Ozempic's biggest side effect: Turning Denmark into a 'pharmastate'?
npr.org
npr.org
The issue with the suggestion in the article, having other companies grow faster, is that Novo is monstrous in size, easily one of Europe's most valuable companies. Catching up is an almost impossible task, as is leveling up any number of smaller companies to sizes that collectively could rival Novo Nordisk.
It’s a side effect of the ownership structure. Novo Nordisk is ultimately (mostly) owned by the Novo Nordisk Foundation through a holding group so any tax shenanigans at the for-profit just bite them in the ass at the foundation, which is already the wealthiest in the world.
For what I know its sales are only limited by how much they can produce. Figuratively everybody everywhere wants Ozempic but the supply is limited and the prices are too high (could be even higher though - people would still buy).
I think a big problem is that pharmacists have to be sure they can _continue_ giving it to a new patient.
If they’re waiting for Wegovy because it’s covered by insurance, unfortunately the pen is fixed dose on those.
Also, the supply constraint seems to be the injector pens, not the drug itself. Personally, I think the scarcity is intentional, or we'd be getting this stuff in vials and using regular syringes. Unless I'm misinformed, I don't think there's any bottleneck in the manufacture of semaglutide itself.
Almost certainly the case. I get semaglutide in a monthly vial for $250/month (off insurance). They provide regular syringes & wipes, but also recommend you order some spare in case any of the needles break (they are super thin). I know someone else getting Wegovy on insurance, and it's all pre-drawn injectors.
> The starter doses are hard to find. The larger doses are not.
My friend's experience was the opposite. When she moved to the higher doses, CVS was often unable to get it in, and she's had to ask her provider put in orders for the lower doses a few times because that was what they could get. I don't know specifically what does she's on though (I swear she said 7.5 once, which is close to the 8 you mention).
Ah that's unfortunate. I guess I shouldn't have concluded my experience was true everywhere. My insurance (PPO from a tech co) doesn't cover Wegovy even with approval (my PPO from a prior tech co did), so my doctor suggested that since I'm going out of pocket and I'm not at the max dose, going with the Ozempic 8mg pens but dialing less than the max would let me stretch it out further. If she's on Wegovy and paying out of pocket, you might pass along this info regarding Ozempic. This assumes she's not at the max dose, though. If she is, it's not cheaper.
You do need to research though (dropping two articles below). Orderly uses Hallandale pharmacy out of Florida., in fact a lot of the online clinics do. As an example, several clinics (such as Henry Meds) was selling "sodium semaglutide" (aka salt semaglutide) ordered through Hallandale that didn't really work for lots of people and there's lots of mix reviews based around that - not everyone was aware of what version they were getting. Also - not everyone is going to properly measure their dosage, which is why the pre-filled injectors the Novo brand provides is important.
FDA Article: https://www.fda.gov/drugs/postmarket-drug-safety-information... NPR Article: https://www.npr.org/sections/shots-health-news/2024/06/07/g-...
You can't order from the pharmacy directly, you need to go through a clinic to get a prescription and have it ordered, but this is the price the clinics pay, before they add their services on top of it.
https://partner.hallandalerx.com/pricing/2024-glp-1-pricing-...
They ship you some vials and a syringe. The name brand Ozempic just comes in autoinjector form like an epipen.
I am a 44 year old who has already had a heart attack (prevalence of Lp(a), not directly lifestyle related), but I am 30ish pounds overweight. My GP and my cardiologist both want me on Wegovy, but my insurance won't cover it. Fortunately, I'm spared from paying $1,000/mo by not being able to find it even if I wanted to.
I keep trying to get into one of the Cleveland Clinic trials for the drugs that rewrite your liver's instructions to prevent it from making Lp(a), but I haven't had much success with timing so far. If I do get into one of those trials, I want to get a tattoo with a "Genetically Modified Organism" logo :-D
There is no shortgage of semaglutide but there is a shortage of the delivery method. IIRC most of the hit drugs like viagra or ADHD medicine had a high chance of being just meth when bought from a pharmacy in Mexico.
28 pills Tadalafil (Cialis) = $30
https://www.farmaciasguadalajara.com/tadalafil-5-mg-28-table...
Amphetamine is hard to find in stock legally in Mexico and I've never seen shops claiming to sell that kind of pharmaceutical illegally. Meth pills? Sounds like a myth.
Every year Americans go to the border expecting Mexico to have a crazy free for all market for illegal pharmaceuticals and they are always left disappointed. What Mexico is good for are cheap over the counter versions of drugs that are annoying to get in the US like birth control (and dick pills) for no good reason.
Disagree, there have been a number of reports of the popular tourist drugs not being pure. In the case of Xanax/Adderall type drugs, they have found Fent/Meth in them. There are a few studies/reports like this over recent history. If the cartel is wanting to control avocados, why not create counterfeit drugs that are not pure?
There are definitely many pharmacies that advertise these types of drugs with a handy doctor to write a Rx if its needed.
I'm in great shape right now, in the middle of my healthy BMI range, would there be any benefit in using it for me ?
Not that I would, just curious.
https://www.cnn.com/2024/07/30/health/liraglutide-alzheimers...
> A small clinical trial suggests that drugs like Ozempic could potentially be used not just for diabetes and weight loss but to protect the brain, slowing the rate at which people with Alzheimer’s disease lose their ability to think clearly, remember things and perform daily activities. The results need to be borne out in larger trials, which are already underway, before the medicines could receive approval for the disease.
Note: I'm not a doctor, just someone who has been prescribed a similar medication.
If you don't need to fundamentally change your relationship with food, I don't see why you'd want to take it.
You are hinting that if only Novo Nordisk invested more in their production facilities, they could see much larger profits than their already astronomical ones they are seeing today.
Except that if Eli Lilly manages to scale up before them, and everyone can buy tirzepatide instead of semaglutide, then Novo Nordisk's customer base could dry up overnight.
> The pharmaceutical company Rexar reformulated their popular weight loss drug Obetrol following its mandatory withdrawal from the market in 1973
> In 1994, Richwood Pharmaceuticals acquired Rexar and began promoting Obetrol as a treatment for ADHD
It's worth reading https://en.wikipedia.org/wiki/Obetrol to understand why it isn't promoted for weight loss. In general, amphetamines are easily abused and can lead to long term health problems.
Because there are very good, fairly obvious reasons to prefer Ozempic over an amphetamine for weight loss.
I am really not the type to seek a “weight loss drug” so I don’t know the state of mind of those who do (big fan of the Maintenance Phase podcast!), it just seems to me if people want focus and weight loss at the same time they might want to consider it.
I see some “it’s an amphetamine” like that means it’s obviously bad. But I guess we all know that “glucagon-like peptide-1 receptor agonists” are totally fine, sure. I think I would posit that amphetamines are more well understood, but I’m no expert.
Certainly I could have realized it would lead to weight loss, I just never really thought of it that way. I can’t be the only one, and I am simply surprised it’s not a part of the broader conversation.
Here's the thing... Unless you (err, uhm) need an amphetamine, they really have nasty side effects and can lead to serious health problems.
IE, in the 1960s and 1970s they were used for weight loss, and they were pulled from the market for good reason. You can go do the digging needed to find out why, but the cliff notes reason is that amphetamines increase risk of heart attack, and for many people cause amphetamine psychosis when used for extended periods of time.
You'll both love this Joe Rogan Guest:
https://www.youtube.com/watch?v=yUsJIcqwARk
>>Norman Ohler is an author and screenwriter whose books include "Blitzed: Drugs in Nazi Germany," "The Bohemians: The Lovers Who Led Germany's Resistance Against the Nazis," and "Tripped: Nazi Germany, The CIA and the Dawn of the Psychedelic Age."
He talks a lot about the history of the making of and marketing and use of meth from its discovery and used by nazis, military, cia, etc...
Its fantasic.
adderall also has some extermely intolerable side effects for a lot of people
This doesn't have to happen. Many people (including me) happily stay on the same dose for years.
Most common fix is take magnesium supplements (threonate is best, oxide worst), but in general Adderall/Vyvanse effects are unusually sensitive to your diet.
People have used amphetamines and other stimulants for weight loss pretty much forever. The reason responsible medical professionals don't prescribe them for such (anymore) is because the risk/reward profile is bad. That doesn't mean it's bad if you need the stimulant -- that changes at least the reward side of the risk/reward tradeoff, so it's totally reasonable to come to a different determination.
The addiction potential for most amphetamines is through the roof and the side effect profiles are fairly intense and mostly negative for a lot of people.
Yes, we do know that amphetamines are bad for weight loss and we know that GLP-1is are good for weight loss. This isn't because amphetamine bad, GLP-1i good, but because we've done clinical trials and determined this to be true.
You will also get these effects with caffeine and cocaine.
…and Novo's patents on Ozempic expire within a decade, at which point it will probably have to fight against a wave of competition from generic-drug manufacturers.
Yup, view the pipeline here, I count 18 competitors...
Just speculation or got a link?
The pipeline is bursting and many are more effective (longer lasting\better form factor). I think I count 18 from the main chart in this research paper...
https://www.nature.com/articles/s41366-024-01473-y
From the conclusion...
>A new era for obesity treatment has commenced where pharmacotherapy with combinations of entero-pancreatic hormones approach the WL efficacy of bariatric surgery. Tirzepatide is the first dual agonist which has been approved for chronic weight management, but numerous other dual and/or triple agonists (cagrisema, retatrutide, mazdutide and survodutide) are also in phase 3 trials as potential treatments for obesity and its metabolic complications. Moreover, oral GLP-1 RA are also under development and will provide an alternative option.
>The plethora of efficacious obesity pharmacotherapies with different mechanisms of action will allow tailored treatment plans based on individual’s preference, comorbidities and treatment response. A percentage of people will not be able to tolerate the new pharmacotherapies or achieve the individualised goals and others may not have long-term access to these treatments. Combining different treatment modalities (including lifestyle interventions, pharmacotherapies and bariatric surgery) may support people to achieve individualised long-term goals, maximise health benefits and improve quality of life.
https://www.forbes.com/sites/roberthart/2024/07/16/ozempic-a...
2 years?
5 years?
10 years?
Do you have anything to back your comment?
https://www.uclahealth.org/news/release/counterfeit-pills-so...
Presumably you mean some sort of copy or clone because Ozempic or Mounjaro are not available over the counter in many countries.
(not that it matters, but our insurance wouldn't cover it)
My understanding is these GLP-1 are rather simple.
Fallacious thinking. It entirely ignores that labor is a market. If Novo Nordisk didn't exist, the labor would be used elsewhere, and who's to say that if used elsewhere it wouldn't be more profitable?
For all we know Novo Nordisk drastically under performs given the inputs and is actually holding the country back.
Disappointing seeing PR clap trap like this uncritically repeated by NPR.
In particular, the assertion that Novo Nordisk single handedly saved the country from recession is ridiculous.
Yet for some reason our species loves to come up with the most convoluted and expensive band-aid solutions rather than fixing a problem at its root. You can see the same with the whole atmospherical carbon-capture nonsense.
This is needlessly judgmental. This drug reduces the impulse to eat when you're not actually hungry. We need to think about obesity as more than just a lack of self control - normal people don't have the impulse to eat all of the time, and this stuff just brings you to that baseline. The weight loss is literally a side effect of the drug.
Do we? I've seen no stats and received no reasons to believe that the majority of obese people have such a distorted appetite that lack of willpower can't be inferred from their state. Also, exercise exists, even for large eaters.
But as always, I don't expect HN (like most places full of Overton prisoners) to react well to the now heretical notion that responsibility is more than a social construct and that the new religion of hedonism is wrong and destructive.
Anyway, "lack of willpower" isn't a cause nor does it fit the evidence very well. For instance, obesity in the US is geographical, correlated with lower altitudes[0], and it happens to animals as well as humans[1].
(Hint: it's caused by pollutants.)
[0] https://journals.plos.org/plosone/article?id=10.1371/journal...
[1] https://royalsocietypublishing.org/doi/abs/10.1098/rspb.2010...
As usual, correlation isn't causation and my best bet is that there are more cities at lower altitude, which means more sedentary and/or "Western" urban way of life (including eating bad food in too large quantities and office jobs).
Anyway, I don't think that anyone rational and arguing in good faith can say that low willpower isn't the predominant ingredient in the 1st world's obesity crisis. Especially anyone coming from said 1st world and having interacted with some of the "victims".
You might be confusing China with Japan. China has well known issues with obesity. Particularly the male population does look far from healthy in any major city. Women not so much, but that can mainly be attributed to beauty standards where having a slim figure is extremely important. Somewhere around ~40% of the male population and 25% of the female population in cities are overweight. For obesity it's 20% and 10%.[1]
Also I'm pretty sure that certain healthier groups hide the extent of the problem a lot. Be out and about at the right time and you'll wonder whether there's any healthy guys at all.
Why? Even ignoring that pollution argument for a minute, China was a place where I actually struggled to not overeat. If you live and work in a city, eating every major meal at restaurants/street food places is perfectly normal there, and almost all of that food is ultra-processed and full of chemicals that will make you want to keep eating. With cheap, near-instantaneous, and ubiquitous delivery of almost everything, there's no financial, time, or logistical reasons to prepare your own food even while at home. By comparison the conveniences that we have in the west (Uber et al.) are laughable, as are any complaints that it is oh-so-hard to find affordable healthy nutrition.
[1]https://dom-pubs.onlinelibrary.wiley.com/doi/10.1111/dom.152...
> "Western" urban way of life (including eating bad food in too large quantities and office jobs).
The issue is "too large quantities". What's the cause of that? It's been available for much longer than Americans have been obese.
Asians work longer hours, probably drink more, and are thin even though their extra walking shouldn't matter that much.
Gluttony is something as old as Christianity...
The point wasn't to be judgemental, it was commentary. I'm not free of vices either.
Modern problems require modern solutions!
A bit like the famous "programmers trying to solve societal issues through tech" thing.
I've heard this multiple times, yet I get the opposite picture at any supermarket. Buying about 14k calories of well-balanced food (oats, bread, high-protein cheeses, some meat, some veggies, fruit, nuts, noodles, yoghurt, milk, whatever) costs me around 30 Euro. Suppose I could've bought nothing but 5kg of the cheapest wiener sausages to get that same number of calories, but even they are 6 Euro/kg, so exactly the same price.
Getting 14k calories buying BigMacs at McDonald's would've cost me 150 Euro (6 Euro / 500kcal).
What the fuck are people buying to live unhealthily for less? Raw sugar? Since you also mentioned "most addictive", I now picture that people have diets consisting mostly of candy. Cheap candy.
The fact remains that a healthy diet is perfectly affordable - I can cover the basics for less than 150 Euro / month, and I'm not price conscious, even opting for the expensive options in the fruit/vegetable department. That amount of money is nothing in a country where the minimum wage is 1600 Euro / month (4k/mo average).
So yes, I'd tentatively agree on "addictive", but not so much on "expensive". At the end of the day humans are supposed to be 'addicted' to food - it's called hunger. Eating oats will get rid of that craving just like eating gummy bears will, but the gummy bears are just bad decision-making. You had to physically go out of your way to buy those over something else, just so you had them on you the next time you are hungry.
"Not just sweetened soda, but many other packaged foods sold in the US contain up to twice as much sugar as their European counterparts."
[https://medium.com/wise-well/us-foods-often-pack-more-sugar-...]
2) You have a fridge to put those spoil prone foods
3) You have time to prepare those foods
4) You have transportation for the raw foods or can drive them and buy in bulk
The people for whom no store/no car/no fridge is a problem are few and far between.
You've never lived in the hood I see.
Assuming that means "dollar store", fair. I live in a country where supermarkets are within walking distance for most of the population and vastly outnumber random convenience stores that sell mostly candy, so my perspective on this may be skewed.
> 2) You have a fridge to put those spoil prone foods
In a developed country everyone does. If you can afford an expensive weight loss drug, you probably own one too!
The local equivalent of craigslist has used full-sized fridges for 50 bucks and if you really need new, you can buy a crappy model on Amazon for 120 Euro.
From traveling a fair bit I can tell you that refrigeration was ubiquitous even in the poorest places I've visited.
> 3) You have time to prepare those foods
I hate cooking and preparing food. The most I do is eggs, noodles, or throwing some stuff in a store-bought soup base. That takes 15 minutes of cooking and 5 minutes of cleaning.
> 4) You have transportation for the raw foods or can drive them and buy in bulk
I have 4 supermarkets within a 15 minute walking distance. I don't own a car. The aforementioned shopping list feeds me for about a week and I can carry that home just fine. If I couldn't, I could have it delivered - add ten bucks, it's still nothing.
My grandparents live on the country side. They each only have one supermarket in walking distance, but they do own a car to get around anyways, since it's the countryside. They also could have their groceries delivered (and many old people do).
I recognize that there may be situations where you're just screwed and it's physically impossible to have a healthy diet, but that is true for maybe 0.05% of the population?
In any case if you can't have a healthy diet where you live, the solution isn't to start taking expensive drugs to compensate. If you have $1k/month to pay for Ozempic, you have money to move. Or get a car. Or a fridge. Ozempic would just be a band-aid and you're gonna bounce right back once you stop taking it.
So in conclusion, both the environment and the money argument is nonsense as long as we're talking about a stupidly expensive drug.
This story is largely the same with the thought model of fast food. You have no time and very limited money. Fast food is the cheapest immediate option to satisfy immediate needs at a minimum even if it fails hard against longer term ideal goals.
Your 20 minutes of cooking and cleaning is a larger luxury than you seem to acknowledge. It's also not in line with your previous comments about the kinds of food you're buying. Noodles and eggs and a store bought soup base is not nutritious or particularly satisfying. And of course the crushing burden of poverty just sucks. The relief that a fast food meal offers is non trivial. I don't eat at McDonalds, ever, but I'm not going to pretend that a burger and fries isn't going to be infinitely more rewarding than some basic noodles in salty packet broth. Mostly because of the protein and fat that is difficult to get in non fresh foods.
Look into food deserts if you're genuinely interested
US https://www.aecf.org/blog/exploring-americas-food-deserts
UK https://www.theguardian.com/society/2018/oct/12/more-than-a-...
What the fuck. I live in a developed country. Even the poorest most-overworked person I've ever met is perfectly able to find 20 minutes to cook. In fact said overworked people would have to, since that's the cheapest way to feed a family. What sort of unicorns are we talking about here.
> It's also not in line with your previous comments about the kinds of food you're buying. Noodles and eggs and a store bought soup base is not nutritious or particularly satisfying.
> [..] Mostly because of the protein and fat that is difficult to get in non fresh foods.
I don't really follow. The stuff I buy gets me all the nutrients I'd need in a day, as well as >30g of protein (a lot of it from Handkäse, which is ~30% protein, contains near zero fat and carbs, and is dirt cheap).
My selection of foods isn't random. Lacking nutrients or too much of the wrong thing makes you feel awful, and I hate feeling that way. Additionally most of what I buy will stay safe to eat for weeks, weeks, or even years. All that really goes bad quickly is fruit, veggies, or milk/yoghurt (depends). If you are physically unable to keep these three things stocked, you are not living in a developed country or require assisted living.
Also I really only cook maybe once a week. I just happen to enjoy the good old bread with cheeses and sliced meats well enough. If I really want a warm meal, I'll eat at a restaurant (10-20 bucks), but that's a luxury that is not a requirement to completing my diet at all.
> And of course the crushing burden of poverty just sucks.
A bit tangential at this point, but if you're paying $1k/month for Ozempic you are not feeling "the crushing burden of poverty".
> Look into food deserts if you're genuinely interested
I'm intellectually aware they exist, but they still bewilder me. If these things are really a problem for more than 1% of the population, then in my head I will downgrade the country in question from "developed" to "mostly developed" and exclude them from any argument talking about developed countries. Millions of people can't get the nutrients they need and their country is struggling to correct that. Maybe the World Food Program should help out? Get some foreign aid shipments? I'm joking of course, but clearly Ozempic isn't the answer here either.
In any case, let's limit the discussion to areas that can actually be considered developed, because clearly most people in overall developed countries don't live in food deserts and their obesity cannot be explained that way either. Bringing this up as a defense is like defending thieves as a whole because some of them have only stolen food while on the brink of starvation or their name may even be Robin Hood. What about the rest of them?
Willpower isn't evenly distributed. A drug that does something close to giving someone more willpower seems like a reasonable therapy compared to your unique solution of "just have more willpower like me".
Who are you, random internet weirdo, to indict seven billion people because of a company making and selling a drug. For a cranky libertarian hermit you sure have a lot to say about how the market is wrong.
When they have a similar solution for helping tamp down on severe alcoholism, I look forward to your equally ludicrous opinion about "people spending too much on alcohol" and "getting intake under control".
You couldn't even be bothered to cite one article that would prove spending more money is correlated with obesity. Luckily for me I have plenty that prove your claim is ridiculous on its face.
Drewnowski, Adam and SE Specter. “Poverty and obesity: the role of energy density and energy costs.” The American journal of clinical nutrition 79 1 (2004): 6-16 .
Ogden, Cynthia L, M. Carroll, Tala H. I. Fakhouri, Craig M. Hales, Cheryl D. Fryar, Xianfen Li and David S. Freedman. “Prevalence of Obesity Among Youths by Household Income and Education Level of Head of Household — United States 2011–2014.” Morbidity and Mortality Weekly Report 67 (2018): 186 - 189.
I'm one of those people, which makes me as qualified to say "we suck" as it makes you to claim the opposite.
> You couldn't even be bothered to cite one article that would prove spending more money is correlated with obesity.
Seriously? Way to twist my words. But anyways:
calories in - calories out - calories burned = weight gain
Also see my comment here: https://news.ycombinator.com/item?id=41133399