Lose 15% of your bodyweight but hooked for life: The new weight loss drug raising all kinds of questions

Sascha: [00:00:02] From Equity Mates media. This is the dive. I'm your host, Sascha Kelly. A miracle weight loss drug. 

Audio clip: [00:00:09] Obesity is a condition accompanied by countless medical, psychological and social challenges. However, a new medication was recently approved by the FDA for weight loss. 

Sascha: [00:00:18] We've read this story before, but we didn't come across this on a late night infomercial. This was a headline in the Financial Times. It read A new miracle weight loss drug really works, raising huge questions. Well, that piqued our interest. So we've read about it further and we learnt Elon Musk has endorsed this drug on Twitter. Marc Andreessen, the billionaire co-founder of Netscape, is a user and musician and actress. Queen Latifah is the drug's celebrity spokesperson. 

Audio clip: [00:00:47] Is not as you age this. 

Audio clip: [00:00:48] Not just me, this is. 

Audio clip: [00:00:49] Bigger than me, this is bigger than us. 

Sascha: [00:00:51] But behind the quote unquote miracle and the celebrity endorsements, there are questions, questions about cost, about reliance and about how we treat the symptoms rather than the cause in our health care system. So we reached out to the author of the article, The FT's Hannah Cutler, to better understand this story. It's Wednesday, the 10th of August. And today I want to know what's the story with this new miracle weight loss drug and what's the catch? I have the immense privilege of being joined by Hannah Cutler, who's the global pharmaceutical correspondent from the Financial Times, to talk about this topic. Thank you so much for joining me today, Hannah. 

Hannah Kuchler: [00:01:33] Oh, thanks so much for having me. [00:01:34][1.1]

Sascha: [00:01:34] It's our pleasure. So let's start by setting the scene a little bit. It's not the first time I've heard the phrase miracle drug. And as you said in your article, this category of drug weight loss is marred by a long history of quackery and safety scares. So could you give us a little bit of a potted history of what this has looked like previously? [00:01:55][20.8]

Hannah Kuchler: [00:01:56] Yes. So this is a category that actually, until recent years, pharmaceutical companies tried to stay out of because it had such a dodgy history Randi. And this goes back to the days when people use that means as weight loss drugs, that obviously they had rather significant side effects and had to be pulled from the market. And then over the years, there have been some other drugs that have been less effective than what we're talking about now. But few of them have been taken off the market either for potential health problems they caused or increased risks of cancer. So there's never been something that both helps you lose a lot of weight and doesn't appear to have that kind of drastic side effect. [00:02:39][43.2]

Sascha: [00:02:40] So that brings us to the company that has stepped into the fray here, the Danish pharmaceutical company Novo Nordisk. And it has a bit of an interesting back story. Can you introduce me to the company and their previous work in the weight loss space? [00:02:53][12.6]

Hannah Kuchler: [00:02:53] Yeah. So no, no, no. This is really interesting because it's actually, I think the 19th biggest pharma company in the world. But you don't hear about it very much and that's partly because it's held the majority shareholder is the foundation. So it's not like one of the big prises or Merck. So it's a number that trades very freely and is and it's really well known. It started the idea is it started from a love story is the way that they put it, which is that it started with these doctors travelling, Danish doctors travelling around Canada. One of them had diabetes and the other one didn't. And this was around the time, at the beginning of the last century when insulin was being discovered. The Danish doctor sort of obtained this insulin for his wife and they then also obtained the licence and they brought it back to Copenhagen. And so it started really as a diabetes company, as an insulin company, and then started producing these diabetes drugs. And then when this new research from this whole in which the base of the drug we're talking about now, the weight loss drug came out in the eighties. They started to use it first as a diabetes drug. And then they noticed that the mice started losing weight and that it wasn't just controlling their diabetes, but it was having some kind of impact on their weight. But it took quite a long time from then to now to make sure this drug actually stays in your body for long enough to have an impact on your weight. But they succeeded and that drug was approved about this time last year in the US. [00:04:22][89.1]

Hannah Kuchler: [00:04:23] How does Wegovy help you lose weight? I guess we start with what is we do. [00:04:28][4.9]

Hannah Kuchler: [00:04:28] I love this. So that's the brand name for. [00:04:30][2.0]

Sascha: [00:04:30] A prescription medication known as Semaglutide. It was FDA approved to. [00:04:35][4.2]

Hannah Kuchler: [00:04:35] Treat. [00:04:35][0.0]

Sascha: [00:04:35] The conditions of overweight and obesity back in June last year. This drug is significantly more successful almost three times than others that have been in the market previously. How is this drug different? Why is it being called a miracle drug? [00:04:50][14.3]

Hannah Kuchler: [00:04:50] The previous versions of the drug, including ones from Novo Nordisk itself, how would you lose about 5% of your body weight, which actually wasn't enough for a. Out of people. And I don't know enough for a lot of insurers to think, oh, this is really worthwhile paying for. But this drug showed in phase three that on average people lost 15% and a third. The people lost 20%, which is basically the equivalent of weight loss surgery. So, you know, that's obviously something much more intrusive that's having that impact. So that's why people were pretty quite stunned by that initial data and don't think they or anyone would love to be on this miracle drug because I said something rather high expectations. But that's why it has been used as a tool. Yeah. [00:05:34][43.5]

Sascha: [00:05:34] So you said high expectations that it was approved by the U.S. FDA in June last year. What did the trial results tell us from that? [00:05:43][8.7]

Hannah Kuchler: [00:05:43] Yeah, so that was showing that they have pretty significant weight loss. In fact, actually since then, another drug from Eli Lilly based on a similar hormone has come out and said that it has even more significant weight loss. So I think that one of the things that interested me about this story is this is starting a new generation of drugs. [00:06:01][18.3]

Audio clip: [00:06:02] Eli Lilly got their diabetes. [00:06:03][1.2]

Hannah Kuchler: [00:06:04] Drug approved by the FDA. [00:06:05][0.8]

Audio clip: [00:06:05] For use as a weight loss drug. And that gives it a little bit of an edge against a higher dose, a version. [00:06:10][5.6]

Hannah Kuchler: [00:06:11] Of the drug from Novo Nordisk. There are any sort of links with really serious things as I was speaking out before. But the the trial results do show and anecdotal experience since then shows that they have kind of of I would be difficult to stomach for many people lots of nausea. Some people describe it as like having morning sickness all the time. In particular, as you start to come on to the drug, you have to titrate up the dose and and that can cause vomiting and people suffer from constipation and things. So it's not like a complete walk in the park. [00:06:46][34.9]

Sascha: [00:06:46] We're going to take a quick break and I'll be back with more from Hannah in just a moment. [00:06:50][3.9]

Hannah Kuchler: [00:06:55] We go by or Semaglutide is an antidiabetic drug administered as a once weekly injection. This drug works for weight loss by mimicking a hormone that targets specific areas of the brain known to be involved with appetite. [00:07:07][11.6]

Sascha: [00:07:07] It slows the emptying of the stomach and affects how our bodies process. Glucose. Sugar. Extremely effective for weight loss. You made the comparison between generic blood pressure drugs that you would take for the rest of your life being $10 a month. And Wegovy is currently is at around 1300, which is obviously significantly greater. [00:07:28][20.8]

Hannah Kuchler: [00:07:28] Yeah. So that's I mean that's a US list price, which is I mean, we could have several hours trying to describe how drug prices are based in the US, but but that's a good indication of where it stands in relation to other drugs. It is much, much more expensive. Those are the pills that U.S. came out, that generics. This is still very much under pass and just came out. So it will be for, you know, many years under pattern and and that is a lot of money and he can see why payers whether they be insurers or public health systems are anxious about that because there's an awful lot of obesity out there. Technically, a third of the US population could qualify for this drug. And so if you're paying that amount of money per person forever, even if it does sell, save, have health costs in the future, which is the argument that it should reduce the number of heart attacks, reduce the number of diabetes patients, reduce the number of operations on knees and things like that. It's still hard calculation for people to say if they have to pay that much upfront. [00:08:28][59.7]

Sascha: [00:08:29] And despite these concerns and despite the side effects as well, Wegovy has now some very famous users, to name some specifically Elon Musk, Marc Andreessen and Queen Latifah is now the face of the drugs advertising campaign. But as you asked in the article, it's wildly effective. But is it misguided? [00:08:48][19.6]

Hannah Kuchler: [00:08:49] Yeah. So on on the celebrities, we actually don't know completely. We know that Marc Andreessen has taken it because he's he's written about that. Elon Musk endorsed it, didn't say that he took it. So it was a very good drug. And Queen Latifah is a really interesting case because no one is her is a spokesperson, but she is really just talking about changing the conversation on obesity and she doesn't even say the word we get it on changing this conversation and this idea that it could be misguided. I think that I spoke to patients who it's really been quite transformative for me. I'm lucky enough not to be suffering from obesity, but I really began to understand the stigma that people were dealing with and also just health problems and not the ability to get out and about affecting their ability to care and do the things they love, love in their life. And so it was so great that they felt that they could. So it may be a really good option for individuals, but I think what really engaged me in the story is, is why the societal question, which is we kind of like quick fixes as a society and we've known for a long time that we have a problem with access to healthy food, with access and encouragement of exercise and all sorts of social factors go into those things. There are mental health reasons why people are obese, and I worry that maybe we could end up choosing this as a quick off the shelf thing that you can pay for rather than tackling those more difficult questions. 

Sascha: [00:10:21] Absolutely. I think you've just answered my next question, which was let's zoom out from this specific drug and understand the broader context in which it's coming to market, because there is that debate about obesity around the world, whether it's a disease to be treated medically or a health issue. And do we treat it with diet and exercise or is it unfairly stigmatised? And should we be working on embracing body positivity and a broader cross-section of bodies on display in society? 

Hannah Kuchler: [00:10:50] Yeah, I think that's really interesting. I mean, one person I reached out to, body positive movement didn't even want to speak because she just felt really, you know, I don't even think the spirit is the word almost betrayed by the idea that people were touting this pill to fix something that she didn't think needs fix that she saw as part of our identity. And I think that that is really worth thinking about. Whether science comes down is, again, harder. I think that there are really serious correlations between obesity and diseases, but I do have some time for the argument that people put forward, which is why don't we why are we so worried about the number on the scale? Why are we so worried about BMI, which is totally outdated metric and doesn't show huge number of things about health? Why aren't we looking okay if we're worried about the health impacts? Look at the cholesterol, look at the blood pressure. And that's certainly there is a size, you know, which is not moral ask but is not also really able to use your body in the way that. You're meant to that that should be accepted and seen as healthy.

Sascha: [00:11:57] I do want to just zoom in on the U.K. for a moment, because they do seem to be embracing it in England. 28% of adults were obese in 2019 and the NHS has started subsidising this drug. So what's the economic rationale, do you think, in the U.K.? 

Hannah Kuchler: [00:12:15] Yeah, so I mean, I think it's interesting because I think there's this traditional narrative in drugs that, you know, the US will pay for everything and countries like the UK will say, say no, you can't have this new, nice, expensive, innovative drug. And yet here they are saying, Yeah, you can. They're not paying for it for the whole population. So it is at the higher end of Pimeyes. And they are also insisting that you do it with a programme of diet and exercise, which actually was how it was trialled in the trials in the first place. So everyone really should be following that. I think it shows that there are people who think it is good value for money because they accept that there are costs further down the line. And it also shows that if you are a single payer system, also, that you can capture that value later, right? The NHS can say, okay, I actually know that if I fix your obesity now I'm going to save money in ten years. Whereas I think the problem with more fragmented systems, with a lot of private players in, say, in the US is they'll say, Oh, actually you're probably going to move to employers and insurers by then. So I'm not actually going to capture the savings, so I'm not sure if it's as good value. 

Sascha: [00:13:22] So where to from here? Do you think this will be the start of many hormone based weight loss drugs you mentioned another that's just come to market earlier in our conversation. 

Hannah Kuchler: [00:13:32] Yes. So definitely, I think that will for a start. One of the reasons why you might not have heard of recovery is they actually had huge supply problems. So they intend to fix those by the end of the year. So then I think we'll see a huge ramp up in the US and especially outside the US. They haven't really targeted outside the US that much, so you'll start to see it come available much more. And then, yeah, Eli Lilly have put out their results, so they haven't yet had an approval, but they expect to be approved and that will come in the next few months or next year. And then you will start to see them sort of also entering this market, and that's for the hormone based ones. But also I think lots of other companies are dabbling in other ways to address this issue now. I think they can start to see that you can create a market is a huge market. Maybe there's concerns about the history of the kinds of drugs are fading a little bit. And so there's some ones even looking at genetics, for example, which we know play a role in obesity. 

Sascha: [00:14:29] Well, Hannah, thank you so much for your time today. I really appreciated getting to talk to you about your article and a really fascinating conversation. 

Hannah Kuchler: [00:14:37] Thank you. 

Sascha: [00:14:38] And that was my conversation with Hannah Critchlow, the global pharmaceutical correspondent from the Financial Times. And that's the end of this episode of the DI for today. If you enjoyed it, please tell a friend about it. It really is the best way for our podcast to grow. And if you're listening because you've been referred, we have a growing back catalogue that's a well worth checking out. We've had episodes about China using trade as a weapon, the case for reparations and women's football, and how Disney could lose control of Mickey Mouse. There really is something for everyone. Remember, you can follow us on Instagram at the Dive Business News. You can contact us by email, the diver Equity Mates dot com and you can subscribe wherever you are listening right now. So see, never miss an episode. Thanks so much for joining me today. Until next time.