This transcript has been edited for clarity.
Hi. I’m Art Caplan. I run the Division of Medical Ethics at NYU’s Grossman School of Medicine.
Who hasn’t heard about all these new injectable drugs currently revolutionizing the size of waistlines all over America and all over the world? Ozempic, Wegovy, Zepbound, Mounjaro— there’s a long list of these, and more are coming.
It is clear that there is an exploding demand for and usage of injectable drugs among those who are obese, diabetic, overweight, or just don’t want to become overweight, or some who are in jobs that demand weight control — think of those in the armed services, maybe in the performing arts, maybe people in sports.
How much? Consider just one company that makes two of these highly used drugs, the Danish pharma company Novo Nordisk. It has a current market value of over half a trillion dollars. It’s bigger than the entire economy now of Denmark. Denmark’s gross national product (GNP) last year grew roughly 2%. If you took out the sales of Novo Nordisk’s Wegovy and Ozempic, the GNP growth in Denmark would have been zero. We’re seeing huge amounts of money being spent on these drugs. That’s just one illustration.
Many other companies are building factories like crazy. I know investments are in the tens of billions of dollars to make more factories available. As former Senator Everett Dirksen of Illinois said many years ago, a billion here, a billion there, and pretty soon you’re talking about real money.
You have to recalibrate that often-invoked quote for today, because if you prescribe these injectable weight drugs for the billion people worldwide who are deemed dangerously obese, and the hundreds and hundreds of millions just in the US who are deemed dangerously obese or morbidly obese, you’re going to be spending trillions of dollars on these drugs.
There is a big ethics issue or set of issues that need to be thought about here. One is, they work. People have lost weight, and I think it’s clear that people with diabetes and those with heart disease have been helped by these drugs. I think many other people feel healthier because they are able to achieve something that no diet, no surgery, no lifestyle change was able to accomplish, which is to let them lose weight.
At the same time, there are ethical issues that are not getting full attention. One is cost, as I’ve already said. Are we going to really spend trillions on these drugs? The costs right now are just for the people who are using them to treat obesity, but it won’t be long before we’re going to go to prevention and prophylaxis. People will say that as soon as you start to put on a little weight, you should be on one of these drugs or their successor drugs in order to make sure that you don’t become overweight or obese. That’s a lot of money to spend.
Hidden behind that choice about whether to spend the money to control our weight is a subtle issue. The way we eat now really extracts a terrible toll on the planet. The injectable drugs so far look safe, although in the long run we may not be as sure because nobody’s really been on them for 10, 20, or 30 years, but let’s presume they are.
If we don’t change our agricultural and animal-raising practices, the planet is still being made sick by how we eat. If many of us continue to pursue diets that involve a large amount of animal protein, sugary beverages, and fatty foods, if we don’t modify our diet — even though the injectables can help us maintain weight despite what might be deemed by many doctors as poor diets, creating other health risks — we’re going to destroy the planet.
Most of our arable land is devoted to raising animals for food. The amount of water we use to grow crops to feed the animals that we then eat is gigantic. If you looked at runoff from farms where animals are, like pigs, chickens, cattle, goats, and so on, it is an enormous source of pollution for the planet, and so are the animals themselves through methane gases.
We’re killing the planet, if not us anymore. We may have the injectable drugs. But the planet needs to get a big agricultural shift, and we need to be thinking hard about how our diets ought to shift, even though perhaps we might be able to still indulge, or some of us still indulge, in foods that aren’t the best for us and are certainly not good for the planet.
I think we have a deep philosophical question raised by the drugs: How much does our lifestyle need to change if we’re all going to be on injectable drugs? Again, I’m not opposed to them, but I just think we have to think very hard about cost, long-term risk, and maybe long-term resistance builds up and they don’t work anymore.
Most importantly, we can’t continue to eat the way we do, even if we have drugs that help us not get so fat from eating the way we do, because it is just making the planet we live on sick.
I’m Art Caplan. I’m at the Division of Medical Ethics at NYU’s Grossman School of Medicine. Thanks for watching.
