The pharmacy knows you better than your doctor does

WEDNESDAY, 4 NOVEMBER

The pharmacy is already the front door to metabolic health.

Why the clinic model breaks down at scale, and what we're doing about it.

Hi —

Pharmacies are more common than GPs in many countries. People walk into them without an appointment, without anxiety, often weekly. They already trust the person behind the counter with their medications, their questions, their awkward ones.

We run clinics in Cape Town and Bucharest. Both are good. But the honest problem with the clinic model is that it filters for the already-motivated. Someone has to decide they have a problem, research solutions, book an appointment, show up. By that point, a lot of time has passed. The people who would benefit most from GLP-1s or the newer metabolic molecules, the ones who are metabolically at risk but not yet sick, are not walking through our clinic doors first. They are walking into a pharmacy. So that is where we need to be.

What this means practically is that pharmacies need to become more than dispensing points. They need lab ordering, basic metabolic screening, a way to flag who needs dose adjustment versus who is doing fine. Expand Health AI is built partly for this: take the labs, the clinical notes, the patient history, and produce one clear record with a personalised plan. A pharmacist, a GP, and a clinic can all see the same thing. No one is starting from scratch at every handoff.

The molecule is just one part of the solution. Getting the right dose to the right person consistently, without needing a specialist clinic every time, is challenging. Pharmacies can improve access if they have the infrastructure to do it safely.

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ONE THING TO TRY THIS WEEK

If you are on any metabolic intervention, whether a GLP-1 or something simpler, ask your pharmacist one direct question: "Is there anything in my records that would affect how this works for me?" You may be surprised by the answer. And if they do not have access to your records, that is useful information too.

If you think pharmacies could replace the first consultation for metabolic health, or if you think that's a bad idea, I'd like to hear why.

As always, reply directly if you want to talk through anything.

— Emilian