SELECT enrolled 17,604 adults with documented cardiovascular disease -- coronary artery disease, peripheral artery disease, or prior ischaemic stroke. Primary endpoint: major adverse cardiovascular events. Hazard ratio 0.80. Published NEJM, November 2023. None of this is a longevity trial. Singapore's private clinic market is pricing semaglutide as one anyway, at monthly fees between SGD 900 and SGD 1,400 for weekly injection protocols marketed to healthy adults with no prior cardiovascular diagnosis. Health Sciences Authority Singapore's registered indications for semaglutide cover type 2 diabetes (Ozempic) and obesity management in adults with BMI of 30 or above, or BMI of 27 with a weight-related comorbidity (Wegovy, listed 2024). The population SELECT studied and the population these clinics are treating are not the same group.

The science is pricing one thing. The capital is pricing another. SELECT's 20% relative risk reduction in major adverse cardiovascular events was measured in a secondary-prevention population (adults who had already experienced a cardiovascular event or who carried equivalent established-disease risk). A healthy 50-year-old adult in Singapore without prior coronary artery disease carries a substantially lower absolute baseline event rate, which means the absolute risk reduction from semaglutide in that person is a projection from SELECT's secondary-prevention data, not a number the trial produced. The prescribing frame carries its own exposure. Off-label semaglutide use is legal in Singapore, but the SMC's Ethical Code and Ethical Guidelines (2023 revision) requires physicians to document the quality and nature of evidence for any proposed treatment; for a longevity claim in a healthy adult, that documentation must name SELECT and disclose that SELECT studied a different population. SMC disciplinary referrals are published by name.