Separating science from morality in new anti-obesity drugs | Hello

A safe prediction at the moment is that medicine will prioritize advanced drugs that are more effective, but also more expensive. This will pose challenging dilemmas for public health systems, which must constantly weigh the value of life against the cost of saving it. Doctors call this screening – a futile attempt to obscure the real target. But it is our civic duty to gain a better understanding of the future we will inhabit and not tolerate such confusion. New anti-obesity drugs are a great example to use as we explore how to better understand our future.

Ozempic is the most prominent brand in this booming sector of the pharmaceutical industry. Although there are competing products, they mainly consist of dosage variations or similar molecules. The key ingredient in all of them is semaglutide, a drug that mimics the hormone GLP-1, which is naturally released in the gastrointestinal tract in response to a meal, creating a feeling of fullness and reducing the urge to eat. It also stimulates insulin secretion from the pancreas, effectively lowering blood sugar levels. As an analogue, semaglutide is an effective drug for type 2 diabetes, which is often associated with obesity.

Semaglutide also affects obesity itself. By mimicking a natural hormone, it comprehensively targets various mechanisms related to the body’s energy management, including hunger, satiety, metabolism, fat generation, and energy expenditure. This leads to more effective and permanent weight loss compared to previous drugs of this type. Ozempic quickly gained popularity, earning the nickname “the Hollywood drug” when Kim Kardashian, Oprah Winfrey and Elon Musk began endorsing it. News outlets and social media have been buzzing about it ever since.

But the label “Hollywood drug” doesn’t mean that Ozempic belongs in the realm of quantum psychology, of tricking your brain into achieving a personal goal. Semaglutide is not only effective against obesity and type 2 diabetes, but also reduces the risk of heart attack by 20% even in individuals without diabetes, and Science recently named anti-obesity drugs the scientific breakthrough of the year.

Scientists have also found that new anti-obesity drugs show potential to tackle addiction, Alzheimer’s and Parkinson’s. Treatment involves a weekly injection, costing approximately $225 each (without insurance) and may need to be continued indefinitely. Most prescription plans cover some or all of the cost of drugs like Ozempic when used to treat type 2 diabetes, but often do not cover weight loss. Here comes the dilemma.

The obesity debate carries an undeniable moral tone. People (especially public health officials) often hold prejudices that blame obese people for their condition. The common belief is that weight loss can be achieved simply by eating less and exercising more. However, this oversimplification fails to recognize complexities such as socio-economic factors. Economically disadvantaged families often depend on affordable but high-calorie options like triple-cheese double burgers, trans-fat-laden donuts, and bacon-and-pepperoni-filled pizzas. The appeal lies in their unmatched calorie/price ratio.

At the same time, we are constantly gaining a deeper understanding of many genetic diseases. These conditions can increase hunger, decrease satiety, predispose individuals to addictions, or directly impair the efficiency of adipogenesis—the process of converting food into body fat. In the past, these genes served us well during times of famine and deprivation. However, in our current era of excess and sedentary lifestyles, these genes have become adversaries. It’s just evolution, my friends.

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