Dr. Peter Attia’s team shared a thoughtful retrospective on a proposed explanation they shared previously.

Two years ago, they shared results from a trial that showed GLP-1 drugs (Ozempic, Wegovy) weren’t just remarkable in combating efficacy and type II diabetes – but that they were also effective in reducing major adverse cardiovascular events (heart attacks, stokes).

Taking a simplistic Occam’s razor inspired approach, they’d suggested that the reduction in cardiovascular risk was likely due to the weight loss involved.

However, additional data released recently showed that the drugs had a separate positive impact on cardiovascular risk because there was no correlation between a patient’s weight loss and their cardiovascular risk.

Their post ended with a reflection –

Occam’s razor is a useful heuristic for problem-solving across many disciplines, but biology and medicine are rife with instances where this principle has failed. (Indeed, there’s a principle that specifically opposes Occam’s razor in the context of medicine—Hickam’s dictum, which is typically presented as the observation that “a patient can have as many diseases as they damn well please.”).

• So although defaulting to the simplest explanation may make sense when all else is equal, biology is often far more complex than we predict, and therefore, we need to be ready to abandon or revise the simpler theory when presented with new information. Such is the case, it would seem, with GLP-1 drugs and cardiovascular benefits.*

There were 3 things I loved about this –

1. The reflection resonated. Topics involving biology are complex and often require a lot of nuance. Occam’s Razor isn’t always the best tool as a result.
2. I appreciated the retrospective post. We need more of these.
3. Hickam’s dictum – a patient can have as many diseases as they damn well please. – is hilarious.

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