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Long-term injection of performance-enhancing substances can lead to heart failure that can occur rapidly with little warning, as documented in recent medical case studies of young bodybuilders

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Some people have reported worsening suicidal ideation, and given the known association between bariatric surgery and suicidality, these reports should be taken seriously and discussed with patients while we await further research on this potential connection

Expanding that framework, or developing alternatives that achieve similar outcomes for the commercially insured population, will require policy innovation that moves faster than the current rate of change

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