Here is a complete editorial on the virtues of GLP-1 receptor agonists, such as Ozempic and Wegovy. Regular readers will recognize it from our October 26, 2024 edition. We would like you to design an alternative cover to ours, with your own title, and send it in as an pdf attachment to [email protected] before Monday February 3.
The top three entries will each receive a copy of our new book “Cover Story,” which collects our 2024 covers week by week. Anyone can participate, so please pass this information on to your budding creators among your friends and family. Good luck!
Every day seems to bring more exciting news. First, the drugs fought diabetes. Then, with just one injection per week, they tackled obesity. They are now being discovered to treat cardiovascular and kidney disease and are being tested for Alzheimer’s disease and drug addiction. It’s still early, but GLP-1 receptor agonists have all the makings of one of the most effective classes of drugs in history. As they become cheaper and easier to use, they promise to dramatically improve the lives of more than a billion people, with profound consequences for industry, the economy and society.
In the three years since semaglutide was approved to treat obesity, it has taken America by storm. After decades of disappointing “miracle cures,” these drugs work. Image-conscious influencers and well-heeled financiers are not their only users. Already one in eight American adults has followed GLP-1 medications. Novo Nordisk, maker of semaglutide, which marketed Ozempic for diabetes and Wegovy for weight loss, and Eli Lilly, which makes tirzepatide, a more effective alternative, have together added about $1 trillion in market value since 2021 .
The action now extends beyond America. With more than two-fifths of the world’s population being overweight or obese, the demand for GLP-1 drug is voracious. Pharmaceutical companies are racing to make them work in pill form, which would be cheaper to produce than vaccines, and to reduce their side effects. Generic versions for older ones GLP-1 agonists arrive on the market. The semaglutide patent will no longer be patented in Brazil, China and India in 2026; eight of these drugs are in preparation in China. It’s also good. As incomes have risen in developing countries and life has become more sedentary, people’s waist sizes are catching up with those of Westerners.
Reducing obesity would be significant. Again GLP-1 drugs promise to do much more. Overweight patients on semaglutide have been found to suffer fewer heart attacks and strokes; Surprisingly, the benefits appear largely independent of the amount of weight lost. Tirzepatide improves sleep apnea. The tests show that GLP-1 agonists reduce chronic kidney disease in diabetics; and there is some evidence that they may reduce brain shrinkage and cognitive decline associated with Alzheimer’s disease. Health records studies suggest they can also help with addictions; people already connected GLP-1 in America, drugs were less likely to overdose on opioids or abuse cannabis or alcohol. Researchers even talk, in hushed tones, about their anti-aging effects.
How can one class of drugs do so much? As our briefing this week explains, drugs not only work in the gut, but they also bind to receptors throughout the body and in the brain. The medications appear to reduce inflammation and interact with mechanisms related to cravings and feelings of reward. With each new discovery, researchers learn more about how the disease works and the connections between the body and the brain.
Naturally, more work is needed. Although GLS-1 agonists have been used in diabetes for 20 years, some of the most recent findings are based on observational studies and will need to be supplemented by randomized trials. Patients may need to continue taking these medications throughout their lives, and their long-term benefits have not yet been quantified.
This also makes costs uncertain. For now, the drugs are expensive: tirzepatide costs more than $500 a month in the United States. Their immediate side effects, which can include nausea, pancreatitis, diarrhea, and muscle loss, can be off-putting; the effects of decades of intake are uncertain. Some worry about the medicalization of daily life and the fear that people will binge, knowing they can resort to a cure.
Yet with time, experimentation and innovation, the benefits will become more evident and the costs will decrease. Healthy habits and good public health advice will remain important. But practitioners have long despaired that nothing works for many obese people. If the drugs deliver on their initial promises, it would be perverse and cruel to deprive patients of medications that could significantly improve their lives. Drugs could hold the same promise when it comes to addiction.
Take a step back and the possibilities are exciting. In 2019, heart disease, stroke, diabetes, Alzheimer’s disease, and kidney disease were among the top ten causes of death worldwide. By 2050, as the world ages and health care in developing countries improves, these diseases will claim even more lives. Last year, more than 100,000 Americans were killed by opioid overdoses and 180,000 died from alcohol.
For patients, new uses of GLP-1 would mean not only a longer, healthier and more productive life, but also a happier life. In a world of abundance, people succumb to their impulses even if they know their behavior is harmful in the long run. Although GLP-1 agonists can limit the pleasure of instant gratification, they promise to stop intrusive cravings and improve long-term health.
The total bill for prescribing these drugs could be enormous. Yet for governments, it would reduce other costs: the direct medical bill linked to obesity alone amounts to $260 billion per year in America; Substance abuse places a huge burden on the criminal justice system. The state would collect less revenue from alcohol taxes, but income tax revenue would increase as the workforce becomes healthier.
Less is more
Just as the birth control pill encouraged women to continue their education and work, so too GLP-1 drugs could lead to profound economic and social changes by improving productivity and freedom. Certain economic models could be disrupted. If cravings can be controlled, junk food companies, advertisers, and even drug dealers could focus more on quality than quantity. Social mores could change. In the West, thinness is considered the ideal of beauty because for many it is hard-won, while obese people suffer discrimination and lower wages. If it’s easier to be thin, that might change. Obesity and addiction are less often seen as moral failures, but as diseases that can be treated. THE GLPThe -1 revolution has only just begun. His promise is tempting. ■
