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The empty stomach requirement matters because food presence affects gastric pH and transit time

PMID 29898649 Sikiric P, Seiwerth S, et al

The direct care is mostly for people who are, dont have insurance or access to health care

arguments against the use of oral cobalamin Oral treatment may be considered in certain situationsfor example, in mild or subclinical deficiency with no clinical features and when absorption and compliance are definitely not a problem

Hopefully, this episode kind of like shed some light on it here, and then I think the talking points that you can tell people again is like, this is a banned substance