Miracle Drugs? (Ozempic/GLP-1 etc)
By now, many Americans are familiar with the benefits of the new-ish class of GLP-1 and GIP pharmaceuticals, including Ozempic/Wegovy and Monjauro/Zepbound—with many more in development.
You can lose 10-20+% of your weight within 1-2 years with a weekly injection (soon to be pills)—in many cases preventing & even reversing Type 2 diabetes.
But miracle drugs are only true miracles, if people can afford them, and they take the meds consistently as needed—in this case, for life—and if the benefits outweigh the risks.
Miracle Drugs? Affordable? Lifelong? with Acceptable Risks?
The GLP-1/GIP/TBD pharmaceutical class seems to be the latest example of potentially major health improvements—but with significant health downsides and problematic health cost-benefits.
These drugs are actually a treatment rather than early prevention, though this drug class does help prevent obesity from becoming severe obesity, and prediabetes from becoming diabetes. They can even bring people back to normal weight and blood sugar levels, with reduced risks of heart disease, diabetes and other chronic conditions.
For the time being, at least, these pharmaceuticals can cost $500/month or more, even after discounts.
(Non-FDA-approved compounded versions have been available for around $200-400 per month, but only for as long as FDA-approved brand names are considered to be in shortage by the FDA. This shortage exemption is expiring, at which point there will likely be far fewer low cost options—until competition and/or government intervention push prices back down again. Public plans such as Medicare or private insurance plans such as Blue Cross Blue Shield could negotiate or subsidize lower costs for individuals taking these meds. But ultimately taxpayers and insurance subscribers pay the real cost with their taxes and premiums.)
Risks of Stopping (& Starting) Lifelong Prescriptions
In addition, even though the first customers using GLP-1’s specifically for weight loss were particularly highly motivated, and often even spending their own money—the vast majority stopped their prescriptions within the first two years.
Unfortunately, 2/3 of those who stop will regain most of their weight within a year or two, and then likely face the same health risks they had before.
In addition, if they continue this “yo-yo” weight-loss weight-gain weight-loss “weight-cycling”, which seems very likely for the many individuals who can barely afford these meds, this weight-cycling creates additional new health risks beyond the risks of obesity or diabetes.
As with statins and hypertension prescriptions, diabetes and obesity prescriptions are supposed to be lifelong—unless the individual permanently changes his or her lifestyle with healthier nutrition and more physical activity.
However, many individuals with chronic conditions are not actually using the pharmaceuticals, which would help manage their disease.
For example, in spite of the availability of effective hypertension prescriptions and the risks of stroke and heart problems, only 25% of people with high blood pressure have it under control.
So it is quite possible that the majority of the nearly 100 million Americans with prediabetes will not take diabetes prevention GLP-1’s on a regular enough basis to prevent progression to diabetes—even if they could afford to take the meds.
Known & Unknown/Long-term Side Effects
The potential side effects of GLP-1’s are also very troublesome.
We have heard a lot about patients experiencing nausea, but have otherwise been reassured that GLP-1’s seem to be “safe and effective.”
However, the high muscle loss that goes along with the fat weight loss is risky, especially given the existing lack of musculoskeletal fitness and physical activity among most of the population needing obesity and prediabetes meds.
In other words, there is good news/bad news with these meds:
People lose a lot of muscle along with the fat. This creates a new set of risks, which counterbalances some of the benefits for a number of people.
Muscle loss could increase back and other musculoskeletal issues, which are already one of our largest health cost and productivity/economic problems.
It is also worth noting that another long-term hormone-based treatment, oral contraceptives, turned out decades later to result in increased risk of breast and some other cancers.
Risks of Starting Meds in Childhood
In addition to risks for adults: since prediabetes is starting so early in life, with 1 in 3 teens having prediabetes already, the medical community is starting to adopt a standard of care recommending GLP-1s even in adolescence.
That’s just the nature of how our health system works. Kids are not developing healthy enough habits at home or at school, so doctors feel they have “no choice” but to put the kids on what will (for those who can afford it) become a lifelong dependency.
Tragically, using such powerful drugs during puberty and adolescent development could create a range of unintended negative consequences, including negative impacts on bone mineralization, muscle growth and brain & behavioral development.
“
During that time [adolescence/puberty] you get bone mineralization and you get muscle development and you probably get changes in your brain and behavior, which are related to energy balance… By the time you're a young adult or beyond, you can't do that again." It's not clear whether GLP-1 use in childhood or adolescence could have an impact on long-term development. And that's exactly Cooper's point. "What's the long-term effect? Nobody knows. So this is my concern, that we should be very very careful about using these medications [for children].
– Dr. Dan Cooper, Professor of Pediatrics, UC-Irvine School of Medicine, Medicalxpress.com.
True, the potential mental and physical health benefits of reducing obesity, particularly severe obesity, in adolescence are significant. But without adequate physical activity and heathier nutrition, medical professionals, parents and teens will have to make scary “triage” choices between different combinations of mental and physical health risks.
It would be so much better, if
children were physically active and had healthier nutrition ever since they began school, with better mental and physical health through their own lifestyle, so that they didn’t need to consider GLP-1s etc.
Lifelong health habits are set in childhood. By not acting early, we remove by far the best long-term health solution for our kids.
Risk of Low ROI
As for the cost-benefits of GLP-1’s et al, at current prices the “return on investment” (ROI) does not yet appear compelling.
Longer term, with many promising Miracle Drugs 2.0 in the pipeline, competition will indeed drive prices down. Until then, only more extreme cases of severe obesity with other chronic diseases may have a ROI that cost-justifies $500-1000/month or more.
A Very Healthy Alternative
In the meantime, we need to do much more—and we can with Healthy Students Healthy State.
Tragically, using such powerful drugs during puberty and adolescent development could create a range of unintended negative consequences, including negative impacts on bone mineralization, muscle growth and brain & behavioral development.