Recently, while contemplating the AAPA-AMA scope creep debate, I encountered a quote about GLP1-RAs for obesity: “We need to just really think about it as a chronic disease … to make sure that we try to keep that patient in [ongoing] treatment.” Another obesity medicine specialist reinforced this view: “These drugs are indicated by the FDA so that you could be on it for the rest of your life.”
This perspective becomes more troubling when considering recent AHRQ and CDC data showing men spend 40 percent of their lives on prescription medications, while women spend 60 percent. Even more concerning is how we frame disparities in medication access. When researchers noted lower statin use among non-Hispanic Black men compared to other groups, the conclusion wasn’t to question our medication-dependent approach but to advocate for equalizing long-term medication use across populations. The GLP boom is seeing the same trend as public health advocacy is focused on ensuring everyone can access the newest, groundbreaking medication regardless of health outcomes.
While we debate APP versus physician care, we’re missing the forest for the trees. Both sides weaponize the same research (see research here, here, here, here, here, here, and here): The AAPA claims equivalent outcomes justify autonomous practice, while the AMA argues these results validate physician-led teams. But this debate obscures a more fundamental problem: our medical system’s overreliance on prescription-based care management and isolated metrics.
Research continues to highlight that statins show impressive 30 to 50 percent LDL reductions but barely achieve 1 percent absolute risk reduction. The celebrated SPRINT, ACCOMPLISH, and ACCORD trials in hypertension management demonstrate minimal absolute risk reductions despite significant blood pressure decreases. GLP-1RAs, despite their impacts on A1C, blood pressure, and weight, yield sub-1 percent absolute cardiovascular risk reductions.
When confronted with numbers needed to treat exceeding 200 for preventing one myocardial infarction, we often hear two defenses: “That one patient is grateful” and “it’s better than nothing.” But these medications aren’t band-aids – they’re blindfolds. They create an illusion of treatment that’s celebrated by patients, practitioners, and clinics alike while masking underlying pathophysiology: gut dysbiosis, glycocalyx and endothelial dysfunction, hyperinsulinemia, inhibited autophagy, REM sleep inhibition, and plenty more.
As clinical practice guidelines become increasingly prescriptive, they diminish the value of both physician and PA education depth. Our assembly-line health care model restricts meaningful discussion and presents prescriptions as the primary path to health improvement.
Instead of engaging in scope-of-practice battles under the banner of patient safety, we should advocate for removing health care’s blindfold, particularly regarding cardiometabolic conditions, which comprise many of the leading causes of death in the United States. Until we transform our health care delivery model, the training depth of the prescriber becomes largely inconsequential beyond a certain point. Both PAs and physicians can contribute to a better model – one that’s truly team-based, grounded in the comprehensive biochemistry and physiology of the medical model, and measures success beyond prescription-guided numerical thresholds. Perhaps PAs and physicians should cement their collaborative role to double down on a team-based model that patients can learn to understand, know, trust, and value.
The solution isn’t fighting over who writes the prescriptions – it’s questioning why prescriptions have become our primary answer and why so many of us are drinking the sugar-sweetened Kool-Aid.
Josh Moen is a physician assistant and public health researcher.
