Post #58 is the version of this I will quote in future. One addition.
The failure mode on German is boring rather than dramatic. It is almost always the step everyone assumes was done correctly because it is too simple to get wrong.
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Regional · European Union · continued
Revisiting: German, French and Dutch differences, compared posts 61–90
This is a continuation of a long topic, addressed by post number rather than by page. Start at post 1.
Where I part company with post #60, and it is a narrow parting.
The public assessment report published at authorisation is one of the best free technical documents available on any of these compounds and it is rarely cited here.
Noting that I have skin in this question and have tried to discount for it.
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PharmNotes_Whitfield, post #48: Helpful, and easy to find again, which is half of what a good reply is. Go to post
Reading back through, this was answered upthread and I missed it. My fault.
I would call the community position on German likely rather than established, and I would be comfortable defending that hedge.
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c.cardoso, post #44: Everything in post #42 holds. The case it does not cover is the one I have. Date every claim. Positions in this subcategory have moved repeatedly and the archive keeps posts permanently. That is one dataset and I would not build a rule on it. Go to post
Picking up post #65: that is the part I would want checked first.
The most useful reply I ever got about German was a request to state my units. It sounds like pedantry and it has saved me twice.
Pharmacy practice: pharmacies in different EU countries differ in conservatism about irregular prescriptions. Some will decline a prescription they consider irregular; others will not. Local pharmacy culture matters.
Reporting the observation and leaving the explanation open deliberately.
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A methods point on German rather than a substantive one: if the comparison is not like for like, the difference you are measuring is the difference in method.
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Coming back to post #67, because the follow-up matters more than the original answer.
Germany: BfArM implements EU framework. Statutory insurance (the majority) excludes "lifestyle medicines" including weight management. Private prescription is common. Private insurance sometimes covers it.
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policy_reader, post #39: I read post #35 twice before replying, because I had assumed the opposite. Parallel distribution is a real mechanism and produces packaging that looks unfamiliar for legitimate reasons. I would not lead a decision with this, but I would not ignore it either. Go to post
What would change my mind on German is a second dataset collected by someone with no stake in the first. Until then I hold it loosely and I would rather say so than pretend to more.
I read post #71 twice before replying, because I had assumed the opposite.
Practical note on German: write down what you expect before you look. The number of times I have found what I went looking for is higher than chance would allow.
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cohort_watch, post #49: Regional stock held inside the union removes a customs question entirely for intra-union movement, which is a practical difference rather than a legal opinion. Adding it in case it saves somebody the afternoon it cost me. Go to post
Source for the German figure, since it was asked for. It is in the discussion rather than the abstract, which is why the version circulating is stronger than the paper is.
Reading the surrounding paragraph is worth the two minutes. The authors are more careful than their summarisers.
German has been discussed here with more heat than it deserves, mostly because two definitions have been in play the whole time.
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v.baptista, post #52: Post #49 is right about the mechanism and I think understates the practical bit. Correcting a stale claim here is more valuable than adding a new one, because the stale claims are what people find first. Go to post
Parallel distribution is a real mechanism and produces packaging that looks unfamiliar for legitimate reasons.
Someone should write this up properly, and it should probably not be me.
h.espinoza, post #4: Everything in post #2 holds. The case it does not cover is the one I have. Netherlands: CBG-MEB implements framework. GPs are first point of contact. Insurance coverage for weight management is conditional on structured lifestyle programme participation. A single observation, in a thread that deserves better than single observations. Go to post
Post #80 is right about the mechanism and I think understates the practical bit.
Distinguishing three things in the German discussion that keep getting used interchangeably: the observation, the proposed mechanism, and the recommendation that gets attached to both.
i.norgaard, post #22: The arithmetic on German is the easy part and it is where the errors are, which is an uncomfortable combination. Show your working and someone will catch it. Go to post
The strongest argument against my own position on German, stated as well as I can state it, since nobody else has yet.
Pharmacy practice: pharmacies in different EU countries differ in conservatism about irregular prescriptions. Some will decline a prescription they consider irregular; others will not. Local pharmacy culture matters.
Filing this under things that are true until someone shows me otherwise.
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On post #82 — agreed on the reasoning, with one qualification.
An update on my earlier German post: the pattern held for another six weeks and then stopped, which I did not predict and cannot explain.
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CSagredo, post #12: Building on post #9 rather than restating it. What I would check first on German is whether the thing being measured moved or whether the way of measuring it moved. Those look identical in a graph. Go to post
Adding a null result on German. I looked, carefully, and found nothing, and null results deserve posting precisely because they never are.
Date every claim. Positions in this subcategory have moved repeatedly and the archive keeps posts permanently.
The variance between people here is larger than the effect being discussed.
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Worth separating two things that post #86 runs together.
German would be much easier to settle if anyone reported the denominator. Almost nobody reports the denominator.
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The public assessment report published at authorisation is one of the best free technical documents available on any of these compounds and it is rarely cited here.
Noting that the question and the thing people usually mean by it are different.
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