When you hear the term “summer blockbuster,” you think of a movie like the box-office juggernaut “Barbie.” However, there are other kinds of blockbusters, too—the kind that, in addition to raking in $16 billion in one year, can transform our behavior and our waistlines. I’m talking about the weight-loss drugs Ozempic and Wegovy (both semaglutide) from Novo Nordisk. The buzz around these two meds really kicked into overdrive this summer with the revelation of positive study findings such as semaglutide’s ability to cut cardiovascular events by 20 percent1 and give renewed vigor to heart-failure patients.2
The drugs’ success is affecting the business world, too, sending companies associated with diabetes therapy and obesity scrambling. For instance, the value of Medifast, a company that provides weight-loss programs, dropped 26 percent. Insulin-pump makers are also hurting, and the maker of the DaVinci robotic surgery system, which is used in bariatric procedures, says the drugs are cutting into patient demand—some patients just don’t need the surgery now.3
However, there are potential negatives with these wonder drugs. First, as pointed out in a recent JAMA commentary, the drugs’ success is hamstringing our desire to study the actual roots of obesity. Why do the hard work on the topic when patients can just get an injection? “Big pharma can come up with a billion dollars to take a promising drug through Phase III clinical trials without difficulty because the profits can be enormous,” wrote David S. Ludwig, MD, PhD, an endocrinologist and researcher at Boston Children’s Hospital, “whereas researchers trying to understand the environmental and dietary drivers of obesity must manage with a shoestring budget.”4
In ophthalmology, paradoxically, the increased use of semaglutide may result in increased complications related to diabetic retinopathy, according to the results of the SUSTAIN 6 trial, though increases in DR appear to be transient.
Probably the most pressing issue—as it almost always is—is cost. These drugs cost $10,000 to $15,000 per year, which has the potential to increase U.S. health-care spending by 50 percent.4 However, now there are rumblings that Medicare may start paying for the drugs for some patients—but analysts say that could be disastrous; at the drugs’ current cost, paying for 100 million obese patients could potentially bankrupt Medicare.3 Where will the money come from? Hopefully, if Medicare gets involved, CMS won’t start eyeing cataract surgery or other ophthalmic procedures, because everything in those arenas has been cut to the bone. The situation probably calls for proactive interactions with lawmakers to reinforce the idea that cataract surgery is a service that’s of tremendous value to patients. Maybe an ophthalmology blockbuster is in order?
I can see it now: “Cataract Surgery 2: This Time, It’s Personal.”
— Walter Bethke
Editor in Chief
1. Company communication, the SELECT Trial. https://tinyurl.com/ywejd92b.
2. Kosiborod MN., Abildstrøm SZ, Borlaug BA, et al. Semaglutide in patients with heart failure with preserved ejection fraction and obesity. NEJM 2023; Aug 25. [Epub ahead of print]. doi: 10.1056/NEJMoa2306963.
3. Wainer D. The Ozempic craze could put these companies on a crash diet. WSJ. August 18, 2023.
4. Powell A. Are new weight-loss drugs the answer to America's obesity problem? The Harvard Gazette. July 10, 2023. https://news.harvard.edu/gazette/story/2023/07/are-new-weight-loss-drugs-the-answer-to-americas-obesity-problem/.
