Business Wars: Ozempic Wars | The Hundred-Year Duel | Episode 1
Date: November 19, 2025
Host: David Brown (Wondery)

Episode Overview

Main Theme:
This episode kicks off the "Ozempic Wars," the story of a high-stakes rivalry between two pharmaceutical giants—Novo Nordisk and Eli Lilly—that has defined diabetes and weight-loss drugs for over a century. With the rise of Ozempic and Wegovy (semaglutide-based drugs) and the entry of Eli Lilly’s Mounjaro, this episode explores the roots, scientific rivalry, explosive cultural impact, regulatory dilemmas, and market turmoil driven by unprecedented demand and a shadow economy of counterfeit drugs.

Key Discussion Points & Insights

1. The Counterfeit Crisis and FDA Crackdown

• Opening Scene [00:10]:
  The episode begins dramatically, describing an FDA raid in a Cincinnati shipping yard where agents uncover 17,000 vials labeled "semaglutide"—potentially hazardous, counterfeit versions of Ozempic, destined for sale through shady online pharmacies.
• Public Safety and Profit at Risk:
  Both the FDA and Novo Nordisk are desperate to remove these knockoffs, which not only endanger customers but also undermine years of pharmaceutical research, consumer trust, and business profits.

2. The Century-Long Rivalry: Novo Nordisk vs. Eli Lilly

• Origins [04:38]:
  • Novo Nordisk and Eli Lilly both began mass-production of insulin in 1923, sparking a competitive relationship that remains foundational in diabetes treatment.
  • "From day one, Eli Lilly and Nordisk were rivals." – David Brown [05:33]
• GLP-1 Race:
  In the 1980s, both companies shift focus to the glucagon-like peptide 1 (GLP-1) hormone, pivotal for regulating blood sugar and appetite.
  • Breakthrough:
    • Scientist Lata Bier Knudsen at Novo Nordisk solves the issue of GLP-1’s short half-life, enabling development of longer-lasting drugs ([09:15]).

3. Innovation and Escalation in Diabetes and Weight-Loss Drugs

• Breakthrough Drugs:
  • Eli Lilly partners with Amylin for Byetta (2005):
    "Eli Lilly gets there first... the first ever GLP1 drug approved for the treatment of type 2 diabetes." [12:44]
  • Novo Nordisk Responds with Victoza (2010):
    "It's an improvement... only requires one injection a day." [13:25]
  • Ozempic (2017):
    Researchers at Novo Nordisk create semaglutide, a synthetic GLP-1 with a longer half-life, reducing injections to once weekly—a crucial leap for diabetes patients.
    • "Turning one shot a day into one shot a week, that's not just a minor perk. It's a different life for some people." – David Brown [14:46]

4. From Diabetes to Weight Loss—A Cultural Shift

• Marketing Tactic:
  Ozempic’s initial commercials hint at weight loss, though labeled as a diabetes drug, creating demand among non-diabetic patients.
  • "What you hint at is what people hear." – David Brown [16:11]
• Novo Nordisk Weighs Risks:
  Internally, executives debate pivoting to the riskier but more lucrative diet drug market, wary of past disasters like Fen-Phen ([17:49]).
  • "Do we really want to go down this road? ... The moment we lean into weight loss, we're inviting scrutiny..." – Novo Nordisk executive recreation [18:30]

5. Wegovy: A Gamble That Paid Off

• Pandemic as Catalyst:
  The COVID-19 pandemic highlights the health risks of obesity, helping push regulatory approval for a higher-dose, weight-loss-specific formulation: Wegovy ([21:22]).
• Wegovy’s Clinical Impact:
  • Patients lose up to 20% of their body weight in trials; previously, weight-loss drugs managed only 8%.
  • "People who take the injections end up eating around 20% to 30% fewer calories each day… Over a third of people lost up to 20% of their body weight." – David Brown [22:49]

6. Supply, Status, and the Rise of a Shadow Market

• Soaring Demand, Soaring Prices ([24:47]):
  With U.S. insurance rarely covering weight-loss prescriptions, Wegovy (and, by association, Ozempic) becomes a status symbol among the wealthy and celebrities.
  • "So it quickly gets a reputation as a status symbol, a luxury drug for the rich and famous." [26:23]
  • Elon Musk credits "fasting and Wegovy" for his weight loss [27:42]
• Novo Nordisk Struggles to Keep Up:
  By March 2022, FDA designates Wegovy as being in shortage, opening the door for copycat compounding pharmacies, some reputable, many dubious ([28:42]).
  • "When you can't meet demand, you don't just lose sales, you run the risk of creating your own competition. A shadow market." – David Brown [29:38]

7. Eli Lilly’s Challenge & Compounding Chaos

• Eli Lilly’s Mounjaro (May 2022):
  Enters the market, mimicking two hormones and quickly creates its own shortage, further fueling chaos ([31:17]).
  • "A full blown arms race to see which company can scale up production the fastest." [31:53]
• Risks of the Shadow Market:
  Copycat weight-loss drugs flood the internet; quality, safety, and legality are all questionable, but desperate demand persists.

8. Media Frenzy and Cultural Ubiquity

• Ozempic becomes a viral phenomenon ([33:12]):
  The hashtag #Ozempic garners over 270 million TikTok views, with “before and after” photos, side-effect warnings, and influencer buzz.
  • Andy Cohen: "Everyone in Hollywood seems to be on Ozempic." [34:35]
• Global Reach:
  U.K. introduces Wegovy to the National Health Service.

9. Scrutiny and Scandal in the U.K.

• The Guardian Investigation ([36:01]):
  Reports surface that Novo Nordisk covertly funded obesity experts and charities praising Wegovy on media, without disclosure.
  • "The lines between ethical education and marketing becomes blurred." [37:13]
    • Notable incident: An expert praised Wegovy on the BBC, failing to reveal his charity’s £3.6 million in Novo funding.
• Regulatory Fallout:
  Novo Nordisk is suspended from the U.K.’s pharmaceutical trade association, but sales remain unscathed ([38:30]).
  • "A punishment that's only been handed out eight times in 40 years. For many companies, this kind of rebuke could be devastating. Investors might panic, heads would roll. But Novo Nordisk's stock price barely wobbles." [38:45]

10. The Battle Isn’t Over—The Future

• Compounding Pharmacies Ramp Up:
  As long as shortages persist, compounding pharmacies exploit legal loopholes, producing close copies of semaglutide, sometimes with unsafe ingredients ([40:13]).
• Novo Nordisk’s Dilemma:
  If the company can’t stop counterfeits, it must instead outmaneuver them—trying to control the narrative and preserve public trust.
  • "If the company can't stop the fakes, it'll have to outmaneuver them." – David Brown [41:14]

Notable Quotes & Memorable Moments

• “Imitation is the sincerest form of flattery. And in business, imitation means opportunity and profit.” – David Brown [03:05]
• “What you hint at is what people hear. Oftentimes, marketing lives in the gaps between words.” – David Brown [16:11]
• “Turning one shot a day into one shot a week, that's not just a minor perk. It's a different life for some people… Remove a customer headache and you unlock demand you couldn't advertise your way into.” – David Brown [14:46]
• “When you can't meet demand, you don't just lose sales, you run the risk of creating your own competition. A shadow market.” – David Brown [29:38]
• “One bad vial could tank public trust in all GLP1 drugs. Jurgensen has to find a way...If the company can't stop the fakes, it'll have to outmaneuver them.” – David Brown [41:14]

Important Timestamps / Segments

• 00:10–03:05: Scene-setting—FDA raid on counterfeit semaglutide; backdrop for the episode’s stakes.
• 04:38–06:33: History and origins of the Novo Nordisk/Eli Lilly rivalry.
• 09:15–10:39: Knudsen’s scientific breakthrough at Novo Nordisk.
• 12:44–14:30: Arms race to the first GLP-1 drugs; Byetta and Victoza.
• 14:46–16:11: Ozempic’s impact and marketing ingenuity.
• 17:49–22:49: Internal Novo debate: Should Ozempic pivot to weight loss?
• 24:47–29:38: Supply crisis triggers copycat industry.
• 31:17–33:12: Eli Lilly’s Mounjaro launch and escalation of pharma "arms race."
• 33:12–35:10: Cultural explosion—Ozempic’s viral rise and celebrity endorsements.
• 36:01–38:45: UK media exposé and Novo Nordisk’s regulatory trouble.
• 40:13–41:14: Growing counterfeit crisis and Novo Nordisk’s next moves.

Conclusion: Tone & Relevance

The episode adopts its trademark Business Wars tone—wry, dramatic, and packed with narrative tension—while providing compelling insight into how a medical breakthrough spiraled into cultural mania, business turmoil, and regulatory gray zones. It deftly combines technical clarity, corporate intrigue, and sharp marketing lessons, making it essential listening (or reading) for anyone curious about the business, science, and ethics behind the world’s weight-loss drug revolution.

End of Episode 1 Summary – Ozempic Wars: The Hundred-Year Duel