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Because the milligram amount is fixed, a lighter body gets more drug exposure per pound: roughly 22% more at 70 kg and about a third less at 120 kg, compared with a 90 kg reference. The dose still comes from response and tolerability, but a lighter person is running a hotter exposure at the same number on the vial

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After the Part B deductible, Medicare pays 80% of approved B12 injection costs

In other words, the 1 in 10 people getting worse after starting with the B12 shots may just be the result of one of the other coexisting illnesses getting worse