps,” and hair loss—though the vast majority seem to feel it’s a small price to pay for losing weight.
During the 68-week Wegovy trial, 4.5% of participants discontinued treatment because of gastrointestinal events. Peter Kurtzhals, Novo Nordisk’s chief scientific advisor, says that such side effects normally decline gradually as patients build up a tolerance to the drug. A company spokesperson adds that patients experiencing nausea on Wegovy “should contact their health-care provider, who can offer guidance on ways to manage it.”