Freakonomics Radio Episode 615: "Is Ozempic as Magical as It Sounds?"

Release Date: December 12, 2024
Host: Freakonomics Radio + Stitcher
Guests: Dr. Ezekiel Emanuel, Oncologist and Healthcare Policymaker

Introduction to GLP1 Drugs and Ozempic

The episode delves into the meteoric rise of GLP1 drugs, particularly focusing on Ozempic, a medication originally developed to treat type 2 diabetes but now renowned for its significant weight loss benefits. These drugs mimic the hormone glucagon-like peptide-1 (GLP1), aiding in insulin production and appetite suppression. As Stephen Dubner introduces, “[Ozempic] is one of a group of drugs known as GLP1s, and many Americans would agree that they are magic” (01:55).

The Science Behind GLP1s

Dr. Ezekiel Emanuel provides an in-depth explanation of how GLP1s work. Initially intended to manage blood sugar levels in diabetic patients, these drugs were discovered to also significantly reduce appetite and promote weight loss. “Ozempic and Wegovy, another GLP drug made by Novo Nordisk and which is authorized to treat obesity, will do a combined $65 billion in global sales this year” (04:16). Emanuel highlights the multifaceted benefits of GLP1s, including protection against heart disease, kidney disease, and even potential reductions in cancer risk linked to obesity and diabetes.

Emanuel’s Insights on GLP1 Adoption and Skepticism

Emanuel emphasizes the enthusiastic adoption of GLP1 drugs despite uncertainties about their long-term effects. “Even though researchers don't know much about the long term effects of GLPs, whether they remain effective over time, whether they have serious side effects, the take up has been enthusiastic” (04:34). He cautions about side effects such as nausea, pancreatitis, and cosmetic changes like hollow cheeks (12:11), underscoring the necessity for selective usage rather than widespread, unregulated availability.

Insurance Coverage and Economic Implications

A significant portion of the discussion centers on the high cost of GLP1 drugs in the U.S., often exceeding $1,000 per month, and the inconsistent insurance coverage. Emanuel criticizes the current insurance system, explaining, “We’ve created a system that perfectly disincentivizes long term investments” (05:47), leading to limited accessibility primarily for affluent individuals. The conversation extends to Emanuel's recent Lancet paper, which reviews GLP1 policies across 13 high-income countries. While most countries cover GLP1s for diabetes, only a few offer reimbursement for weight management, citing outdated cost-effectiveness metrics (30:05).

Policy Recommendations and Ethical Considerations

Emanuel advocates for a subscription-based model with drug companies to ensure affordability and accessibility. “If I were in charge, I would go to these drug companies and I would say, listen, let’s get a subscription model” (32:03). He underscores the ethical imperative to prioritize patients who suffer the most from obesity and related conditions, arguing that current policies disproportionately exclude those in dire need.

Impact of GLP1s on Public Health and Society

The episode explores the broader societal implications of widespread GLP1 use. Emanuel discusses the importance of addressing obesity through public health measures, such as improving diet and increasing physical activity, rather than relying solely on pharmaceutical interventions. He states, “We need to invest more in the public health of our children and encouraging their parents to change their diet” (34:03). The conversation also touches on the potential behavioral changes and social shifts resulting from the GLP1 revolution.

Future of Healthcare and Technological Advancements

Looking ahead, Emanuel shares his views on the future of medicine, emphasizing the need for public and private collaboration in research and healthcare delivery. He acknowledges the promise of AI and machine learning in improving medical diagnostics and access but notes the challenges in scaling these technologies equitably. “I do think the biggest advantage is going to be in access people who can’t get to the doctor” (45:12).

Reflections on the Affordable Care Act

The discussion shifts to Emanuel’s involvement with the Affordable Care Act (ACA), assessing its impact on healthcare coverage and spending. He praises the ACA for significantly increasing insurance coverage and reducing healthcare spending growth relative to GDP. However, he critiques ongoing issues like high out-of-pocket costs and systemic inefficiencies. “We spend ... $13,000 per person. So yes, we’re burning lots of money that we shouldn’t be burning” (40:05).

Personal Insights and Ethical Stance

In a more personal segment, Emanuel reflects on his life goals and ethical beliefs, including his controversial stance on end-of-life care. He explains, “I’m not forswearing all medical care. It was really about life saving people” (56:09) and emphasizes the importance of empathy and meaningful engagement in life over mere longevity.

Notable Quotes:

• Ezekiel Emanuel on Drug Benefits:
  “[Ozempic] is really impactful, both in terms of decreasing weight. With Wegovy, you get about 15, 16% weight reduction” (10:00).

• On Insurance Disincentives:
  “We’ve created a system that perfectly disincentivizes long term investments” (05:47).

• On Public Health Investments:
  “We need to invest more in the public health of our children and encouraging their parents to change their diet” (34:03).

• On Empathy and Personal Growth:
  “I can be a little too dismissive, and I would like to improve those. I’d like to be more empathetic to the people around me” (53:42).

Conclusion

The episode offers a comprehensive examination of the GLP1 drug revolution, highlighting both the transformative potential of drugs like Ozempic and the systemic challenges that impede their equitable distribution. Through Dr. Ezekiel Emanuel’s expert insights, listeners gain a nuanced understanding of the intersection between pharmaceutical innovation, healthcare policy, and ethical considerations. The conversation underscores the need for systemic reforms to harness the full benefits of medical advancements while ensuring accessibility and affordability for all.

Note: Timestamps in brackets refer to the point in the transcript where the quoted content appears.