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Dr. Melissa Harris-Perry: This is The Takeaway. I'm Melissa Harris-Perry. For the past few months, the US has faced shortages for hundreds of prescription drugs, everything from things like Adderall to also over-the-counter necessities like baby aspirin. According to the FDA, manufacturing quality issues, discontinuations, and delays in the global supply chain for raw materials have all contributed to the small global stockpile of drugs. Outside of the production process of pharmaceuticals, increased demand for drugs from both patients and medical providers has been a driving force of some of these shortages, especially for one particular drug.
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Dr. Melissa Harris-Perry: Oh, oh, oh, the demand for Ozempic and alternatives like Wegovy and Mounjaro has spiked since 2021 when the FDA expanded the use of these diabetes drugs by approving them for use for patients with obesity. Off-label uses for the drugs have fueled questions about who gets priority access to a miracle weight loss drug during a shortage. They're sparking tensed conversations about how the medical community classifies and treats patients with obesity. Joining me now to walk through the latest is Julia Belluz, a health and science reporter who's been following the Ozempic story. Julia, thanks for coming on The Takeaway.
Julia Belluz: A pleasure to be here.
Dr. Melissa Harris-Perry: Let's just start with what is Ozempic as a drug. When it was initially developed, what was it developed to do?
Julia Belluz: It's an injectable drug that was first developed for patients with type 2 diabetes, and the key ingredient in it, semaglutide, had been studied for decades for people with diabetes, so it helps lower blood sugar and regulate insulin. People started to lose a lot of weight and the companies started to study exactly what effects these drugs had on body weight and whether they could help people with weight loss. It turns out they could. Ozempic, which is manufactured by Novo Nordisk, they created another semaglutide-based drug called Wegovy, and that was approved in 2021 for people with both obesity and obesity-related conditions.
Dr. Melissa Harris-Perry: Julia, now it's my understanding that these drugs are very expensive and that initially, at least, a lot of insurance companies just weren't even paying for them.
Julia Belluz: You're absolutely right. Insurers are grappling with whether to cover these drugs. For people with diabetes, gaining coverage is easier, but if you don't have diabetes, it can be quite difficult and you're paying out of pocket a thousand or more to get access. Yes, I think you're absolutely right. For most people, that means the drugs are out of reach, and, in particular, in places in the US where people don't have access to insurance and where people are less likely to have access to insurance, and where obesity rates tend to be much higher, I think these drugs aren't reaching the people in those places, for sure.
Dr. Melissa Harris-Perry: You talk about, or we talk about off-label uses for these drugs. That Ozempic is initially developed as a type 2 diabetes management drug, and then through observation and then through clinical studies, they've realized, "Oh, wait, it really helps to manage hunger, blood sugar, all those things. You end up with pretty substantial weight loss." Off-label sounds like there's some doctor in a back alley writing a prescription, but off-label happens all the time. Folks are given birth control pills to address acne. Isn't that just part of how the medical process works?
Julia Belluz: For sure, yes. It's a very common practice in medicine. Drugs are approved for one thing, but they might help with other things, although the drug companies never sought or gained approval for the other things, and then people use them for those purposes. I think the reason it becomes so contentious in this case is that obesity is a more fraught disease if you will. I think people will readily accept that diabetes is a real disease, but then question whether obesity is something that people just inflict on themselves and whether they truly deserve access to these drugs. I think doesn't help that there's this whole Hollywood element that's come into play.
Dr. Melissa Harris-Perry: Let's dig into the, as you called it, the Hollywood aspect here. What is going on with that?
Julia Belluz: I actually wrote my first story on these drugs in 2021 when Wegovy was approved. It was crickets. There wasn't a lot of interest. The story didn't really go anywhere and not a lot of news outlets were covering it, although the buzz in the obesity and diabetes research community had long been there and people were paying very close attention to what was happening with these medicines.
Then I think as word of mouth spread and you had people on social platforms like TikTok sharing their personal success stories, people telling their friends and family about their successes with using these drugs, and then the drugs got a-- they got a lot of public attention because people in Hollywood were coming out.
Dr. Melissa Harris-Perry: Let's take a quick pause right here. We'll be back and have a bit more of this conversation about Ozempic and how it's changing the conversation around obesity. This is The Takeaway.
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Dr. Melissa Harris-Perry: It's The Takeaway. I'm Melissa Harris-Perry, and I'm still here with Julia Belluz, who is a health and science reporter who's been following the growing trend of people using Ozempic across the globe. All right. Are the drug companies providing physicians with some incentive? Are insurance companies provide-- I'm wondering, given that you still have to have a prescription, that middleman, who is the doctor, what are they facing here? Is it to give out more Ozempic or hold back Ozempic?
Julia Belluz: You touched on something that's really interesting. I've been talking to many patients who have been using these drugs, and they're finding very creative ways to get them. Since the pandemic, there's been this rise in online prescribers, so you don't actually need to go to your doctor to get a prescription. I've heard patients accessing the drugs that way to get around the cost issues we talked about earlier.
They're going to online pharmacies in Canada and ordering the drugs from Canada and having them shipped to the US. People are finding really interesting ways around these drugs. In the past, the only really effective option available to patients was bariatric surgery, but something like only 1% of patients who are eligible actually sought surgery out. Obviously, these drugs can provide weight loss in many cases to people without the need for surgery. It's hitting the US health system where it hasn't. Usually, it was something that you had diets, popular diets, or people taking gyms, people taking matters into their own hands. Now this is, I think, something that's a little bit new.
Dr. Melissa Harris-Perry: There's a lot of money to be made or has been in American weight loss. I'm wondering if there's now a prescription one that might be covered by health insurance and it's effective and doesn't have all the side effects of surgery. Why wouldn't we, given that for decades people have been made to feel so guilty, ashamed, distressed, spending so much money to try to lose weight? Why not be shouting this from the rooftops?
Julia Belluz: In addition to the guilt, all the health complications that come with excess weight and the difficulties people face just on many, many levels at work seeking healthcare, and with their own health. I think that the kind of obesity doctors who have been waiting for a drug like this all say, "Why do we treat obesity different from other diseases? We finally have an effective drug. Insurer should cover it. People who want it should have access."
I guess the counter-arguments are that I think there's people on the health at every size body positivity movement who feel like these are-- they frame them as really novel drugs, even though they've been used for many years for type 2 diabetes, and that why should-- [unintelligible 00:09:14] the effects aren't very long term. You need to continue taking the drugs in general, it seems, to keep the weight off. Why are we exposing people with larger bodies to the risks of newer "drugs" for only short-term gain?
Then on the other side, you have the doctors saying, "Hey, with every other condition that's chronic, people need to be on long-term medication, why do we think obesity is anything different?" One thing I want to circle back to in the opening, you called them miracle drugs. I think we need to be really careful about that because most of the people-- I think a lot of people are having tremendous experiences, change relationships to food. They're losing weight, but, oftentimes, they're either switching between different drugs because they plateau at the highest doses of one drug. I think it's a little bit dangerous when the expectations on these drugs are running quite high and maybe unrealistic.
Dr. Melissa Harris-Perry: Julia Belluz is a health and science reporter following the ongoing Ozempic use and shortage worldwide. Julia, I so appreciate you taking the time with us today.
Julia Belluz: It was a pleasure to be with you. Thanks so much for inviting me.
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