In 1998, Viagra received FDA approval. A financial bonanza followed for its manufacturer, Pfizer, and later for its competitors. Although initially approved—and marketed—specifically for erectile dysfunction, Pfizer and later competitors used aggressive targeted marketing to catapult the drug from an erectile dysfunction treatment to a lifestyle pill pocketed by nervous 30-year-olds heading out on Internet dates.
The erectile dysfunction drugs market was valued at $2.6 billion in 2022 and is projected to reach $5.1 billion by 2032 Huge numbers of men get the drug online, skipping time-consuming and costly in-person doctor visits but often getting counterfeit varieties, after receiving a token sign-off by a doctor with who-knows-what expertise whom they never see again. This is dangerous since it leaves the underlying cause of sexual dysfunction undiagnosed and untreated.
Another drug is experiencing a similar meteoric explosion—only the downfall could be far worse. The injectable drug semaglutide, better known by trade names like Wegovy and Ozempic, is going to create an ethical and financial maelstrom that will make the downsides of Viagra’s history, with huge numbers of men not treated for their diabetes or heart disease, pale in comparison. The drug, alongside a cache of similar weight-loss medications, has become immensely popular over the past few years—the demand revealing cost issues, dubious marketing, questionable online sales and failures to address underlying causes of disease.
As we all know, many Americans are dangerously fat. The U.S. is the most obese nation on the planet, with 42 percent of adults considered obese. Even more of us qualify as overweight.
And the problem is getting worse. Obesity rates are rapidly increasing among children and adolescents, with nearly 20 percent having obesity—more than triple the number since the mid-1970s. It’s not just an American problem: obesity is a major public health challenge all over the world, with projections indicating one billion people will be obese by 2030. The main symptom of obesity is excessive body fat, which increases the risk of serious health problems like arthritis, diabetes and heart disease. To date nothing has slowed the growth of obesity in any nation—diets, calorie counting, pre-packaged meals, surgery, lifestyle coaching, exercise programs, group therapy or behavior modification efforts have done little curb the problem.
That is about to change.
As anyone conscious knows, an enormous breakthrough has occurred in the battle to lose weight. In 2021, the FDA approved Wegovy as the first injectable to specifically treat chronic diseases associated with obesity. It was meant for adults who were obese or overweight and who had at least one weight-related health condition such as high blood pressure, type 2 diabetes, or high cholesterol. The agency’s approval set off a rush for prescriptions, with Hollywood limelighters, who did not qualify as obese competing with diabetics, who did, for scarce initial supplies of the drug.
Other injectables that also help lower weight such as Ozempic, Mounjaro and Saxenda rapidly entered the market, along with various non–FDA approved products like Aqualyx, Lipodissolve and concoctions brewed up by specialty pharmacies and sketchy wellness clinics. Then, on November 8, 2023 the FDA granted Lilly, which manufactures Mounjaro, approval to sell/market its new drug Zepbound for chronic weight management. The race to sell is now on.
A nation, indeed a world, that had no idea what to do about obesity, including how to describe the problem without perpetuating stigma and bias on the afflicted, is launching into an era in which the majority of humanity may use injectables not just for obesity control but simply for maintaining normal weight while eating as they please. The trend echoes that of Viagra—a drug originally used for erectile dysfunction, now used regularly without batting an eye by those who are just nervous, not dysfiunctional. Being overweight will soon not be a source of stigma, shame or failure; the problem will diminish because of people taking a drug.
What is now approved for adults will soon be being used by other groups, with or without regulatory approval—by children, the worried well, those who need to maintain low weight for their jobs (in particular, members of the military). They may also be used to prevent weight gain by people who care deeply about their appearance, and those who won’t or can’t change their diets and lifestyles. This just about covers nearly every human on Earth.
There are real benefits to treating and preventing obesity. The disease costs our health care system $173 billion a year to treat its consequences. However, putting just this nation on injectables will also come at an enormous cost. A person’s monthly supply of an injectable costs about $1,000. Throw in a doctor visit or two and the treatment’s cost will be, conservatively, $15,000 per year. Let’s say, also conservatively, about a third of both obese and weight conscious people in the U.S. go on one of the injectables—that’s a hundred million of us. The tab then skyrockets to $1.5 trillion—that is per year. Even assuming competition drives down prices, and that there are fewer users, the medical war on weight will be the most expensive one ever fought.
If you don’t believe potential gigantic profit is fueling sales efforts, pay attention to Lilly’s effort to capture the market with its newly approved injectable. The pharmaceutical giant is going, for the first time ever, into direct-to-consumer telemarketing. Its new website LillyDirect is a one-stop shop that helps people find a doctor or telehealth provider, who will provide prescriptions online with the drugs sent directly to them, no pharmacy needed. If you wonder about the ethics of direct-to-consumer TV ads that funnel viewers to particular drugs, then this Web marketing strategy should raise even greater fears.
Lilly touts a marketing partnership with “independent” telehealth providers as a solution for improving accessibility for those who require the medication. CEO Dave Ricks says the new direct-to-consumer option isn’t about boosting sales; rather, he asserted, “This is about patient success. Our sales will be the same whether we sell it to CVS or Walgreens or sell it on our website.”
Maybe, but it is hard to imagine Lilly won’t make every effort to have its telehealth partners subtly push business toward their injectable. It is equally hard to imagine the partnership touting the glories or lower cost of competitors’ injectables. And who thinks the marketing message will be about “healthier dieting” or “more exercise” over jumping, as Viagra’s marketing did 25 years ago, to lifestyle? “Here’s a quick drug fix for your worries about weight, no need to give up on dessert!”
Saving money by driving down the costs of obesity through these new weight-loss drugs is worthwhile. But the savings won’t be immediate, and the costs of putting tens if not hundreds and hundreds of millions of people on injectable drugs will be.
Beyond costs are many other hugely problematic questions: What will be the consequences of using injectables for many years, if not a lifetime? What are the risks for children? How long will efficacy continue? What are the risks of long-term use?
Magic bullets for intractable problems are what patients and public health crave, but they are rarely as they seem. If the prior experience with Viagra reveals anything, it is that pricing, proper medical supervision, responsible marketing and attention to underlying causes go out the window when the chance to make a fortune is all but guaranteed.
This is an opinion and analysis article, and the views expressed by the author or authors are not necessarily those of Scientific American.