It’s not just obesity: drugs like Ozempic will change the world

It seems like every day brings more and more interesting news. The drugs attacked diabetes first. Then, with just one injection a week, they conquered obesity. They have now been found to be capable of treating cardiovascular and kidney diseases and are being tested for Alzheimer’s disease and addiction. It’s still early days, but receptor agonists GLP-1 They have all the ingredients to become one of the most successful classes of drugs in history. As they become cheaper and easier to use, they promise to radically improve the lives of more than a billion people, with profound implications for industry, the economy and society.

Within three years from the date of approval semaglutide for the treatment of obesity, has taken by storm USA. After decades of disappointing “miracle cures,” these drugs work. influencers Image-conscious and wealthy financiers are not its only users. Already, one in eight American adults takes GLP-1 medications. Novo Nordisk, semaglutide manufacturer, brand name Ozempic for diabetes and veg for weight loss, and Eli Lilly, which makes tirzepatide, a more effective alternative, have together added about $1 trillion in market value since 2021.

Now the action is expanding beyond the US. With more than two-fifths of the world’s population overweight or obese, the demand for GLP-1-based drugs is insatiable. Pharmaceutical companies are racing to make them work like pills that would be cheaper to produce than injections and reduce their side effects. Generic versions of older GLP-1 agonists are coming to market. Semaglutide will no longer be patented in Brazil, China and India

in 2026; eight such drugs are in development in China. This is very good. As incomes have risen in developing countries and lifestyles have become more sedentary, people’s waist sizes are catching up with those in the West.

Stopping obesity will be important. However, glp-1-based drugs promise to do much more. Overweight patients taking semaglutide have been found to suffer fewer heart attacks and strokes; Surprisingly, the benefits appear to be largely independent of how much weight is lost. Tirzepatide improves sleep apnea. Trials show that GLP-1 agonists reduce chronic kidney disease in diabetics, and there is evidence that they can reduce brain shrinkage and cognitive decline in Alzheimer’s disease. Medical records studies suggest they may also help with addiction; People already taking GLP-1 medications in the United States were less likely to overdose on opioids or abuse cannabis or alcohol. Researchers even quietly talk about its anti-aging effects.

How can one class of drugs do so much? As we explain in our report this week, drugs act not only in the gut, but also bind to receptors throughout the body and brain. The drugs appear to reduce inflammation and interact with mechanisms associated with cravings and reward. With each new discovery, researchers learn more about how the disease works and the connections between the body and brain.

Naturally, more research is needed. Although GLP-1 agonists have been used for diabetes for 20 years, some of the latest findings are based on observational studies and should be complemented by randomized trials. Patients may have to continue taking these medications throughout their lives, and their long-term benefits have yet to be quantified.

This also makes costs uncertain. The drugs are still expensive: in the USA, Tirzepatide costs more than $500 per month. Its immediate side effects, which may include nausea, pancreatitis, diarrhea, and muscle loss, can be unpleasant; the consequences of decades of taking them are uncertain. Some worry about the medicalization of everyday life and whether people will overeat knowing they may turn to medication.

However, with time, experimentation and innovation, the benefits will become more apparent and costs will decrease. Healthy habits and good public health advice will continue to be important. But doctors have long given up hope because nothing helps many obese people. If the drugs live up to their original promises, it would be perverse and cruel to deprive patients of drugs that could greatly improve their lives. Drugs can offer the same promise for addiction.

If we zoom out a little, the possibilities are exciting. In 2019, heart disease, stroke, diabetes, Alzheimer’s disease and kidney disease were among the top 10 leading causes of death worldwide. By 2050, as the world ages and healthcare improves in developing countries, these diseases will cost more. Last year, more than 100,000 Americans died from opioid overdoses and 180,000 died from alcohol.

For patients, new ways of using GLP-1 drugs will mean not only longer, healthier and more productive lives, but also happier ones. In a world of abundance, people give in to their impulses even when they know their behavior will be harmful in the long run. Although GLP-1 agonists may limit instant gratification, they show promise in ending compulsive food cravings and improving long-term health.

The total cost of prescribing these drugs can be enormous, but for governments it will reduce other costs: direct medical bills for obesity are $260 billion a year in the United States; Substance abuse is a huge burden on the criminal justice system. The state will receive less revenue from alcohol taxes, but income tax revenue will increase as the workforce becomes healthier.

Just as birth control pills encourage women to continue studying and working, GLP-1 drugs can lead to profound economic and social change by increasing productivity and freedom. Some business models may be disrupted. If cravings can be controlled, junk food companies, advertisers, and even drug dealers can shift their focus from quantity to quality. Social customs could evolve. In the West, thinness is valued as an ideal of beauty because it is difficult to achieve for many people, and obese people suffer discrimination and lower wages. If it’s easier to be thin, that might change. Obesity and addiction can be seen less as moral failings and more as treatable diseases. The LPG-1 revolution is just beginning, and its promises are tempting.

© 2024, The Economist Newspaper Limited. All rights reserved.