New to Substance Over Noise? Start here.
Evidence-based obesity medicine, minus the noise. Begin
It's Already on Every Panel. Nobody Reads It.
Remnant cholesterol costs nothing to calculate and predicts events when LDL no longer does. Its first real drug just proved it can prevent pancreatitis, and then failed to move plaque.
CV
+4
One in Five Carry It. Nothing You Prescribe Touches It.
Lp(a) is the most common inherited cardiovascular risk factor in medicine — and the first outcomes trial that could give us a drug for it has gone quiet.
CV
+4
Every First Claim Is Denied. That's the Design.
One month into the Medicare GLP-1 Bridge, the denial at the counter isn't a coverage decision — and CMS built no appeals process for the ones that are.
Coverage
+4
Retatrutide Won Twice. The Heart Data Didn't.
TRIUMPH-2 and TRIUMPH-3 both hit — 20.8% in type 2 diabetes, 22.6% with established cardiovascular disease. Then there's the MACE table.
GLP1
+4
The Basics
Appetite, Food Noise, and What We’ve Been Getting Wrong
Why Weight Returns After Stopping GLP-1 Therapy
The Controversies
The Peptide Wild West (Part I)
I’ve Been Taking Low-Dose Tirzepatide for Two Years
Obesity Care: I Was Wrong
The Future
Medicare Will Pay for Wegovy Now. Here’s the Catch.
How Much Muscle Are GLP-1 Patients Actually Losing?
GLP-1 Resistance Is Real. You Probably Don’t Have It.