The recent excitement about the expiry of the patent on the GLP 1 drugs and that this would herald a seismic drop in the otherwise exorbitant cost of these medications has dominated discussion in the news media over the last few weeks.The GLP 1 drugs – ‘Glucagon Like Peptides’ – are medicines that mimic what is called the GLP 1 hormone to lower blood sugar, delay stomach emptying and reduce appetite. These have been marketed primarily in the United States under their brand names familiar to us as Ozempic, Mounjaro, Wegovy etc.The prevailing opinion is that this is undoubtedly a good thing and that this will mean that many more people will have access to these medications. And this does not just mean that those with difficulty to control diabetes will benefit. I suspect that part of the recent excitement is that this would mean that all those who are struggling with difficult exercise regimens or vainly trying to adhere to diets, may not necessarily need to struggle that much.What has quietly happened is that the boundary between using a medication for medical indication, to using a medication for aspirational lifestyle modification has become just that little bit more blurred.It may be argued correctly that the use of the products of scientific advancement for human benefit is completely valid. However, there may be some things that we may want to think about here.Game-changing, but at what cost?The first is that the history of medicine has been replete with promises of game-changing discovery, and while advancement has certainly happened, the rosy futures promised have often hidden thorny boughs. The last such breakthrough being the statin moment of not so long ago.Statins, prescription drugs used to lower cholesterol levels, were introduced to practice in the late 1980s, with much fanfare and large expectation. The pharmaceutical buzz at that time was that these were good enough, metaphorically speaking, to be mixed with the water supply. The heady expectations, sadly ran into inconvenient obstacles in the form of some rather inconvenient side effects in some people. Their use continues, but in a more tempered fashion.The second is that change comes with accoutrements. Has anyone noticed the difference in the nature of pharmaceutical advertising?The full first page spreads in major newspapers heralding availability of the medication are surrogate advertising in ways that we in India have not been used to. In the West, advertisement of everything from antibiotics to antidepressants is commonplace.In India, the pharmaceutical company has, so far, restricted its selling to the prescriber rather than to the consumer. This has changed rather fundamentally, and the pharmaceutical company has in a sense co-opted the medical professional as an ally, in a manner that may perhaps have rather long term consequences. There are also no prizes for guessing who eventually bears the cost of this.The message is also clear: the medication is available, go speak to your doctor, weight gain is a disease, ask her to treat it. The nuancing of the discussion, the distinction between morbid obesity and weight gain, the difference between prescription for medical reasons and aspirational ones has in a sense, become flattened.The third is that medicine, which should be engaging in these discussions, is conspicuous by its absence. The rather vociferous and enthusiastic approval of the medications by many doctors, the promise that they will change the world and the world view of the individual, that they will in a sense, alter the individual’s relationship with everything from exercise and diet, to their equations with significant others, are in themselves, a cause of concern.Too good to be trueMedicine, like society, has a long history of believing in magical cures – the ‘pill’ that will alter the suffering of the human condition. It may be a good idea to remember that even magic is often too good to be true.This is also not to say that the saner voices in medicine that plead for moderation, for regulation, for reflection are absent. They are very much present, but it may be good to remember that effective regulation in medical prescription is almost non-existent. The individual doctor may demur at prescribing it to the person who would be better served by lifestyle measures, but ‘market forces’ and societal pressure will ensure that anyone wanting to try it, will.It also means that the new rules of the game will be determined not by medical diagnosis, but by societal or market forces. The cynic will argue that none of this is new, but the blatant ways in which this is changing, certainly is.None of this clearly is to suggest that the GLP 1 agonists are akin to snake oil – worthless. The fact remains that they are highly effective medications, and are clearly a marker of scientific advancement. The truth is that, however, that their effects are limited to their duration of use, and many of their adverse effects are only beginning to be understood.As prices drop, and society experiments with both the available options, and the different ways that the medications can be taken (including micro dosing regimens), these conversations will necessarily become more important.The larger discussion of the use of these potent medications for aspirational purposes is something that both medicine and society may want to unpack a bit more, even as the concept of the ‘Mounjaro bride’, who takes the medicine for weight loss before the big day, or the sunken ‘Ozempic face’, become commonplace.Alok Sarin is a consultant psychiatrist based in Delhi.