DealBook Summit – How Anti-Obesity Drugs are Redefining Pharma and Wellness

Host: Andrew Ross Sorkin, The New York Times
Guests: David Ricks (CEO, Eli Lilly) & Dr. Fatima Cody Stanford (Harvard Medical School; Obesity specialist)
Date Recorded: December 4, 2024

Episode Overview

This episode, recorded live at the New York Times DealBook Summit, centers on the transformative impact and future promise of GLP-1 receptor agonist drugs—like Ozempic, Mounjaro, and Wegovy—that are redefining the boundaries of pharmaceuticals, wellness, and human health. Host Andrew Ross Sorkin leads a dynamic conversation with David Ricks (Eli Lilly CEO) and Dr. Fatima Cody Stanford (obesity medicine expert and Harvard professor), exploring these drugs’ expanding clinical uses, societal and ethical considerations, accessibility challenges, and the changing language and stigma around obesity.

Key Discussion Points and Insights

1. The Evolution and Mechanisms of GLP-1 Drugs

• History & Misconceptions
  • GLP-1 drugs have been in development since 2005, initially for diabetes—contrary to the “new” narrative.
    • “We launched the first GLP1 medication in 2005. And when I say that, a lot of people find that odd because this feels like a very new story.” — David Ricks [02:39]
  • Early use showed unexpected weight loss signals, leading to their repurposing.
    • “What we saw in those initial studies was the signal for the loss of adiposity... Now, that medication... is a dual agonist... where we see 22.5% total body weight loss compared to the early days of exenatide, where we didn’t see that.” — Dr. Fatima Cody Stanford [03:42]
  • Eli Lilly alone is running 100 clinical trials on GLP-1’s potential in a slew of conditions.
• Mechanisms
  • GLP-1 is a gut hormone signaling satiety and influencing metabolism. Newer drugs (e.g., Tirzepatide — Mounjaro/Zepbound) combine GLP-1 with GIP for enhanced effects.
  • These medicines impact not only weight but metabolic health (lipids, glucose, heart health).

2. Expanding Therapeutic Promise: Beyond “Weight Loss Drugs”

• Cardiometabolic Conditions
  • Documented benefits in diabetes, obesity, cardiovascular disease, and more.
• Inflammation and Additional Uses
  • Emerging evidence points to anti-inflammatory effects (e.g., reductions in knee pain, possibly not just mechanical).
    • “Novo just did a very interesting study which showed knee pain reduction... the most effective drug for pain that we’ve seen in the last 20 years... also this anti inflammatory effect.” — David Ricks [05:22]
  • Ongoing studies: Parkinson’s, Alzheimer’s, liver disease, sleep apnea, even substance use disorders and addiction.
    • “We’re going to see different disease processes begin to come into the mix... alcohol use disorder, opioid use disorder... Parkinsonism, Alzheimer’s disease.” — Dr. Fatima Cody Stanford [15:05]

3. Language & Stigma: Person-First Framing for Obesity

• Stigma-Fighting Rhetoric
  • Dr. Stanford strongly advocates for “person-first” language: Say “people with obesity,” not “obese people.”
    • “Please delete the word obese out of your vocabulary. Okay... Obesity is a disease. People have obesity. We should be using person-first language and respecting these patients.” — Dr. Fatima Cody Stanford [06:52]
• Scope of the Problem
  • Recent Lancet data: 75% of Americans have overweight or obesity.
    • “That is three quarters of the country. When we... call persons obese, that is stigmatizing.” — Dr. Fatima Cody Stanford [07:52]

4. Accessibility, Inequity, and Market Dynamics

• Addressing Coverage and Cost Disparities
  • Many U.S. employers and insurers do not cover anti-obesity medications, despite obesity's disease status.
    • “The major problem we see is that many... employers... don’t cover... obesity medications, even though... it is a disease. That needs to change.” — David Ricks [08:53]
• International Price Comparisons & U.S. Pricing System
  • U.S. prices are higher (~$1069/mo) than UK/Japan, due to fragmentation and “archaic” payer system—real U.S. average (~$500) still much higher.
    • “It’s not about profiteering on the back of Americans. It’s about a system where we have to give a slice of every bit of our revenue all the way down and then fight with the patient to gain access.” — David Ricks [10:08]
• Prescribing Patterns and Equity
  • Most current users have severe obesity (average BMI 37), countering media notions of “vanity” usage by thin people.
  • During shortages, drugs should be prioritized for those most in need.
    • “In a shortage situation... we should direct the medicine to those who need it most.” — David Ricks [12:27]
  • But social disparities remain (e.g., predominance on Manhattan’s Upper East Side).

5. The Not-so-Distant Future: Widespread Use and Societal Shifts

• How Many Will Ultimately Use GLP-1 Therapies?
  • Likely to match or exceed statin use (~1/5th of Americans at peak), given health benefits. Actual figure limited by access and affordability.
    • “You can make an argument it could go higher than that... but there is... an affordability and payment issue.” — David Ricks [08:53]
• Pill Forms and New Indications
  • Oral versions and broader disease targets arriving soon.
    • “We have 11 ourselves [in the pipeline], there’s probably 60 in the industry... for all those uses you’ve mentioned.” — David Ricks [16:26]
• Potential Societal Impacts
  • Speculation around the downstream impact on industries (food, alcohol) and general human urges.
    • “Maybe the dream scenario here is we can use these medicines to control like our urges and including food, but maybe other things.” — David Ricks [18:27]
  • Host wonders: Should investors “short” food and alcohol companies?
    • “Maybe those behaviors which aren’t good for us, we’ll do less of and that will have consequences.” — David Ricks [17:30]

6. Risks, Side Effects, and What Comes Next

• Adverse Effects
  • GI upset/nausea during initiation, managed through titration; contraindicated in pancreatitis, not studied in pregnancy.
  • Muscle loss (“Ozempic face”) as a concern; new drugs may target muscle maintenance, plus lifestyle modifications encouraged.
    • “How do we encourage patients... in terms of building how much strength training... how much protein supplementation they are having... to ensure that they're retaining lean muscle?” — Dr. Fatima Cody Stanford [17:52]
• Caveats
  • “No drug is a panacea.” Caution on off-label use and need for physician oversight.
• Regulatory Uncertainty
  • Concerns voiced over political leadership affecting FDA and scientific integrity.
    • “FDA is the gold standard regulator in the world, and we’re the only country on earth that does primary data review... that’s a value to society we need to keep. We’ll argue that strongly with our new regulator.” — David Ricks [20:02]

Notable Quotes & Memorable Moments

• On the scope and potential of GLP-1s
  “When you think right now about the most significant innovations of our lifetime... one of them is, of course, the new blockbuster drug class of drugs called GLP1s.”
  — Andrew Ross Sorkin [01:08]

• On language and stigma
  “Obese is a label. Obesity is a disease. People have obesity. We should be using person-first language and respecting these patients.”
  — Dr. Fatima Cody Stanford [06:52]

• On U.S. drug pricing
  “It’s not about profiteering on the back of Americans. It’s about a system where we have to give a slice of every bit of our revenue all the way down and then fight with the patient to gain access to the product.”
  — David Ricks [10:08]

• Vision for GLP-1s beyond food
  “Maybe the dream scenario here is we can use these medicines to control our urges... not just food, but maybe other things. That would be, I think, a breakthrough across health.”
  — David Ricks [18:27]

Important Timestamps

| Timestamp | Segment/Topic | |-------------|------------------------------------------------------| | 01:08 | Sorkin introduces GLP-1s and outlines their potential| | 02:39 | Ricks explains the history and mechanisms of GLP-1s | | 03:42 | Dr. Stanford on early use for diabetes & weight loss | | 05:22 | Ricks and Stanford on inflammation and new indications| | 06:52 | Dr. Stanford on person-first language and stigma | | 07:56 | 75% of Americans have overweight or obesity | | 08:53 | Ricks predicts large-scale adoption—affordability issues| | 10:08 | Ricks on international vs. U.S. drug pricing issues | | 11:17 | Stanford on daily struggle for insurance coverage | | 12:27 | Addressing “vanity” prescriptions and equality of access| | 15:05 | Stanford lists upcoming indications for GLP-1s | | 16:26 | Side effects, upcoming muscle-building advancements | | 18:27 | Ricks draws analogy to the impact of oral contraception| | 19:18 | Ricks on regulatory challenges and the FDA |

Tone and Style

The discussion is candid, forward-looking, and occasionally humorous, especially when tackling misconceptions or the difficulties in American healthcare bureaucracy. Both guests blend scientific rigor with a clear advocacy for patient well-being and systemic change.

Summary Takeaways

GLP-1 drugs—years in the making but only now widely appreciated—are poised to reshape not just obesity care, but potentially the entire landscape of chronic disease management, addiction, and even behavioral health. With their broadening clinical promise comes intense debate over access, cost, and the cultural meaning of obesity itself. Pharma leaders and obesity experts alike foresee a near future where these therapies are as prevalent as statins, but only if regulators, insurers, and society can resolve who pays, who gets treated, and how we talk about weight, wellness, and health.

End of Summary