Ozempic will disrupt big tobacco, candy companies, and alcohol brands(curingaddiction.substack.com) |
Ozempic will disrupt big tobacco, candy companies, and alcohol brands(curingaddiction.substack.com) |
Also it's an injection, which raises the barrier. If drugs like these become orally administered and over-the-counter, then yeah, I'd be more confident that it could have a positive effect. But currently, it looks like a drug that few can access/afford in the US.
[0] https://www.sanders.senate.gov/press-releases/news-sanders-s...
It's $450/month out of pocket (no insurance coverage)
Therefor, there will actually be price competition and we should see pretty cheap prices in the coming years.
I'm not sure exactly why pharmacies are free to compound it independently. I guess whatever patents exist on Ozempic/Wegovy etc aren't sufficient to squash competition.
The $1000/month for Ozempic is purely a name brand markup. I'd guess we'll see prices closer to $100/month for the compounded variants within a few years
That said, with China and more notably India entering the GLP1 RA race, there will be much cheaper options very soon, hopefully!
Considering how man times pharmaceutical companies have been lightly taken to task for doing the exact opposite, this seems extremely optimistic.
Because in exchange they could unlock a bulk order from e.g. the U.S. government. That in turn could unlock economies of scale that let them price competitors out of the market.
From a lifetime value perspective, I think it’s priced cheap. This drug is a miracle drug and is going to eliminate a lot of suffering and healthcare costs.
https://www.fiercepharma.com/pharma/novo-nordisk-patent-sema...
This seems incredibly optimistic considering all of pharmaceutical history in the united states.
I'm not aware of how legislation works in US but I feel like a senator should have more power than just "calling on" a company?
I’m speaking legally rather than economically. If the US Gov did this, big pharma would stop investing in research (even though I wouldn’t be surprised if USG pays for the private research in the first place) and cause worldwide slowdown in new medicines all in the name of profits
It allows the public to comment and maybe the senator will like the public support they are getting. Alternatively a pharma lobbyist will show up and toss them a few hundred thousand in campaign contribution promises. And they'll weight the relative value of those things. Depending on how that goes they (or another senator seeing this play out) will actually make an issue of it and it will start the more formal processes.
If you think things happen differently in Canada, you don't understand how the sausage is made.
Eli Lilly who makes the Ozempic rival Mounjaro is in late stages of clinical trials for their oral GLP-1 medication.
Edit just to add that in 10 months I've lost 40lbs and halved my insulin usage. That insulin is the pricy synthetic stuff (Tresiba and Novolog), so the cost of the mounjaro is probably close to paid for by that decrease.
Think enjoying tasting menus instead of double baconators.
some people need the kick start to experience the effects of a healthy living
So it scares me a bit when something like Ozepmic pops up and tons of people jump on it, without knowing the long term effects that might appear. I read the other day there's an entire subreddit devoted to Ozempic side effects, and those are only short term ones (maybe those being discussed there were already discovered during the trials, I don't know to be honest).
Are my fears unfounded and just the result of my lack of knowledge around the approval process and/or the inner workings of drugs?
> Goldman Sachs asks in biotech research report: ‘Is curing patients a sustainable business model?’
https://www.cnbc.com/2018/04/11/goldman-asks-is-curing-patie...
I wouldn't try any of them right now, but if my insurance covered one for treating alcoholism at some point I'd give it a shot. If it actually worked it would likely significantly improve not only my life experience, but also my productivity and thereby the lives of others I have an impact on. It's a nice thought.
What it boils down to is that on some level, I often feel death would be preferable to not being able to experience the 'reward' my brain has been long conditioned to expect from my next drink. If there was a lasting way to shift that to something healthier it would be miraculous. Simply taking it away would just drive me to despair. Having attempted suicide in the past, I do everything I can to avoid that situation again, and unfortunately drinking became a big part of this effort.
If you're looking for a quick primer on what the term "GLP1 Agonist" even means: https://glp1.guide/content/what-are-glp1-agonists/
This will absolutely have a huge effect on companies that sell ingestable... "luxuries"/addictive substances -- the only thing holding back the deluge of change is the accessibility/pricing of the drugs.
It also seems like the next phase of this is gene therapy:
https://glp1.guide/content/a-glimpse-of-the-future-glp1-gene...
we are looking for folks with MDs and PhDs or other experience in the field or in EA type writing to join the project. the thesis is that the addiction crisis is solvable if we put sufficient resources into new medication development, including GLP-1 for addiction and powerful non opiate painkillers like the Vertex drug that will be approved early next year.
addiction is the number 1 cause of DALYs in the united states if you include opiates, stimulants, alcohol, and cigarettes.
the right policies can get new treatments to people rapidly without massive public costs and without disrupting incentives. but we're currently on track for at least another decade of massive damage if we don't change things. join the effort!
* Low libido and erectile dysfunction * Constipation, diarrhea, and extreme bloating (burping all night long) * Often difficulty sleeping. Waking up a lot. Very restless.
We need a drug that doesn't slow digestion but decreases hunger and increases satiety.
This is exactly what it does for me. The only side effect I have is a little bit of occasional acid reflux.
Note that GLP1 RAs do decrease hunger, and their effects are very much also psychological. It's not simply a digestion slowing pharmacological effect.
There are a few articles in the news. Nothing substantial yet.
"Oh yeah, someone comes in here to buy a $10 HDMI cable, and impulse buys a $2 candy bar at checkout. Instant 20% more sales. Gas stations, pharmacies, they all do it."
0. https://en.wikipedia.org/wiki/Cigarette_Labeling_and_Adverti...
1. https://en.wikipedia.org/wiki/Public_Health_Cigarette_Smokin...
2. https://en.wikipedia.org/wiki/Family_Smoking_Prevention_and_...
3. https://en.wikipedia.org/wiki/Tobacco_Master_Settlement_Agre...
Ah yes price controls, the best way to keep something inaccessible to everyone except those with personal connections.
I'm not considering taking Ozempic nor am I aware of anyone who has, so I'm curious.
I think it makes great sense if you're badly out of shape, you fix it, and then you can maintain a healthy weight. But going on ozempic every few years sounds really bad.
This is a really bad-faith interpretation of what the reporter said. The "mounting concern" is linked to a CNBC video. It's obvious in context that it's the investors in processed food companies who are concerned, not the reporter herself.
I was under the impression that for lasting change the behavioral program was pretty much required anyway, unless the patient wants to take Ozempic for the rest of their life. It helps someone go from obese to the point where they can exercise to maintain their health but they still have to eat healthy and exercise afterwards.
I'm a bit biased of course (I do a lot of trying to keep up with the research and effects of GLP1 drugs), but I honestly don't think the weight loss scene has seen something so effective and safe for a very long time.
Last time I looked into it the "loss" is only happening while taking the medication and you get back to normal once you stop, regardless of how long you’ve been taking it. So if stabilizing at a thinner state is your goal, the drug would be mostly useless or you should be ready to take the rest of your life.
Going only a tad too far, it feels like recomming meth for its energizing and diet effects, that's not something we want at wide scale.
The ethical considerations are more difficult when it comes to someone who simply wants a little help. Consider the common case of someone mostly happy and successful, but is a little overweight and has been struggling off and on for decades to lose 20 pounds; almost all of us have been there, or will be. Do you give those people the drug? Do you allow them to choose for themselves, or should big organizations decide for us?
It's just that these considerations run up against a very solid understanding of how much death is caused by being overweight and having high blood pressure.
Right now, Ozempic does not have to be very good, to be most likely a lot better than the alternative.
I wish I could just quip a "citation needed", but we're at a point where the visceral hate for fat includes researchers spitting out feel good papers going with the flow, as funding is basically guaranteed.
We don't have satanists, so this has become our day's moral panic IMHO:
It isn't that different from what happened with vapes and e-cigs, and they were even worse (nicotine-based, explicitly harmful).
Test in production. YOLO!
I understand that it is a trade off if you are obese. A buddy of mine died with 43 bc a combination of obesity and COVID. Yes, it might be justified for high risk patients but currently it looks like it will become a life style drug like Viagra. And a drug that digs so deep into your metabolism and take it for life? Call me a sceptic.
The potential to deliver “one shot cures” is one of the most attractive aspects of gene therapy, genetically-engineered cell therapy and gene editing. However, such treatments offer a very different outlook with regard to recurring revenue versus chronic therapies, particularly in certain diseases where it is possible to cure a large proportion of the prevalent patient pool (or at least prevent an additional dose from being required for an extended period). While this proposition carries tremendous value for patients and society, it could represent a challenge for genome medicine developers looking for sustained cash flow. GILD is a case in point, where the success of its hepatitis C franchise has gradually exhausted the available pool of treatable patients. We highlight several potential solutions for these genome medicine companies to sustain an attractive profile. Solution 1: Address large markets: Hemophilia is a $9-10bn WW market (hemophilia A, B), growing at ~6-7% annually. We estimate that the hemophilia A market currently represents ~$6.5bn, while hemophilia B is ~$1.2bn. Solution 2: Address disorders with high incidence: Spinal muscular atrophy (SMA) affects the cells (neurons) in the spinal cord, impacting the ability to walk, eat, or breathe. It is the leading genetic cause of death in infants. SMA affects ~1 in 11k babies, and 1 in 50 individuals in the US is a genetic carrier. Cancer is also a sustainable market given the patient population is almost entirely incident driven. Solution 3: Constant innovation and portfolio expansion: There are hundreds of inherited retinal diseases (genetics forms of blindness). Once a gene therapy is approved for a genetic eye disease, the validated platform could be used to quickly develop many more eye-based gene therapies. Pace of innovation will also play a role as future programs can offset the declining revenue trajectory of prior assets.
or innovators dilemma upsets or forces the incumbents. the transformer (attention is all you need) model paper did release in 2017 and Google did nothing about it until OpenAI forced their hand
awaiting this happening to pharma as well as new technology reduces the barrier to entry for innovators
My favourite example is ulcer drugs. Big pharma has found many drugs to control it, lifelong, but a critical cure for many cases was found by doctors with limited funding https://duckduckgo.com/l/?uddg=https%3A%2F%2Fwww.nobelprize....
Way for Goldman Sachs to say the quiet part out loud. Not curing people so you can sell them something that merely deals with the problem's effects. This shouldn't even be up for discussion.
Seems like one company is selling the cure to a problem another company (companies) caused. Not to be all "capitalism bad" but I thought promise of the Invisible Hand of the Market was that it was supposed to make life better by directly solving everyone's problems. Instead, it seems to be creating more and (as Goldman Sachs admitted) not even trying solving those.
https://www.bbc.co.uk/bbcthree/article/966b1bdd-69ff-4de0-9c...
Once demand is met, there starts to be an argument for lowering the price and growing the market. Getting the price down to half the current price is when we start to see health benefits that outweigh the cost of treatment and an obvious win for insurance companies to start covering it for everyone.
But until there is supply, lowering cost just means more people fighting over the same supply, not more people getting access.
First, worth noting that this is very much TBD. There are grave 1st Amendment concerns with the government's efforts there and it is very much an open question for now whether the effort will actually hold up in court. That said:
>what’s stopping Uncle Sam commandeering Novo to either sell off its Ozempic ownership as a subsidiary to force a lower general sales price, or forcing to nullify its patents? I’m speaking legally rather than economically.
So as a practical matter, and as with TikTok, Novo Nordisk is not a domestic company it's a foreign one. But unlike TikTok where China is a geopolitical opponent, Novo is Danish and thus part of a close ally. Second the people pushing the TikTok thing are fine with TikTok going away entirely in the US, that's the stick. The US has zero power jurisdiction over China just as the reverse is true, but can police its own market and thus say "comply or lose access to our market". Same as how the EU is pushing stuff like the DMA. Since the US market is valuable that's a sizable stick, but TikTok very likely even if they lose will tell the USG to pound sand and just leave, but Congress/WH wouldn't mind that.
But here the whole point is that people desperately want this product. So if Novo said "no, and we're ceasing all sales in the US" they'd take a major financial hit sure, but there'd also be massive blow back in domestic and international politics. It would definitely be questioned on various US/EU trade agreements which would have messy legal implications, and invite tit-for-tat. Nationalizing foreign IP would implicate a bunch of treaties and US itself pushed hard and benefits from.
But putting all that aside and pretending it was all domestic (or going specifically after domestic components), there is still the Takings Clause of the 5th Amendment. The government could legally seize it using eminent domain powers, though it'd no doubt face as good a legal fight as the highest paid law firms could put on. But I don't think there's any doubt this would be a clear case of public use and courts have approved vastly more dubious and worse takings.
However, there's no dispute government would then have to pay the entire fair market value for it, whatever anyone else would have to pay to buy the whole shebang right now. Novo as traded on the NYSE has a market cap of over $430 billion, and a sizable chunk of that is from this product which has sold well enough to measurably boost the entire Danish economy. The stock has nearly tripled in just the last year and half or so. Even if the US part of that one component was "only" 25%, $100b is not nothing, not even for the USG. And FMV might well be double or more.
There would be other legal avenues to explore but that's a big one, and in turn it's not actually clear it'd save the US any money which is kind of the point, eminent domain isn't supposed to be used that way but for some critical greater good. You can gain control but you have to pay for it.
I worry that framing the goal as, "a lasting way to shift that to something healthier", will prime you to switch from one addiction to another. I would prefer for you to frame it as diversifying the sources of pleasure in your life and becoming able to take pleasure (and consequent to take interest) in practical things that you currently experience as tedious obstacles that must be endured so that you can get your next drink.
Ozempic hasn't been around long enough to make that conclusion. It hasn't been prescribed at scale. It hasn't even been around long enough for its patent to expire, which is significantly shorter than a human lifespan ("rest of their life").
You're just making stuff up.
That's the same as asking,
> "Is curing patients a sustainable business model?"
The offense in question is letting profits effect a decision to develop a treatment over a cure. You're literally spelling out the bad thing.
If the society says to manufacturer "if you do this, you'll get less money from us" that is effectively the society saying "please don't do this". People and governments vote with their wallets about what they want, and if they're "voting wrong" or ineffectively, then they need to change what they pay for, instead of being surprised that they don't get what they disincentivize.
I could see patenting mechanism of delivery, like injections versus oral, but not the example above.
Well, yes. If there's a 10% chance of success, these differences matter. Decision making happens at the margin.
There's a heuristic that goes, "Shortcuts will catch up to people eventually," but I'm ok with letting the evidence bear that out.
However, putting food in your mouth is a completely conscious decision. If people have problems with controlling that then I think that's what should be treated, instead of medicating your body to react to food differently. I think a future where we turn to drugs on an ongoing basis to compensate our unhealthy lifestyles is pretty dystopic.
Again, if someone is obese and struggles to lose weight I think Ozempic sounds like a great way to get on the road to health. I just don't think you should take it for the rest of your life instead of changing your lifestyle.
Would you same the same thing about insulin or statins or even caffeine? Why couldn’t something like Ozempic be something you take long term?
With regards to caffeine, as a doctor would you prescribe lifetime energy drinks to people who intentionally don't sleep enough?
Insulin is totally different because if you're diabetic and you don't take it, you die. There's no cure for diabetes, so there's no other option but to take it for the rest of your life.
But if you've lost weight (either with ozempic or not), it's possible to not be obese again, you're totally in control of what you put in your mouth. It feels really weird to me to keep medicating people forever when there are well understood ways to manage your weight.
I think it's probably a great solution to help people who have lost control of their weight and need to get back on track. But using it to compensate for an unhealthy lifestyle going forward just seems like bad health policy.
But from a reputable one regulated by an industrialized nation, it would not be fitting to call them dangerous.
India is quite good at pharmaceuticals -- their generics basically serve the rest of the world that are priced out of US-made products IIRC.
Ex. their generic version of Paxlovid:
https://www.reuters.com/business/healthcare-pharmaceuticals/...
Basically, with the expiring patents coming up on a bunch of these drugs:
https://www.biospace.com/article/9-drugs-losing-patents-or-e...
We're going to be in interesting waters soon.
GLP-1 looks increasingly like a miracle drug. We see problems of addiction and obesity skyrocketing across the developing world. It’s not cost free, but it’s a hell of a lot better than the majority of America, China and India becoming potatoes.
When vitamins were discovered, there was similar moralising about there being no free lunch. With the benefit of hindsight those concerns were misfounded. Perhaps Ozempic has terrible side effects that haven’t been noticed since 2005. Given that timeline, however, we can confidently say someone obese taking the drug is better off with it.
> never cures it
I have friends who took it, lost weight and then stopped. The rebound was real but nowhere close to what they lost. (The lifestyle changes also mostly stuck.) For all practical purposes, their fatness was cured.
> when probably 99% of cases could be reversed naturally
Scientifically unfounded.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7400171/#:~:tex.... "Although treating type 2 diabetes complications is of utmost importance to protect organ damage, it is now increasingly recognized that even the more ambitious goal of diabetes remission may be possible [6]. Thus, while there is little doubt that healthy lifestyle habits are the cornerstone of prevention of type 2 diabetes, they could also be used as an effective treatment to even potentially reverse type 2 diabetes. In this regard, the interesting narrative review published by Hallberg SJ and colleagues [7] has summarized the evidence that type 2 diabetes reversal is possible with the use of three different approaches: bariatric surgery, low-calorie diets and carbohydrate restriction."
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10716578/ "Unlocking the Potential of Type 2 Diabetes Mellitus Remission"
Even the ADA had to finally acknowledge this is possible in a statement back in 2021: https://diabetes.org/newsroom/international-experts-outline-...
It's not such a crazy idea really - You consume so many carbohydrates that you overproduce insulin and become insensitive to it in a vicious cycle. The more you fast, stay in a ketogenic metabolic status, reduce carbs and/or go zero carb, compress your feeding windows the more insulin sensitive you become.
There is no such thing as an essential carbohydrate. Your body can maintain your glucose needs by converting proteins into glucose. Fat and proteins are essential. Glucose is not it can be produce by liver.
It’s absolutely possible. It’s unfounded that it even medically works for 99% of people, and that is while ignoring the obvious compliance problem.
> stay in a ketogenic metabolic status
Want to point out the naturalistic fallacy in assuming putting your body into an extreme condition for the long term is less harmful than a drug. (I say this as someone who intermittently fasts.)
> when probably 99% of cases could be reversed naturally.
What does that even mean? We aren't 'naturally' exposed to such calorie dense foods all the time and aren't 'naturally' supposed to be able to get any food with so little effort. What is natural about processed foods?
Source?
I agree. People did not need these drugs in the past but instead of fixing the social and economic structures which caused the obesity epidemic we tell people to take drugs to manage.
Oh, and take Adderall so you can focus. Again, nobody needed this in the past.
And Xanax to manage the anxiety people did not use to have either.
Feel unhappy and alone? They will make a pill for that too.
"Brave New World" turned out to be even more prophetic than "1984".
Of course you could still sell the same drug if you get it approved with a different dosage but that is a long and costly process.
In this case, is there a dosage patent on ozempic’s current dosage? If manufacturers tweak ozempic’s current dose and get a patent, what’s to stop the existing dosage from being made by generics?
https://www.nbcnews.com/health/health-news/gaming-us-patent-...
Many things get better with time and progress but I don't think our current lifestyles are some kind of evolutionary peak.
All other things considered, how important is it that proximate or ultimate causes of obesity are addressed?
You don’t think having the heft of the U.S. government behind one of those parties will help with that access?
They're not buying generics, and even at a 20% discount will get hosed compared to the $7 generics
There is competition, I see ads on Facebook and Instagram for it all the time, there are clinics all over where I live advertising Semaglutide treatment for weight loss.
It's like when COVID hit and somehow "Zoom" became the shorthand for online video meetings even though there were (and still are) a ton of options for that functionality on the market.
Are there competitors or are they under patent protection?
What it can do is help one "bootstrap" into healthy habits. Someone who is sufficiently overweight might suffer injuries from exercising, which makes it difficult to lose that weight. Someone who's drank a soda every morning for decades might break the habit if they stop for long enough.
Why does it feel like recommending meth? Are they similar in addiction and harmful effects?
In the meantime overweight people are going to take what they can get.
So GLP1 gene therapy (if it ever gets here) might be the most reasonable way to achieve this, and might be the safest we've ever seen so far outside of maybe brain control.
> In the meantime overweight people are going to take what they can get.
100%. And AFAIK GLP1s are some of the safest we've seen so far, and much more effective than "eat less and move more" (as true as that may be).
Up until now we say "no, fuck it" after a few decades of having the thing widely available. My point is wether we should shortcut the cycle and so no _before_ doing the society wide trial and having to fight for decades to have it stop.
> In the meantime overweight people are going to take what they can
Most don't take anything right now
I don't think I've seen anybody tweaking out for a fix of ozempic, though please feel free to inform me if addiction is an actual side effect that I've not heard of.
Yes, but note that there are other more legitimate alternatives like gastric bypass, etc!
> Last time I looked into it the "loss" is only happening while taking the medication and you get back to normal once you stop, regardless of how long you’ve been taking it. So if stabilizing at a thinner state is your goal, the drug would be mostly useless or you should be ready to take the rest of your life.
This is untrue -- most people do not bounce all the way back to their original weight once they stop, and simply having the space from what seems to anecdotally be quite annoying symptoms ("food noise") might be well worth it.
https://glp1.guide/content/do-people-regain-all-the-weight-l...
> Going only a tad too far, it feels like recomming meth for its energizing and diet effects, that's not something we want at wide scale.
It's absolutely not this -- there are studies and trials on how GLP1 RAs work, their effects, and at this point they are a go-to effective treatment for type 2 diabetes, and the FDA has just approved them for heart disease.
The way they work is not completely known (for example the mental effects seem to be underweighted), but the mechanism of action is completely different a drug like meth.
5% weight loss at the end of the day, and no cardio metabolic improvement [0]. So basically the net change was super small and cosmetic. I understand this could still be useful for very specific cases, but it's more of a niche that we're willing to admit.
> the mechanism of action is completely different
I hear you, I and I think we'll see more and more diverse drugs with different mechanisms. I'm just not sure we should be saying "this time it's different" every single time when we could take more measured approach before pushing it to the masses. Right now we're already in the YOLO phase waiting to see how it will pan out now that everyone and their dog want the miracle weight loss drug.
Hey 5% weight loss is pretty good! And remember, there maybe a period of time where the process repeats after getting off (no research to support this yet).
Also, I think you're under-estimating the psychological benefits. The lessened/blunted impulses to eat/do other addictive things might prove to be way more valuable in the time frame than simply the weight loss.
Also, note that the 5% is basically the worst case -- it's possible for more motivated people to keep more than that off, especially if they change their lifestyles appropriately, and importantly the drugs help people get in a headspace to do that.
> I hear you, I and I think we'll see more and more diverse drugs with different mechanisms. I'm just not sure we should be saying "this time it's different" every single time when we could take more measured approach before pushing it to the masses. Right now we're already in the YOLO phase waiting to see how it will pan out now that everyone and their dog want the miracle weight loss drug.
Yeah but I'd say this time it is different -- we've literally never had any weight loss drug that was this effective with so few side effects, and is well studied and essentially has an arms race between the largest pharma companies in the world to produce.
I agree with you though -- it's not a miracle drug, but it's the closest we've seen so far, so that's worth celebrating.
Personally I don't think anyone has to push this drug -- the masses are demanding it -- it's just that only rich people/lucky people with good health plans can afford it so far.
Cheap and plentiful high-calorie food and you're not forced to move if you've got a desk job. That might be modern but that doesn't mean it's better.
When the one being disrupted is a European pharma? Yes.
Have you been around our lawmaking institutions, or lawmakers? The idea that we'd sandbag something like Ozempic, which by the way is being negotiated for mass deployment through Medicare [1], to save the likes of Frito-Lay is nuts. Even if we reduce American politics to the lobbyist-conspiracy model, which isn't terribly predictive but whatever, you're pitting big pharma against chips and fast food.
[1] https://qz.com/wegovy-ozempic-weight-loss-drugs-medicare-rul...
My point is we still know very little about long term effects, and in particular about what happens when the brain's reward centers are affected at scale (for a diversity of people) + for years.
Yet we're already going down the path of the "miracle drug" [0] and that freaks me out.
[0] https://www.amazon.com/Miracle-Drug-Crystal-Meth-ebook/dp/B0...