Wegovy Isn’t A “Game Changer”, But An Update.
Source: Unsplash
By now, you may have heard about Wegovy, the first weight loss medication approved by the FDA since 2014. According to outlets, Wegovy is being discussed as a “game changer” for the field of “obesity medicine”, which sees it as a potential end to the imprecise science of weight loss.
Wegovy works by triggering insulin production and slowing the rate at which food leaves your stomach, creating a sense of fullness and satiety. Wegovy, plus a diet and exercise regimen, resulted in an average loss of 15% of participants’ initial weights in a recent study, with a third of participants losing 20% of their initial weight. For those who have been struggling to lose weight, this feels like amazing news. One study participant quoted in many articles about Wegovy says that she dropped 65 pounds over the course of 16 months after a lifetime of weight cycling. Once the study was over, she regained half of that weight back, but is considering going back on Wegovy once it’s available. With these promised results and an estimated retail price of $1,300 per prescription, the manufacturer Novo Nordisk stands to make a killing off Wegovy while bringing relief to people who have been discouraged in their weight loss efforts. However, probing beyond the veneer of recent media coverage reveals how Novo Nordisk uses its massive cache of resources to profit from our society’s fear of fat.
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The study demonstrating Wegovy’s effectiveness was published in the prestigious New England Journal of Medicine and has since been circulated through news articles about the drug. Clearly displayed at the bottom of the article are the words “Supported by Novo Nordisk”, followed by a section of detailed financial disclosures, describing each author’s affiliations with numerous pharmaceutical companies, as well as adjacent diet-focused companies, like WW International (formerly known as Weight Watchers). Every single one of the study’s 14 authors disclosed receiving funds of some kind from Novo Nordisk, although most listed long strings of industry giants like AstraZeneca, Johnson & Johnson, Eli Lilly, and Boehringer Ingelheim. Three authors, Dr. Marie T.D. Tran, Dr. Salvatore Calanna, and Niels Zeuthen, are employed by Novo Nordisk; Calanna and Zeuthen additionally own stock in the company. The authors also thank Lisa von Huth Smith, another Novo Nordisk employee, for “data representation of participant-reported outcomes and critical review of an earlier draft of the manuscript”, as well as a medical writing and editorial assistant who was also funded through the generosity of Novo Nordisk. However, companies don’t just bankroll the work of individual academics, actively shape the manuscripts that disseminate research findings, or, possibly, install their employees onto research teams. They also often provide grants to researchers’ respective universities. Advisory board fees from Novo Nordisk and WW International were paid to the University of Pennsylvania for Dr. Thomas Wadden, former director for the School of Medicine’s Center for Weight and Eating Disorders. Another author, Dr. Ildiko Lingvay, had various forms of support paid to UT Southwestern from Merck, Mylan Pharmaceuticals, Pfizer, and Novo Nordisk. It takes a village, indeed.
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The study’s corresponding author is Dr. Robert Kushner, a professor of medicine and medical education at the Northwestern University Feinberg School of Medicine. Kushner’s profile on the Centers for Medicare & Medicaid Services’ Open Payments website, which has data on payments made by drug and medical device companies to physicians and teaching hospitals from August 2013 to December 2019 reveals he received $448,239.47 in general payments and $150,980.14 in associated research funding from various pharmaceutical companies. Almost $400,000 of those general payments came from Novo Nordisk.
General payments are for expenses like consulting fees, covered travel and lodging, food, and “services other than consulting”, like speaking engagements. Associated research payments are for studies where the physician in question is named as a principal investigator. From 2013 to 2019, Novo Nordisk sent over $150 million in general payments and over $85 million in research payments to physicians and teaching hospitals. Another of their recipients was Dr. Harold Bays, the medical director of the Louisville Metabolic and Atherosclerosis Research Center as well as the chief science officer of the Obesity Medicine Association (OMA), who also helped run studies for Wegovy. Bays received $816,301.95 in general payments from biomedical companies, as well as $7,034,903.42 in associated research funds between 2013 and 2019. Novo Nordisk sent him approximately $14,000 in general payments and $953,837 in associated research payments.
The Obesity Medicine Association has, understandably, spotlighted Bays’ work on Wegovy through social media and appeared in the press as proponents of the medication. Its members who have spoken to outlets about Wegovy, including President-Elect Ethan Lazarus, are typically identified as recipients of various “fees” from Novo Nordisk, but this often obscures the true depth of corporate influence on the organization. The Open Payments website also revealed that multiple members of OMA’s Board of Trustees have received thousands of dollars in general payments from Novo Nordisk. President Craig Primack, co-director and -founder of the Scottsdale Weight Loss Center, received $49,547.73 from Novo Nordisk and $213,639.11 in general payments from various pharmaceutical companies in total. Trustee Larry Richardson, former OMA president, chairman, fellow, and master fellow, received $87,114.74 from Novo Nordisk and $97,902.74 in general payments from 2015 to 2019.
President-Elect Lazarus, who received $258,730.34 in general payments from Novo Nordisk, is noted on the OMA’s website for his success advocating for the American Medical Association’s (AMA) recognition of “obesity as a disease” as OMA’s delegate to the Association in 2013. The AMA’s decision to classify “people with obesity” as diseased is known by weight stigma scholars and fat acceptance advocates to be a major development in fat stigma’s longtime presence in the United States and the sciences. As the largest professional association and lobby group for physicians and medical students in the US, the AMA’s declaration that “obesity” is a disease provided a ‘win’ for entities, like insurance companies and The Obesity Society, who had long reasoned classifying obesity as a disease would do more good than harm. However, as fat acceptance advocates and weight stigma scholars predicted and maintain, this move on the AMA’s behalf ignored the stigmatizing consequences of medicalizing body size and of endorsing weight loss, which is statistically unlikely and often harmful, as a disease “cure” .
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When the AMA joined others in calling “obesity” a disease, it did so while reasoning that “the financial and treatment arguments are particularly pertinent to the discussion of how classifying obesity as a disease might improve health outcomes”. The AMA noted “widespread recognition” of fat people as diseased could “result in greater investments by government and private sector to develop and reimburse obesity treatments”, as well as how this could complement ongoing interest in the implementation of a “limited use” FDA approval for certain drugs, like those made to “treat obesity”, which would make it harder for insurance companies to deny coverage for weight-related therapies. The organization’s overt interest in the financial impacts of the disease designation becomes less confusing with the knowledge that corporations have always had a hand in contemporary panic about the so called “obesity epidemic”. A 1997 article by Kitta MacPherson and Edward Silverman for the Newark Star-Ledger revealed “eight of the nine members of the National Institutes of Health task force on prevention and treatment of obesity have ties to the weight-loss industry, either as consultants to pharmaceutical companies, recipients of research money from them, or advisers to for-profit groups such as Weight Watchers.”
Financial disclosures may illuminate conflicts of interest like these, but disclosure only goes so far, if at all, to actually quell unethical behavior. This is especially true if there is a lack of regulatory action or sanctioning that results from behavior that is clearly unethical in an effort to prevent harm. For an example, one can consider Novo Nordisk’s 2017 scandal with another medication very similar to Wegovy. Four years ago, Novo Nordisk was ordered to pay $58.65 million to the federal government and state Medicaid programs for misleading physicians about the potential risk for developing medullary thyroid carcinoma (MTC), a rare form of cancer, while taking Victoza.
Victoza is another glucagon-like peptide 1 agonist, like Wegovy, sold for treatment of diabetes. It’s active drug is liraglutide, which is extremely similar to semaglutide, the active ingredient in Wegovy. Victoza is manufactured by Novo Nordisk, which rebranded it as Saxenda in the same way it rebranded Ozempic into Wegovy. Wegovy is Ozempic at a higher dosage just as Saxenda is Victoza just at a higher dosage. When the medication was approved in 2010, the FDA required Novo Nordisk to ensure that the potential risk of developing MTC was communicated clearly to physicians. Seven whistleblowers came forward alleging that some Novo Nordisk sales representatives downplayed the significance of the FDA’s requirement for disclosure, saying it was unimportant or in error.
According to the government’s complaint, Novo Nordisk actually provided the sales team with a training specifically intended for them to learn how to assuage any concerns about the FDA’s disclosure requirement during conversations with physicians. Following the training, sales representatives used tactics like claiming “physicians should not be concerned about MTC because it is easy to treat if a patient does get it” and stating that “the risk of MTC associated with Victoza is only applicable to rats and mice.” In 2011, Novo Nordisk was required by the FDA to conduct surveys with doctors to measure their awareness of the risks of MTC associated with Victoza, which revealed that only about half of primary care physicians were aware that Victoza had a boxed warning (the most serious warning given by the FDA, which Saxenda also has) and awareness was even lower among endocrinologists. Novo Nordisk was then required to draft a letter to primary care physicians properly informing them of the risks, which the FDA worked with them on. However, Novo Nordisk then directed its salespeople to pair the letters with a verbal message to physicians “intended to mislead them as to the purpose of the letter.” Even a recorded voicemail from Novo Nordisk’s Vice President of Marketing for Victoza was sent to the sales team, instructing them to “provide context”, “qualify with them that there are no new safety concerns”, and “transition to the promotional messaging”, ensuring that physicians were not aware of the risks of Victoza that the FDA had intended on being communicated through the letters. That year, Victoza prescriptions generated more than $1 billion in sales. In the aftermath of the settlement, Novo Nordisk continues to deny any wrongdoing and Victoza continues to be sold in the US and UK.
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While the consequences that corporatized science has on public health are always unfolding, fat people are particularly vulnerable to harm when capitalism and science mix. There is plenty of uproar from scientists when tobacco companies, for example, attempt to meddle in research for profit, but the antics of diet industry players are comparatively accepted. This is because weight stigma in science meshes incredibly well with the profit-seeking behaviors of companies like Novo Nordisk and other major stakeholders in the “war on obesity”. Many scientists are often encouraged by corporate sources of general and research funding to promote stigmatizing ideas about fatness, but, ultimately, corporate influence usually just reaffirms the biases that already shape science. Unless researchers face their deep seated biases against fat people, then corporations will continue to influence the bedrock of public health—its evidence base—and the wellbeing of people everywhere.
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