Transcripts For CSPAN2 After 20240703

Thank you so much for joining me. Im so excited to talk about this book. This conversation about antiobesity medications and ozempic has been dominating the news in the us and its something that i cover every single day and its kept me quite busy. Like there is just constant news about this. So im actually i was really curious, you know, when you were writing this book, how did that factor to the writing process . Because i can imagine that, you know, in the in the process of writing this book, there was news and things were changing constantly. And i know that you addressed this the sort of questions that are still lingering out there. But, you know, was was it difficult to sort of render with the constant news flow about these drugs and yeah, i mean, that was a really big and fascinating challenge. Its like documenting a kind of explosion. And 47 of americans want to take these drugs. And were learning more and more about them with every day that comes. And i think it kind of fed into this wider approach that i had all these new developments, because i remember from the moment i learned about these drugs, i felt so divided about them. I dont remember any subject where i felt so conflicted, so when i learned about a topic i remember exactly the moment when i learned about them. It was the winter 2022, and it was that moment when the world was opening up again, after everything weve been through and i got invited to party, it was thrown by an oscar actor. Im not saying that just to name drop. Theres relevance to this and and i was the uber on the way there and id gained a lot of weight during lockdown and ive been quite the star and i was feeling a bit selfconscious. And then i suddenly remembered, oh, loads of people i know weight during the pandemic this going to be fascinating. Im going to go to this party, see loads of hollywood people with a bit of like chub on them. Right. Ill be some interesting and. I arrived and i started Walking Around and it was really weird. Not only are they not going away, everyone was like skinny. Everyone was gone. Everyone was markedly thinner than they had been before. And i was kind of Walking Around a bit of a daze and i bumped into a friend mine by the dance floor, and i said to her, wow, looks like everyone really did take up palazzos during lockdown. And she laughed at me and i didnt know why she was laughing. And she said, johann, you know, its not palazzos, right . And i had no idea what she was talking about as she pulled up on phone and ozempic pant. It was the first time i learned that we now a new form of weight loss drug that causes the average person who uses it to lose 15 of their body weight for the next. In this class drug, you actually get 24 loss of body weight on average staggering is going to be available next probably and as soon as i learned it i immediately thought well can see the benefits right you know im older now than my grandfather ever got to be because he died of a heart attack when he was 44. Lots of the in my family get Heart Disease i knew that obesity makes it much more likely youll get over 200 known diseases and complications. So i thought well if theres a drug that can actually reverse or hugely reduce obesity, thats going to have all sorts of advantages. But i also thought, wait a minute, wait a minute, ive seen this story before, right . Theres about every 20 years a new weight loss drug is announced. Were told its going to save the world. Huge numbers of people take it. We always up discovering it has some kind catastrophic side effect always gets pulled from the market, leaving a trail devastated people in its wake. I was also worried about body positivity, the progress weve made with that, with eating disorders. So i thought super, super conflicted, which is why i went on the big journey to write the book all over the world from iceland to minneapolis to japan to interview the leading experts on the drugs, leading critics of the drugs. And all through that journey. Like you say, were getting all these new developments. Were learning more every. So it was thrilling and daunting. Yeah. And what the experience like of, you know, like you said, youve traveled all over the world, interviewed you know, the leading experts, the people that were there at the very beginning of the discovery of glp one. But this is also a very personal journey for you throughout book and you know, your own friendships and your own experiences are weaved throughout the book. And what was that experience like . Because this is, you know, an issue that is highly stigmatized and, you know, was that a scary or difficult to sort of bury your own soul and your own experiences in this book . Yeah, theres so much emotion tied up with these topics with fear food, with obesity, with the new antiobesity drugs and and its a very charged and febrile. So i was dealing with you know, i thought if im going to write about these drugs, ive got to take them. So i was taking them pic and there was just the actual physical and psychological effects of taking ozempic. What pretty big. Then theres interviewing all the experts, realizing, oh, this is actually an experiment on millions of people and im one of the guinea pigs. And then theres the kind of effects on the culture that are playing out. I mean, to start with the first one with just the physical effects, it was the weirdest feeling. Ill never forget the second day i was on ozempic, i woke up and i was lying in bed and i thought, oh, i feel something strange. What is it . And i couldnt. I couldnt locate in my body what it was that felt strange. And then i suddenly realized i had woken up and i wasnt hungry. I dont remember that ever happening before in my life. I used to get woken up often with a kind of raging hunger, and i went to this diner just up the street from where i live, and i ordered what i used to order every morning for breakfast. Im slightly embarrassed to say, which was a huge brown with loads of chicken and loads of mayo in it. And i used to eat the whole thing and still be hungry. And on that morning i had like three or four mouthfuls and i was full. I didnt want any more fat when i left the diner. The woman who runs it, tatiana, the woman shouted after me, hey, are you okay . Because she was so puzzled that i left food and it really was like the kind of shutters had come down on my appetite. I was 80 less hungry than i had been before. I was full really fast. I later learned, of course, the science of why that was happening. Me but just, it was such a dramatic effect. I lost so much weight so quickly, lost about 42 pounds in a year. So i was sort of dealing with the physical transfer and the transformation in my habits, as well as absorbing years of my training, the sciences at Cambridge University to to really absorb the science around this into a deep dive into. It it was head spinning in a positive way in a negative way. They were real and incredible, high points, incredible, low points. And real intellectual excitement. Actually is going to have such a huge effect on not just the people, the drugs, obviously, which is going to be, i would predict, half of americans, ten years from now provided some of the really catastrophic side effects that im worried about dont end up being worse than we think. But also just just what its going to do to how we think these very deeply, as you say, very charged issues. And how did you figure out how to strike this balance of talking about potential benefits and also the potential risks . And what are some of those risks . I think . Actually, if you just look at the facts, people should be very wary of people whose response to these drugs, after looking at it in detail, is either, yeah, theyre going to save us all or boo that the devil. The truth is, this is really complicated and anyone whos in a position like i was, i was obese. Realistically was going to continue being obese. I had tried dieting a thousand times. I usually ended up fatter than i was at the start. Thats not true of everyone who tries diets. If you never tried diet, try it first. But most people, 90 of people are going diets. It doesnt work so realistically i was going to continue being obese. So really i realized i was facing two choices. There was. The risk of continuing to be obese with sadly all the Health Problems that that poses or the risks of these drugs. Right. And i think there is a kind of magic calculator that can tell you that. I think you have go down the risk of obesity that i lay out in magic pill and the 12 big risks that these these drugs and really look at them in relation to yourself. I guess the place to start though is i think before we get to the risks which im very concerned about and actually i think is to start with the benefits because the benefits are really significant. And if want to think about both the benefits and the risks of these drugs, i think it might help to look at apparel area of science. People have only been taking these drugs to treat obesity for a couple of years. Obviously for diabetes, theyve been taking them much longer. And so helps to look at a different a different area, which bariatric surgery up to now its been very hard to lose a lot weight and keep it off over the long term some people can just through calorie and exercise might come its actually one of the best analogies is with things like stomach stapling, gastric. And theres a few things we know about that for sure. This has been very well studied. The first thing we know is that bariatric surgery is a horrible, grueling nightmarish operation. One in 1000 people die. The operation, its no joke, but people go put themselves through that because of what happens next. If you reverse, youre obesity or massively reduce it through this surgery. The benefits to your health are staggering. In the seven years that follow the surgery, you are 6 less likely to die of a heart. You are 60 less likely to die of cancer. Youre 92 less likely to die of. Diabetes related causes. In fact, its so good for your that youre 40 less likely to die at all those seven years. So this fits with a much wider body of evidence. Obesity, sadly, should never be stigmatized, but is very bad for your health on average. Of course there are exceptions, but on average and reversing it massively improves health. And were seeing that with these drugs, right . If you these drugs and you started with a bmi higher than 27, you are 20 less likely to have a heart attack or in the next couple of years, which is a subject very close to my heart, literally very close to my heart. Right. So the benefits are very clear, but the risks are also very alarming. Some of them actually emerge from looking at bariatric surgery. So as i say, theres a big risk. But theres a really interesting other effect to bariatric. Surgery isnt often about if you have bariatric surgery in the aftermath, your risk of committing suicide almost quadruples and your risk of depression is really quite significant. 17 of people who have bariatric surgery need inpatient Psychiatric Care in the aftermath. And you think that seems really weird, right . Whats going on here . Why would that be . And i think its lots of reasons, but one which is very relevant to these drugs, we know a significant minority of people who use these drugs seem to be becoming depressed or this even concerns some people may become suicidal. You think, well, why would that why would that be . Theres a debate about other drugs affecting your brain. We know these drugs primarily work not on your gut, but your brain. I think there is something going on there. But actually, my own experience kind of help me to to think about this. I think whats happening for a lot of people and theres good evidence for this is. One of the things these drugs do is they radically interrupt your eating patterns. You cant eat like you did before. And i had a real epiphany about this i was in las vegas. Im writing a book about a series of crimes that been happening in vegas. Ive been working a long time. So i spend a lot of time there. And i was researching the murder of someone that i knew and really loved he was an amazing person. So it was very painful, as you can imagine. Very painful thing to be working on. Im really on autopilot. This was seven months into taking the drugs on autopilot. I went to a branch of kfc. Its the one on west sahara for the people in vegas. Its one of the grimmest kfc in the world and i went in, i ordered just instinctively to make myself feel better. I ordered what i would have ordered a year before a bucket of fried chicken, and i had it in front of me and i had a chicken drumstick and. Then i looked down at the food and i thought, oh, i cant eat this right. Like on ozempic cant overeat. You would you would throw up right . You cant comfy in the way that you did before. I remember very clearly thinking, oh, im just going to have to feel bad, right . I go through in the book the five psychological drivers of of overeating and a lot of them me it was eating. I realized that since i a small child, ive been using food to kind of numb my emotions, calm myself down. And when i couldnt do that in the long term, that was a good thing. It brought those to the surface. Ive tried to find better ways to deal with them, but it was a difficult transition. It was painful. I felt it was hurtful, was difficult, and i think that happens with bariatric surgery. I think that happens here. Its one of the many kind of unexpected effects that are emerging of these drugs. Yeah. And i mean, were learning about so many other unexpected effects. And, you know, what were the scientific surprises you discovered or the really interesting things that you discovered scientifically about these drugs . Well, delving into of the research and the scientists that have spent decades and dedicated their career to, you know, bringing these drugs life that so many surprises. Its a great question. And i think a lot of them relate to the 12 big risks associated with these drugs that i go through in the book. So, for example, one of them, if youre asking experts about safety in relation to these drugs, generally what theyll say and its an important point and that good scientists is actually, we know quite a lot about the short and medium term effects of these drugs because diabetics have been taking these drugs now for 18 years. Right. The people who dont know in addition, having these effects on your appetite, these drugs also stimulate the creation of insulin, which is what diabetics, both type one and type two. Diabetics need. So diabetics been taking them for a long time. And what the experts say is, well, if the drugs had some catastrophic short, medium term effect beyond the wellknown side effects like nausea, we would know by now, to put it more crudely, than they would you know, if the drugs made you grow horns, the diabetics would have grown horns now. And thats an important point. And it should give us some reassurance. But some other scientists said, well, wait a minute, if were going to base a lot of our confidence on the safety of these drugs when theyve been used by diabetics, lets dig a bit more deeply into the diabetics. Lets see whats going on there. So, for example, theres a brilliant expert in france, professor jeanluc faye. Hes at the University Hospital in montpellier who was commissioned by the french medicines to look into the safety of these drugs for the french market. And so he started looking at whats called the preclinical literature, the research on animals first noticed something really disturbing, which is that these drugs when theyre given to rats the active component, when its given to rats, it makes them much more likely develop Thyroid Cancer. And we know these drugs work by changing by stimulating a hormone called glp one that im sure well talk about more. And we know you have receptors for glp one, not just your gut and in your brain, but in your thyroid. So kind of make sense of your screen with glp one, it might screw with the thyroid. So what he did is he looked at the data, but he did a big analysis of the databases in france and he compared diabetics whove been using drugs between i think it was 2006 and 2012 to diabetics who had not been using these drugs but what otherwise similar and why he calculated this is contested. What he calculated is that these drugs make you 50 to 75 more likely to develop Thyroid Cancer. Now, its important understand what that doesnt mean. It doesnt mean if you take these drugs, you have a 50 to 75 chance of getting Thyroid Cancer. If that was the case, we would be having bonfires of ozempic all over the world. What it means is whatever your Thyroid Cancer risk was at the start, if hes right, the risk goes up by 50 to 75 . Now, Thyroid Cancer is relatively rare. 1. 2 of people get it in their lives. Nonetheless, its a big increase in that risk right now against that. And this is where you begin to see, again, the surprising here against that, some of the scientists said to me. Well, even if hes right, you got to compare that to the cancer risk just from being obese, you know, as Cancer Research uk, the biggest british cancer group, warns, when you carry excess weight in your body. That fat doesnt just sit. Its not inert, its active. It sends signals through your body and one of the signals that it sends is for your cells to divide more rapidly, which, of course, can cause cancer. This is why, in fact, obesity is one of the biggest causes of cancer here in the United States. And we dont think of it that way. You think, oh, my auntie died breast cancer, but actually obesity is may well be what killed your auntie. The obesity may well have triggered the breast cancer. Its not the cause of all of it, but its the cause of a lot of it. So, again, you see at every stage youve got to be weighing the complexity here. And i think people really need to go down the risk of obesity that i lay out in book and the 12 risks associated with the drugs and see, well, which of these apply to me . Some of them dont apply to me. Right. And one risk im really worried about is pregnancy. We know that when you give these the component in these drugs to rats, theyre much more likely to have fetuses with birth deformities. Right pregnant women are told not to use these drugs, but of course, some people dont know theyre going to get pregnant for all sorts of reasons. Right. And im very worried about that risk. That doesnt apply to me, obviously. But thats a thing im very worried about and im very worried about eating disorders. We already had an epidemic of eating disorders in this country that disproportionately obviously mostly young girls, eating disorders, experts are really worried about whats happening when young girls are getting hold of these drugs and using them to starve themselves. Theres a lot we can do to prevent that. I can talk about. So theres a very broad range of risks alongside the significant benefits. Yeah, i mean, theres theres a couple of different questions that i have now out of what have you, what you just said, but i mean, this idea and i know that this is something you touch in the book, the idea of weighing benefits versus risks and how thats sort of a different calculation. And for different populations. And here were talking about people, obesity, you know, whose bmi is over 30 or whose bmi is over 27. And they already have comorbidities. And they eligible to take these drugs. And for them the, you know, risk benefit calculation might be a little bit different. But were also seeing a ton of off label use here in the us and people who might not necessarily you know maybe shouldnt be taking these drugs are seeking them out and you know what did you learn and what did you discover about this sort of like shifting culture around these drugs and off label use in the us . Yeah, the worst moment for me in working on the book was a moment it was maybe three or four months into working on it. I was face time with my niece, sisters daughter, and shes called erin and shes the baby of my family. The only girl in that generation, and shes the youngest. So i know what makes more protective. Shes actually 19 now, but in my head shes always fixed as a six year old. And we were face timing and she was kind of making kind of complementary jokes like, you know, oh, i didnt know you had a jaw before. You didnt know you had a neck. And i was sort of preening and. And then she looked down and she said, will you get me some ozempic . And thought she was kidding because shes a perfectly healthy weight and always has been. And i suddenly realized she wasnt. And i thought, what am i doing . Im undermining every ive ever given her in her life, you know, about valuing herself, but not judging herself this way i thought i fed into this. Think you phrased it really well in the question and i think theres a big distinction between people who are obese or overweight who are taking these drugs to go down to a healthy weight. They still significant risks associated with that. But i think that is a wholly defensible decision. And i interviewed of people whod made that decision and have seen their health improve in the short to medium. But theres another group of people who are already healthy, weight or indeed skinny. I think about the people at that party that i went to that i mentioned at the start. None of them were overweight right at the start and who taking it to be super skinny and i dont judge anyone in that position that overwhelmingly women i dont want to does ridiculous demands bring this to you you know this much better than i do but theres nothing women can do this culture with their bodies that wont get them insulted and pressure and women are under staggering amounts of on that and im not judging anyone in this situation what. I would say, though, is what we do know is that if youre already a healthy weight or skinny and you take these drugs to be even skinnier, you could be triggering more people like my niece to get into that spiral. But but being more importantly, youre actually endangering your own health. So one of the things we know about these drugs, firstly, youre incurring all the 12 risks that i write about in the but with none of the Health Benefits. Right. So the cost benefit analysis, its all risk. No benefit. In addition, youre taking on another to your health. So as you age, you naturally lose muscle mass, which is the total amount of soft in your body. Its really important for things like, you know, getting out of a chair, climbing the stairs very important and and what these drugs do you naturally lose that for depressingly, for of 30 years onwards, you lose mass every year and and thats obviously, you know, natural process. But when you take these drugs or indeed when you lose weight in any way, bariatric surgery, when you lose huge amount of weight, generally you lose a lot of muscle mass as well. You dont just shed fat, you shed muscle mass. So what those people who are skinny, who are taking the drug to be super skinny are risking is that they will go into the aging process with very low levels of muscle mass. So as they lose it more and more, as they theyre really at risk of a wont show up much now they have big problems now but when theyre 670 their risk of if you have very low muscle mass when youre old, thats nightmarish. You can get a condition called sarcopenia, which means poverty of the flesh, where you just basically cant do much. You cant climb the stairs, you cant get out of a chair. If you fall over, youre much more likely to die. So the risk is that all these skinny people take it to be super thin that were sitting in train, a kind of timebomb that doesnt show up now, particularly, but further down the line, well have a lot more people who are incapacitated in old age. Yeah. And i. What did you tell your your niece in this situation . And like what . You know, from talking to eating disorder experts and what did you learn from them about how we can help prevent this from worsening eating disorders and contributing to issues that are would be so prevalent in our society . Yeah, i had a very i felt very ashamed when i spoke to my niece and i tried to talk to her about how a bit like what we were just saying, how i had done it because, you know, a lot of the men in, our family get Heart Disease and was worried about that. But its very difficult because the truth is you cant separate out the Health Benefits from, the fact that you become you more in line with like the societys idea of what it means to be heart. Right. And i cant deny i got pleasure from that. Like, you know, few months into taking the drug, my neighbors gardener hit on me. There were loads of benefits to that, right . So its its difficult that because she could see ive got to be honest i wasnt just enjoying the Health Benefits. I can sit here and go. It was a purely thing and health a really big factor for me. But i was also enjoying that and she could see that and shes a very intelligent young woman. There was no point lying to her about that sat very difficult kind of conversation with her. But i think gone to exactly the right point, which is would this effect with eating disorders, which i was warned about by lots of experts. The think met someone called dr. Kimberly dan is brilliant shes ceo of sun cloud health in chicago, one of the leading eating disorders experts in, the United States and dr. Dennis, you know, and this steps we could take urgently to reduce this risk. So at the moment, anyone watching, pretty much anyone you could just go on zoom, get an appointment today if you got the money, get an appointment with the doctor. The doctor looks at you on the mint to check your bmi. Well, good with that on virtually. And. Oh, sorry. I got a weird distortion in my earpiece then sorry and yeah. That meant to check your bmi. I mean, good luck with that doing that virtually. And in practice, you could be effectively any bmi and you would get it, you know, do that. You pay the money and you get it delivered by courier the next day right. Now what . So what . Dr. Denis argues, i think unanswerable is that these drugs should only be prescribed through inpatient, inperson meetings with the doctor, never on zoom and the doctors should be trained. It should be doctors who are trained to detect eating disorders and to divert people with eating disorders into treatment for their eating disorders, not starving. So my biggest worry about these drugs, ive got lots of worries about the drug that i go through and some worries for myself about the long term effects of these drugs. But in the worst case scenario, anyone whos known anyone with eating disorders knows that, you know, theres a conflict within them between the part them thats trying to starve themselves, thats driven by these psychological factors, which obviously very complicated and the biological part of them that just wants to and stay alive. Right. And what these drugs do is they give you a tool, amputate your appetite and empower that psychological part over the biological part. So in the in my Worst Nightmare about this, we get an opioid like death toll of young girls who would have survived their eating disorders. But now hold of these drugs and die. So i think we absolutely urgently need to make reform. It doesnt take away from the people whose lives are saved. The drugs and i met lots of people like that as well. People like for example, a guy called jeff parker, whos a retired lighting engineer in san francisco, a lovely guy 67, and he was very severely overweight. He was finding it painful to walk anywhere. He had gout. He had a liver problems, kidney problems, heart problems every day he was swallowing fistfuls of pills and was quite unwell. And then his friend mel gave him some injury. One of these new drugs, he lost an enormous amount of weight as doctor took him off almost all the pills. Now walks his dog over the Golden Gate Bridge every day and said, i think im going to enjoy my retirement. Right. So it doesnt away from jeff the legitimate although theres still these 12 brits that replied potentially apply to him some of them it doesnt take away from him that theres this eating disorders but but weve got to act on both right. And got to make it available to the people who need it for obesity if they want to take the other risks. And we absolutely need to do everything we can to keep it out of the hands of people with eating disorders. And what do the because i know that you talk to the company is novo nordisk and eli lilly that make these drugs. And you know what their response to you raising these risks asking about these risks you know what they have to say about all of this. Yeah, i want to stress, i think theres of Drug Companies im critical of. I think both novo nordisk and eli lilly pretty responsible companies. Theyre reputable companies. You know, this i mean, i have issues with all Drug Companies because of the way we structure these things and the nature of lobbying. But as far as it goes, i think theyre pretty responsible and theyve a good thing. Right. These drugs would not exist were it not for novo nordisk. So they do deserve some genuine credit. Stayed with these drugs for a long way down the line. And they deserve some, some, some real credit here. I dont think theyre behaving irresponsibly. You know, its not their that some people use it off label and i was surprised that eli lilly declined to comment on it any of the 12 risks that i put to them are genuine they dont know what to make of that novo. Nordisk did go through engaging with the risks. I mean, you know, as you would expect, i think they underplay some of the problems and underplay maybe too strong a word. They they emphasize the positive, the good news and the potentially bad news. And and theres some things that you put to them that they literally cant answer. So my biggest worry about, these drugs for myself is something very simple, which we have absolutely idea about the long term effects of these drugs. Literally nothing. No ones been taking them for more than 18 years. Itll be 19 is pretty soon. And theres a kind of a and and we know these drugs primarily affect your brain. Right initially it was thought they work on your gut. There is an effect and actually they mainly work by changing your brain into a neuroscientist. But what is doing to our brain that goes through the different theories about this . But im and the concern of course is like your brain thats a pretty intimate part of who you are and who i am right. Its absolutely core to ourselves and and there was a doctor who raised a concern me a brilliant research scientist, dr. Gregg stanwood, whos at Florida State university. He stressed to me hes broadly optimistic about these drugs. But as a responsible scientist does have to raise some concerns. And one of them is he gave an analogy now, i want to be clear, hes not suggesting these weight loss drugs will have this specific effect. But when you hear the analogy, youll understand why hes coming from. If you go back to the 1950s, late 1950s, doctors started prescribing antipsychotics to people because they judged at the time controversially, but they judged at the time that the benefits outweigh the risks right. And so for 40 years, you have lots of people taking antipsychotics. It was only literally 40, 50 years down the line that it was discovered. If you take these drugs for a long time decade after decade, you are way more likely to get alzheimers disease, dementia, all forms of dementia. Now, its not that the Drug Companies or the psychiatrists indeed were being remiss in the 1950s. Right. Theres just no way you could have known that that you had to have people using it for a really long time. I think of this, you know to quote donald rumsfeld, these are unknown unknowns, right . We cant know. So i can put that to eli and novo notice. What can they say . We dont know. Right . They can say we monitor safety very carefully and theyre telling the truth. But so so i think theres a theres a huge amount of indeterminacy around these drugs, although doctor sean oliver, whos a brilliant obesity specialist at tulane universitys school of medicine, said to me, we dont know the long term risks these drugs. We do know the long term risks of obesity and the long term risk of the drugs would have to be staggering to outweigh the risk of obesity. Now, that question only becomes more when you think about the issues relating to children. Right. You know, i interviewed parents who are facing an agonizing decision. Theyve got very obese children. Theyve not been able to reverse their childs obesity. The child is unwell. We know obese children find it really hard to ever become an obese. And we know that if you are obese at age of 18, you have a 70 chance of becoming diabetic, which knocks 15 years of your life. On average, these parents have this nightmarish decision, but they choose to put their child on the drug that, you know, because the drugs only work for as long as you take them. Thats a decision youre effectively choosing for your child to use a drug for, like 80 years. Right . Long term effects, no idea. That is very sobering. Yeah. And one of those decisions, too, when i mean, were talking about whoever is taking these drugs, you know, usually they will have to be on them for rest of their lives because of this weight, regain issue. When people go off and stop taking the drugs and cost is something that really comes consideration, especially when youre thinking about taking a drug for the of your life and these drugs not cheap in the us they cost over 1,000 at least will go by and ends down in monteiro do i think those impacts little bit cheaper you know way in the in writing this book and interviewing people for this book, what were the concern about cost . You know, this has been a Big Conversation in the us recently and people are saying drugs are not affordable. It could could hinder your access. You know. Is this something that youre concerned about and what were the experts that you spoke with saying the price of these drugs . Yeah, an important question. I know youve done a really important reporting on this as well. And i guess the the the were in this kind of the danger is that the situation were in now kind of continues which is a situation where the real housewives of new jersey get these drugs to be super skinny, while the real schoolchildren of new get to be diabetic at the age of 12. Right. Im slightly overstating it, but you get my point and the danger is that these drugs remain confined to a tiny elite of rich people. So the first thing to point out is these drugs do not cost very much to make. Its about 40 a month to make these drugs. One of the great scandals of this country. And again, i know you know this from your reporting much better than i do, is how much more americans pay for drugs just across the board. Right. I live between britain in the us, you know, when i buy the drugs in britain, theyre about 200 a month. When i buy them in vegas, theyre about 1,200 a month is out courageous. The americans tolerate this this is your political system allowing companies to rip you off and built every and so this is going be a big issue for the next eight years. In eight years time, ozempic goes out of patent at which point it will be a daily pill. It will cost a dollar a day. And my prediction is that half the country will be taking it right. But in those eight years between now and then, weve got a real problem here. Right. And and i think theres lots of ways in which the drug prices could come down between now and im conscious, you know, much more about this now. Its such a silly saying to you, but so one thing is the Drug Companies could compete on price. They could try to get more of a mass market. Another thing is, as senator Bernie Sanders is arguing, we could finally regulate the Drug Companies to stop them ripping people off. I know crazy notion that theres all sorts of things we could before we get to that point where. The patent passes and itll be, you know, available to everyone. And its a window which novo nordisk and eli lilly argue. Look, we develop these drugs, we should make some money in that period. We should benefit. I agree with them, but i would argue they dont need to make quite as much as they currently do. We could regulate them. You know, at the moment, novo nordisk is now the most Profitable Company in, the whole of europe. So i think we should be, you know, prioritizing, getting the drugs to people who need them, not least because by many measures, obesity is the killer in this country. Professor mander at harvard, who the food label thats on all food the United States sold in the us. So explain to me, presented with his calculations that obesity and food related illnesses. Kill 678,000 american boys every year thats more all the american soldiers who died in all the wars of the 20th century and indeed the war in this century and. I mean, that is a staggering toll. Thats, you know, not far off having covid every year. The covid pandemic, every year. Right. And that stock, we shouldnt accept this and we need to deal with the underlying factors that cause obesity. I write about what they are in the book and i went to countries that have done that countries like japan there is almost no obesity and literally almost no Childhood Obesity at all. Weve got to learn from them. But in the meantime, weve got to use the tools we have and what are some of those tools . I mean, you know, what are the what are the that you learned from japan, from visiting some of these other places where obesity rates are not quite as high star in answering this question, which is, i think one of the most important questions with something really basic. Right. I would just urge everyone i was born in 1979. I would just add everyone to just take out their phones. I would not normally recommend this way of watching tv or listening to a podcast and just Google Photos and. Just google photographs, beaches in the United States in the i was born just take a look at them for a minute when we look at them now with our eyes, they seem really strange because everyone is what we would call skinny or jacked. Everyone you look at them and youre like, oh, this is weird wheres everyone else, right . Was it a skinny Person Convention on the beach the day that photo taken . And then you look at the population figures, obesity really rare. When i was born. Right. So you basically have 300,000 years where youve got a human beings, an is really rare and then in my lifetime explodes between the year i was born in the year i turned 21 it more than doubled and then in the next 20 years, severe obesity more than doubled again. So weve gone from there being almost no obesity in the early 20th century to 42. 5 of americans being obese today. What happened . The core to understanding that question is also caught. How the drugs work and it comes down to a word we dont use it that often in everyday english, but its a word we know its satiety. Satiety is the feeling of being sated the feeling of having had enough and not wanting anymore. And it turns out this explosion, obesity thats happened here, happens in every country that makes one change. Its not what people become, weak willed or lazy or all the stigmatizing things we say about this. Its where people move from a diet that mostly consists of fresh whole foods that prepared on the day that are consumed to people move to eating a diet mostly consists a process. An ultra processed food that is constructed out of chemicals in factories, in a process that isnt actually even called cooking. Its called manufacturing food. And it turns out this new kind of food never existed before affects our bodies completely differently to the old kind of food. And this an that really helped me to understand this. It was done here in new york. I nickname it cheesecake park in the book its not the official name its done by a brilliant irish scientist irishamerican scientist, co professor paul kenney. So whos the head of neuroscience at mount sinai, just up the road from where i am now, and its very simple. He got cage and he raised a load of rats and all they had to eat was kind of Healthy Foods and pellet form that were the kind of foods rats evolved over thousands of years. And it turned out when they had food, rats would eat when they were hungry. And then just stop, right . They never became fat. They never overweight, overate. They had some kind of natural, nutritional. That meant they were like, oh, guys, ive had enough right then. Professor introduced the rats in cheesecake to the american diet. He fried up some bacon, he got a load of snickers bars. He bought all leather cheesecake, and he put it in the cage alongside the healthy food. And the rats went. Crazy for the american. They would literally dive into the cheesecake and eat their way out and emerge just totally slicked with cheesecake. And they ate and i and i and i, as professor kenney put it to me, within a couple of days, they were different animals. That nutritional that they had had when they had the natural food evolved to eat, vanished and they all became obese and actually all sorts of poor indicators for their health. Then professor kenney tweets the experiment again in a way that feels a bit cruel to me as a former kfc addict, he took away all the american and left them with nothing but the healthy food they up with. And he was sure he knew what would happen. They would eat more of the healthy food than they had in the past, and this would prove that processed and ultra processed food expanded the number of calories. Write in a day that not what happened. Something much weirder happened once they had the american diet and it was taken away, the rats refused to eat the healthy food. All it was like they no longer recognize it as food and it was only when they were literally starving that they went back to it. Now this theres a lot of evidence that human beings are a similar situation. We all live in cheesecake park now. Were eating food profoundly undermines our ability. Ever feel sated to feel full and what these drugs do is they give us back our sense of satiety, right . If you eat something now, your pancreas will produce a hormone called glp one. Japan one is basically just your bodys natural signal going, hey, youve had enough eating, right . Its the brakes. Basically but not true. Glp one only sticks around in your system for a few minutes and then its washed away. So what these drugs do is they inject you with an artificial copy of glp one that goes to your annual brain, where you also have jlp one receptors and that sticks around in your system. Not for a few minutes like natural glp one, but for a whole. Which is why when i went into that, i suddenly felt full right. You see why you suddenly feel sated . Because youve got artificially boosted levels of this copy of glp one. So you can see processed food undermined, does satiety these drugs, give us back acetate but with a cost. And as professor michael low in said to me, these drugs are an artificial solution to an artificial problem. Right. In japan, they never allowed processed food to screw up their children. They never allowed it to dominate their kids diets. I went to japan to see how they achieve this. Its incredible. Its a really weird feeling to walk around a Normal School of a thousand children and realize there is one overweight child in that school. They didnt allow processed food to screw them up. They didnt allow obesity to get halt. And as a result, you can get ozempic japan, but theres no market for it because theres almost no fat people right. So you see this what been done to us at the moment, people like me who are obese are in a trap. Right. So weve got to make this painful choice. Do you want to continue with this risky condition, obesity, or do you want to take this risky drug . But that is not an inevitable choice. We do not have to tolerate being the choice for our children and our grandchildren if we fix the environment like they did in japan, we can save them from having to make that choice. And i know that sounds a bit pie in the sky, but think about smoking. I think were probably about the same age when we were kids. I mean, if you could take a contemporary american child back in time, they would be stunned. People smoked everywhere. People smoked on the subway, smoked on the bus, people smoked on game shows. And theres a photo of me and my mother where shes breastfeeding, smoking and resting the ashtray on my stomach. Right when i found this photo a few years ago, i thought shed feel guilty. She looked at it and said, you were a difficult baby. I needed that cigaret. That was normal then, right . And now you know, you would be amazed if saw a breastfeeding mother smoking or you saw someone smoke on the you call the cops. If you saw someone smoking the subway. Right. Weve gone from more than the population smoking to about i think its 11 now. Right. That was because we we really worked at it. We changed the culture we can do the same around food. Weve got to take on these big vested interests like we had to take on the tobacco companies. But we can do that and that will get us out of that trap. Japan did it and as a result, they have the healthiest population in the whole world and the longest living population in the whole world. We deserve that to. And so, i mean, what what comes next like everyone that ive talked to is like even though these antiobesity drugs are absolutely dominating the headlines and just theres some urge out there about them right now like were really at the beginning of all of this. And so, you know what next after this, what are you worried about . What are you excited about . What should people be watching out for Going Forward . You know, what are what are your sort of predictions for whats next in this world of antiobesity medications . Yeah, its fascinating, isnt it . Im Barclays Bank commissioned a very sober minded financial analyst called emily field to go away and look at these drugs to figure out you know how it should guide their Investment Decisions Going Forward. And she came back and said if you want a comparison for the effect this is going to have the economy in the society, youve got to look at the invention of the smartphone. Right. Which sounds very sobering. This is me now. But if you imagine if you know, this is the obesity is the biggest killer. Half the population almost wants pay to take these drugs. And thats now before theyve even seen the effects on everyone else. And so i think this is going to be huge if we have been talking on the day that steve jobs unveiled, the iphone in was it 2007. I dont we would have been able to game out, you know, ticked can doordash and uber and all these things that are profoundly the way we live. I do think were beginning to see glimpses of it. And i end the bit by talking about lots of potential scenarios for what might happen now. And they range. Its disconcerting having done all the research ive done and having thought as deeply about this topic as i have that such a broad range of scenarios is still possible. So the most pessimistic scenario, which i dont think is likely, but i dont think can rule out, is that this is like a diet drug in the nineties called bentham. So fen fen was a combination of an appetite suppressant called flex flush remain and an amphetamine called fantome and this is kind of been a history now, but it was the most popular drug ever. By 1995, there were 18 million fen fen prescriptions in this country. In that single year, the front of Time Magazine was the new miracle weight loss drug. It was talked about in exactly the way were talking about ozempic now. And then just a group of ordinary doctors in fargo, north dakota, notice that a lot of the patients taking it were also having troubles breathing, and they raised an alert, which eventually led to the discovery that this drug caused primary pulmonary hypertension, a horrific where the blood vessels in your lungs contract and you cant breathe if youre not on oxygen you literally die. It it killed an enormous number of people. It led the biggest payout in the history of the pharmaceutical industry up to that point, 12 billion. Its not impossible that these drugs will turn out to be like that. Its not likely, but you cant rule it out right . There could be some medium term effect is catastrophic. And i did speak to scientists who think that is a plausible but not likely. Thats the most pessimistic, the most optimistic is the drugs work in the long term. The benefits outweigh the risks. We get them for everyone who wants to take them. They become affordable and we wake up and say, how did we to this point, how do we change the society so we dont have to drug ourselves en masse . But i think thats the scenario i most want to happen. But theres a really kind of range and a huge number of things for us to look out for the reason i wrote my book, magic pill, is because i really we need to take a beat to deeply about this. And its funny because i think about this as you were asking your question, the book is called magic because theres three ways this these drugs could be magic. The first way is the most obvious. They could just solve the problem. Right. And ive got to tell, there are days when it feels like that. My whole life ive over eaten. Ive been addicted to junk food. Now i inject myself once a week in the leg. Ive gone from eating 3200 calories a day to 1800 calories a day. It feels like magic. The second way it could be magic is much more disturbing. It could be like a magic trick. It could be like the conjurer who you a great card trick while hes picking your pocket. It could be these drugs dont imply that implies negative intent to the Drug Companies, which i dont mean, but it could be that you know that it causes you so much harm in longer term that it outweighs the benefits. I dont rule that out. But the third way in which it could be magic is actually the one i think is most likely is the key to answering your question. Think about the stories about magic that we grew up with as kids. Think about what we could example a lot of right in those stories you find the lamp, you rub it. The genie appears. He grants your wish and your wish comes true. But it never quite comes true in the way that you expect it, right . You get your wish. But a weird right angle already seeing that in so many ways with these drugs. So many strange and unpredictable effects. Who would have thought that krispy kreme stock would be down . Right. Jefferies financial just did a report for the airlines saying that it had to spend a lot less money on jet fuel soon because its going to take so much less jet to fly a thinner population. Does companies that manufacture the hinges for knee and hip replacements. Their stock is down because the biggest driver of knee and hip problems is obesity. And theres going to be a lot less obesity really. So even think about something as basic as jewelers in l. A. , about a big run on them, because peoples fingers are shrinking so much that their wedding rings dont fit them anymore. Theyve got to be refitted right . This is going to have crazy unpredictable effects for good for sure for bad, for sure. We need to think about this. If youre an individ thinking about it, theres a lot youve got to be prepared psychologically that i hope i explain in the book i would really recommend if youre thinking it go down the list of the risks obesity go down the 12 big risks that are brought by magic. Think about which ones apply you. Theres no magic answer. Ultimately its a judgment call that no one can make for you. But i also think when you think about what its going to do to all of us, right, its the stakes here are so high, so many people will live or die based on whether we get this right. Its really important we think about it and dont mindlessly make the shift. And obviously everyone should go and read this book themselves, what are you hoping that people take away from or, you know, what is the that you hope people walk away from this book with when theres so much information out there right now on these drugs . Theyre being discussed so much like weve said, you know. What is the takeaway that youre hoping and the contribution that this book is going to make to so many but its funny. Its kind of hard to say at this point, but i felt like such a failure for being fat and for failing at dieting and i felt so embarrassed about it and looking back now, if i could speak my former self, id say you were a failure, you were an entirely typical product of your times. If you understand the difference between that beach in 1979 and us now is not that people became moral failures, as is that the environment screwed with us in profound ways and put us left us with this difficult choice, put us in this trap where these drugs are the only trap door were being offered, and they are a risky and rusty trap door. And many people want to pull the lever to go down it, and they may turn out to be right. But i guess the main thing i want to say is when you can to see this in a different light, i think these drugs throw everything up in the air. If you think deeply about these drugs, you have to think deeply about the whole question of obesity and it throws so many things in the air about it. It shakes up the old stories. It draws out these deep ideas. We have obese people are sinners. If youre taking these drugs, youre cheating. I where those ideas came from because i felt them towards myself. I thought that and but i hope we can begin to tell a more complex, more truthful story about how we got here and how we can find our way that will lead to less blame and anger as a culture where pretty much every argument turns toxic very quickly. But i really think this is an argument thats a topic which has been so with string landmines of shame and toxicity. I really think now we can begin to a lot of them, everyone watching it a year from now you will know someone whos lost lot of weight taking these drugs right. And that in itself is going to shake up the conversation and really ways i hope i hope the book prepares us a bit for that conversation and how to think about it and how to how to have the conversations were about to have to have in a way that isnt toxic and doesnt just wake up more blaming and anger, but actually brings us to more towards more love and compassion. Definitely. And i know that you mentioned in you know, your own personal story and friends stories, your friend in the book and, you know, shes in the beginning and the end. How did your friendship with and her personal experience sort of inform this book and shape this book . Hannah was one of the best people i knew. She was the funniest person ive ever met. She was a couple of years older than me, maybe, i think tea is older than me. And we met when i was 19, she was 21 and she was no. One will ever make me laugh as much as she did. She was hilarious and. One of the things we would bond over is our love of junk food and terrible food. And we had a running joke where we would go to like the scariest diner and we would eat the most awful food and we would like review it as if we were like food critics and she was very overweight. And she became sick with all the illnesses associated with obesity, not all of them, but a lot of them. She got very bad back pain and got addicted to opioids and she came off. Then she got cancer, which is made much more likely by obesity. And then she got and was much sicker with it than she otherwise would have been. And then she had a heart attack and died and. Everyone watching will know someone should have had a long life and was denied it because of obesity and because we live in this environment that drives obesity. And you might not think of it that way. I mean, one of the things that most shocked me from the research for the book, im embarrassed to say this was something i thought id known since i was a little kid. It was how shockingly bad for your health obesity. Obesity should never be stigmatized. Its no ones fault except the Food Companies and the people who screwed is over. But the Scientific Evidence and i looked at it skeptically is think about diabetes, right . I guess ive known since i was a kid. If youre obese or more likely to be diabetic. Right. Much more likely to become diabetic to get type two diabetes. But i guess i thought before i did the research for the book. Okay, thats not good. But if youre a diabetic providing health insurance, you get insulin. Youre basically like everyone else a type two diabetic plus insulin is like me or you. Thats not true at all. From interviewing the experts on diabetes and looking deep dive into the research. If youre diabetic, it knocks 15 years of your life on average it is the biggest preventable cause of in this country and. More people have to have a limb or extremity amputated in the us because of diabetes than because they got and you will have noticed a lot of us get shot. Right diabetes is devastating. It makes your much shorter and it makes it much more likely youll have a terrible last few years of your life. In fact, the effect is so bad. One of the leading doctors in brittany treats diabetics. Doctor Max Pemberton said me. So it sounds really shocking when you first hear it and you look at the facts, he said, if you gave me a choice between becoming diabetic and becoming hiv positive, i would choose to become hiv positive. Because youre hiv positive and you get treatment live as long as everyone else. But its not true. Diabetics and diabetes is just one of the causes. So think about my friend hannah. You know, we always had this promise to each other. We learned. However, we must repeat maybe when we were in midterms those. We learned one day that in vegas theres a place called the heart attack grill. Lots of people will know its. A free month straight. Its a place where its a restaurant where at the entrance there are cattle scales. And if you weigh more than 350 pounds, you for free when you go in or the waitress is addressed as nurses you have to sign a waiver saying if the food gives you a heart attack, its on you. Its not their responsibility. If you dont finish the food, they kind of spanky with a paddle. So we had this running joke that one day we would go and we would toast our friendship in a banana milkshake in the heart grill. And after she died, not long after she died, i was in vegas and i thought, ill go, ill toast. And i went and i, i looked at these scales and i looked at the people in the and it was like this joke just turned dust in my mouth. It was all ashes in my mouth. It was it felt like the joke was on us. It was yeah. It was tough. Yeah. And like you said, im sure so many people, especially in the u. S. , have similar experiences. No people with obesity who have struggled with obesity and related conditions. And i think that thats why all of this is so relevant and these weight drugs are so relevant and so i think we are just about out of time, but i am so appreciative your time today and it was so great to talk to you about this book so. Thank you so much. You ask Great Questions and i admire your reporting for bloomberg. And i really enjoyed conversation