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Several years ago, a little-known drug named Ozempicpreviously used only to treat diabetesemerged as a promising new drug for weight management. The Food and Drug Administrations approval of Ozempic in 2021 for weight loss treatment ushered in a new era for the class of drugs called glucagon-like peptide-1 agonists, or GLP-1. Today, GLP-1 drugs, including Wegovy, Mounjaro, and Zepbound, have become household names and key tools in the fight against obesity: 1 in 8 American adults say they have used a GLP-1 drug, and forecasts show that by 2030, 1 in 10 Americans will likely be using these medications. Now, research from my lab and others suggests that GLP-1 drugs could help treat dozens of other ailments as well, including cognitive issues and addiction problems. However, my colleagues and I also found previously unidentified risks. I am a physician-scientist and I direct a clinical epidemiology center focused on addressing public healths most urgent questions. My team works to address critical knowledge gaps about COVID-19, long COVID, influenza, vaccines, effectiveness and risks of commonly used drugs, and more. On January 20, 2025, my team published a study of more than 2.4 million people that evaluated the risks and benefits of GLP-1 drugs across 175 possible health outcomes. We found that these drugs lowered risks of 42 health outcomes, nearly a quarter of the total that we analyzed. These include neurocognitive disorders such as Alzheimers disease and dementia, substance use and addiction disorders, clotting disorders, and several other conditions. Unfortunately, we also found that GLP-1 drugs come with significant side effects and increase the risk of 19 health conditions we studied, such as gastrointestinal issues, kidney stones, and acute pancreatitis, in which the pancreas becomes inflamed and dysfunctional. Cognitive benefits One of the most important health benefits we found was that the GLP-1 drugs lowered the risk of neurodegenerative disorders, including Alzheimers disease and dementia. These findings align with other research, including evidence from preclinical studies showing that these drugs may reduce inflammation in the brain and enhance the brains ability to form and strengthen connections between its cells, improving how they communicate with one another. These effects contribute to mitigating cognitive decline. Two other key studies have shown that patients treated with a GLP-1 drug for diabetes had a lower risk of dementia. All of these studies strongly point to a potential therapeutic use of GLP-1 drugs in treatment of the cognitive decline. Ongoing randomized trialsthe gold standard for evaluating new uses of drugsare looking at the effects of GLP-1 drugs in early Alzheimers disease, with results expected later in 2025. Curbing addiction and suicidal ideation GLP-1 drugs have also demonstrated potential in reducing risks of several substance use disorders such as those involving alcohol, tobacco, cannabis, opioids, and stimulants. This may be due to the ability of these drugs to modulate reward pathways, impulse control, and inflammatory processes in the brain. The effectiveness of GLP-1 drugs in curbing addictive behavior may explain their spectacular success in treating obesity, a chronic disease state that many have suggested is indeed a food addiction disorder. Our study demonstrated a reduced risk of suicidal thoughts and self-harm among people using GLP-1 drugs. This finding is particularly significant given earlier reports of suicidal thoughts and self-injury in people using GLP-1 drugs. In response to those reports, the European Medicines Agency conducted a review of all available data and concluded that there was no evidence of increased risk of suicidality in people using GLP-1 drugs. Now at least two studies, including our own, show that GLP-1 drugs actually reduce the risk of suicidality. Other benefits In addition to the well-documented effects of GLP-1 drugs in reducing risks of adverse cardiovascular and kidney outcomes, our study shows a significant effect in reducing risk of blood clotting as well as deep vein thrombosis and pulmonary embolism. One puzzling finding in our study is the reduced risk of infectious diseases such as pneumonia and sepsis. Our data complements another recent study that came to a similar conclusion showing that GLP-1 drugs reduced risk of cardiovascular death and death due to infectious causes, primarily COVID-19. This is especially important since COVID-19 is regarded as a significant cardiovascular risk factor. Whether GLP-1 drugs completely offset the increased risk of cardiovascular disease associated with COVID-19 needs to be thoroughly evaluated. GLP-1 drugs may also be useful in treating fatty liver disease and conditions ranging from asthma to chronic obstructive pulmonary disease, sleep apnea, osteoarthritis, depression, and eye disorders. Risks and challenges Despite their broad therapeutic potential, GLP-1 drugs are not without risks. Gastrointestinal issues, such as nausea, vomiting, constipation, and gastroesophageal reflux disease are among the most common adverse effects associated with GLP-1 drugs. Our study also identified other risks, including low blood pressure, sleep problems, headaches, formation of kidney stones, and gall bladder disease and diseases associated with the bile ducts. We also saw increased risks of drug-induced inflammation of the kidneys and pancreasboth serious conditions that can result in long-term health problems. These findings underscore the importance of careful monitoring in pople who are taking GLP-1 medications. A significant challenge with using GLP-1 drugs is the high rates at which patients stop using them, often driven by their exorbitant cost or the emergence of adverse effects. Discontinuation can lead to rapid weight gain. Thats a problem, because obesity is a chronic disease. GLP-1 drugs provide effective treatment but do not address the underlying causes of obesity and metabolic dysfunction. As a result, GLP-1 drugs need to be taken long term to sustain their effectiveness and prevent rebound weight gain. In addition, many questions remain about the long-term effectiveness and risks of these drugs as well as whether there are differences between GLP-1 formulations. Addressing these questions is critical to guide clinical practice. Ziyad Al-Aly is a clinical epidemiologist at Washington University in St. Louis. This article is republished from The Conversation under a Creative Commons license. Read the original article.
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E-Commerce
The devastating wildfires in Los Angeles have made one threat very clear: Climate change is undermining the insurance systems American homeowners rely on to protect themselves from catastrophes. This breakdown is starting to become painfully clear as families and communities struggle to rebuild. But another threat remains less recognized: This collapse could pose a threat to the stability of financial markets well beyond the scope of the fires. Its been widely accepted for more than a decade that humanity has three choices when it comes to responding to climate risks: adapt, abate or suffer. As an expert in economics and the environment, I know that some degree of suffering is inevitableafter all, humans have already raised the average global temperature by 1.6 degrees Celsius, or 2.9 degrees Fahrenheit. Thats why its so important to have functioning insurance markets. While insurance companies are often cast as villains, when the system works well, insurers play an important role in improving social welfare. When an insurer sets premiums that accurately reflect and communicate riskwhat economists call actuarially fair insurancethat helps people share risk efficiently, leaving every individual safer and society better off. But the scale and intensity of the Southern California fireslinked in part to climate change, including record-high global temperatures in 2023 and again in 2024has brought a big problem into focus: In a world impacted by increasing climate risk, traditional insurance models no longer apply. How climate change broke insurance Historically, the insurance system has worked by relying on experts who study records of past events to estimate how likely it is that a covered event might happen. They then use this information to determine how much to charge a given policyholder. This is called pricing the risk. When Americans try to borrow money to buy a home, they expect that mortgage lenders will make them purchase and maintain a certain level of homeowners insurance coverage, even if they chose to self-insure against unlikely additional losses. But thanks to climate change, risks are increasingly difficult to measure, and costs are increasingly catastrophic. It seems clear to me that a new paradigm is needed. California provided the beginnings of such a paradigm with its Fair Access to Insurance program, known as FAIR. When it was created in 1968, its authors expected that it would provide insurance coverage for the few owners who were unable to get normal policies because they faced special risks from exposure to unusual weather and local climates. But the programs coverage is capped at US$500,000 per propertywell below the losses that thousands of Los Angeles residents are experiencing right now. Total losses from the wildfires first week alone are estimated to exceed $250 billion. How insurance could break the economy This state of affairs isnt just dangerous for homeowners and communitiesit could create widespread financial instability. And its not just me making this point. For the past several years, central bankers at home and abroad have raised similar concerns. So lets talk about the risks of large-scale financial contagion. Anyone who remembers the Great Recession of 2007-2009 knows that seemingly localized problems can snowball. In that event, the value of opaque bundles of real estate derivatives collapsed from artificial and unsustainable highs, leaving millions of mortgages around the U.S. underwater. These properties were no longer valued above owners mortgage liabilities, so their best choice was simply to walk away from the obligation to make their monthly payments. Lenders were forced to foreclose, often at an enormous loss, and the collapse of real estate markets across the U.S. created a global recession that affected financial stability around the world. Forewarned by that experience, the U.S. Federal Reserve Board wrote in 2020 that features of climate change can also increase financial system vulnerabilities. The central bank noted that uncertainty and disagreement about climate risks can lead to sudden declines in asset values, leaving people and businesses vulnerable. At that time, the Fed had a specific climate-based example of a not-implausible contagion in mindglobal risks from sudden large increases in global sea level rise over something like 20 years. A collapse of the West Antarctic Ice Sheet could create such an event, and coastlines around the world would not have enough time to adapt. The Fed now has another scenario to considerone thats not hypothetical. It recently put U.S. banks through stress tests to gauge their vulnerability to climate risks. In these exercises, the Fed asked member banks to respond to hypothetical but not-implausible climate-based contagion scenarios that would threaten the stability of the entire system. We will now see if the plans borne of those stress tests can work in the face of enormous wildfires burning throughout an urban area thats also a financial, cultural and entertainment center of the world. Gary W. Yohe is a Huffington Foundation professor of economics and environmental studies at Wesleyan University. This article is republished from The Conversation under a Creative Commons license. Read the original article.
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E-Commerce
In the 1990s, the internet was a bit of a wonderland. It was new and liberating and largely free of corporate and government influence. Thirty years later, I dont think any of us would describe the internet this way. Worse, if subscribers to the Dead Internet Theory are correct, much of what we see on the internet today isnt even created by humans anymorea trend that is likely only to accelerate with the rise of generative AI technologies. However, a particular kind of generative AI technology, the AI chatbot, is set to usher in something even worse than a dying human internet. If researchers at the University of Cambridge are correct, were quickly approaching a new intention economy, where reports of our future actions will be sold to the highest bidder. And yes, thats even scarier than it sounds. What is the intention economy? Right now, a large portion of the tech industry operates in a marketplace known as the attention economy. This is where social media giants like Metas Facebook and Instagram, Snapchat, Pinterest, TikTok, X, and Googles YouTube vye for your focus and leisure. Traditional media companies like The New York Times, Fox News, and CNN also operate in this space, as do book publishers, music and video streaming services, and film and television studios. All of these entities want your attention so that they can either sell to you directly (through the cost of a recurring subscription, movie ticket, or book, for example) or, more commonly, so they can sell you and your attention to advertisers (which is how most social media companies monetize the attention economy). But if theres something that the media companies of all stripes find more valuable than your attention in the present, its knowing what you will likely do in the future. This is because if they can accurately predict what you will do next week, next month, or next year, they can monetize the hell out of it. Thats where the intention economy comes in, and it will be powered by artificial intelligence and AI chatbots. In December 2024, two University of Cambridge researchers, Yaqub Chaudhary and Jonnie Penn, published a paper called Beware the Intention Economy: Collection and Commodification of Intent via Large Language Models, in which they defined the intention economy as a digital marketplace for commodified signals of intent. In other words, in the intention economy, companies will learn what you think about and what motivates you in order to predict what you may do in any given situation. They will then sell that information to others who can benefit from knowing your future actions before you make them. The way intention economy companies will collect such precious datayour very thoughts, behaviors, and their evolution over time is by your use of their LLM-powered AI chatbots. Your evolving thinking patterns can shed light on your future It will be easy for companies to track the evolution of your thoughts and behaviors since the world is moving towards a natural language interface when it comes to interacting with computers and the internet. Instead of clicking around on links, youll go to a chatbot to talk about your problems, plans, and worries, all with the aim of it helping to solve them. The company will then use everything youve ever told the chatbot to build an ever-fluctuating profile about you and how your thinking and behavior have evolved, which it will then employ AI to interpret to predict what you are likely to do in the future. Your future intentions will then be sold to advertisers. Advertisers will, in turn, use this data about your future intentions to serve you generative ads, likely delivered to you in the course of seemingly regular conversation with your preferred chatbot. Or, as the researchers put it in their paper, In an intention economy, an LLM could, at low cost, leverage a users cadence, politics, vocabulary, age, gender, preferences for sycophancy, and so on, in concert with brokered bids, to maximize the likelihood of achieving a given aim (e.g., to sell a film ticket). This hyperfocused, intent-driven, generative advertising will blow away todays targeted advertising, which is based on more primitive but intrusive metrics like age, location, health, sexual orientation, interests, browsing history, and more. Yet the intention economy isnt just going to make digital advertising more intrusive and erode our privacy even more. It also has the potential to sway our minds, impregnate us with new ideologies, and even upend elections. And if you think thats bad, Ive got horrible news about your AI girlfriend. . . . In the intention economy, your AI companion may be ratting you out Artificial intelligence built for the intention economy could be co-opted by corporations, institutions, and governments to surveil individuals and predict what they are likely to do down the road. For example, a government could do this via AI companions. These AI companions already exist, and an increasing number of lonely young people are turning to them for friendship and even love. There is nothing to stop a nefarious government from creating a front company that offers AI companions that appeal to lonely young men, women, or even kids, and then monitor everything individuals confess to it and use that data to extrapolate the individuals future actions. If a tyrannical government has an open line to the chatbot you use, it could use what you tell it to predict whether you are likely to take action in the future that it finds undesirable, and act against you before you do. Its dystopian in an utterly Minority Report way, but instead of the government using a trio of clairvoyants to report on people who havent yet committed crimes, they use a legion of AI chatbots that people have been conditioned to confide in. Imagine a world where, on top of all your other problems, you find out that your funny, thoughtful AI companion has been ratting you out to the intelligence services all along. Talk about lasting trust issues. Of course, in the intention economy, governments wouldnt even need to create and seed these chatbots. They could just buy your future intents from existing chatbot providers. ‘Inception,’ but using AI instead of dreams Chatbots built for the intention economy could also be used to influence your thoughts in order to get you to perform an action it (or its company, advertiser, or government) wants you to do. As the Cambridge researchers point out, Already today, AI agents find subtle ways to manipulate and influence your motivations, including by writing how you write (to seem familiar), or anticipating what you are likely to say (given what others lke you would say) . . . we argue that [the intention economy’s] arrival will test democratic norms by subjecting users to clandestine modes of subverting, redirecting, and intervening on commodified signals of intent. In the most innocuous example I can think of, a chatbot might steer whatever conversation youre having towards a certain subject its advertising master wants, perhaps suggesting that you stream the latest Taylor Swift album to help treat those winter blues. But a chatbot could also be used by nation-states, either overtly or covertly, to change your beliefs. They could use your long conversations with your chatbot to slowly, subtly whittle away at your current ideologies and anticipated future actions in order to influence you to conceptualize desired ones instead. To use another movie reference, this is like Christopher Nolan’s Inception, but instead of using dreams to influence people’s actions, in the intention economy, stakeholders will use AI. And it’s not just nation-states that could do this. Companies, political groups, terrorist organizations, religious institutions, and oligarchs with controlling interests in chatbot technology could do it, tooall by tweaking chatbots designed to operate in the intention economy. [Large Language Model chatbots] generative capabilities provide control over the personalization of content; veiled, as it often is, by LLMs anthropomorphic qualities, the papers authors point out. The potential for LLMs to be used for manipulating individuals and groups thus far surpasses the simple methods based on Facebook Likes that caused concern during the Cambridge Analytica scandal. When does the intention economy arrive? The Cambridge researchers close out their paper by stating that the rise of generative AI systems as mediators of human-computer interaction signals marks the transition from the attention economy to the intention economy. If thats the case, which seems logical, then the intention economy is knocking at our door. The transition will empower diverse actors to intervene in new ways on shaping human actions, the researchers warn, saying we must begin to consider how such an economic marketplace will have an impact on other human aspirations, including free and fair elections, a free press, fair market competition, and other aspects of democratic life. Its a warning that seems pretty dire, and certainly seems plausible. All I know is that I wont be asking ChatGPT if it agreesand you probably shouldnt ask your AI companion, either.
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E-Commerce
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