Inside Canada’s Ozempic craze

CLIP You’re listening to a frequency podcast network production in association with City News.

Jordan Heath-Rawlings This is a story about a drug, but it’s also a story about a disease, or I guess a story about what makes something a disease that we take seriously. And before we start, I’d like to play you this commercial, which I record. Off my television that aired during a national baseball game. I share it because it sounds mysterious. It sounds like those old ads for Viagra that promised you that something really amazing and wonderful was just about to happen.

CLIP “I just asked, I asked, we just asked.”

Jordan Heath-Rawlings That ad is for Ozempic, which you have likely heard of unless you’ve been living under a rock. It is the absolute hottest drug on the market, not because it helps treat type two diabetes, which was why it was invented, but because of what else it. Ozempic helps you lose weight, a lot of weight and quickly. And this has led to shortages to Americans trying to snap up Canada’s supply to bans from some governments on foreign purchases to a quandary for insurance companies and to a reckoning in the medical community about how we treat obesity. And what that does to patients. And most of all, it has led to questions. Does it work? How does it work? Am I eligible? Will my doctor prescribe it? Will my insurance cover it? Can I find some, if I get a prescription, am I obese? What actually qualifies as obese anyway? And are we at a tipping point for obesity and weight loss and how we view it and maybe even cure it? I am Jordan Heath-Rawlings. This is the big story. Carly Weeks is a health reporter at the Globe and Mail. Hello, Carly.

Carly Weeks Hi there.

Jordan Heath-Rawlings Carly. Have you seen a commercial for Ozempic that airs in Canada because. I played one in the intro and, and it’s, it’s quite something.

Carly Weeks I’ve seen quite a few commercials and advertisements actually. They seem like they’re kind of everywhere now. Just like the discussion around Ozempic is everywhere. And it is really funny because Ozempic is actually one of two medications that are on the market. It’s the same generic ingredient called Semaglutide, but one is available and one is not. And what’s interesting is that the company that. This medication, Novanortis has told me that, you know, for the time being, they’ve stopped doing media interviews for the drug that’s not available, the one that’s actually approved to treat obesity, which is called Vy, because it would be irresponsible to promote a drug, you know, at this time, given that it’s in shortage. But then in the meantime, knowing what we know about the way Ozempic is being used, Sort of funny, or maybe that’s not the right word, to see a lot of these advertisements for Ozempic.

Jordan Heath-Rawlings Well, I think they’re getting around it by simply not saying anything like the commercial I saw just says, we asked, we asked, I asked, they asked. And then it says, ask your doctor if Ozempic is right for you. But that’s it. There’s no information beyond that.

Carly Weeks Well, that’s because. In Canada, our laws actually prohibit drug companies from saying what the drug does. Hmm. You can name the drug, but you can’t say what it does. Or if you say what the drug does, you can’t use the name. So, you know, we’re kind of stuck in this situation that’s designed to sort of cut down on the type of. Pharmaceutical advertising you see in the United States that’s really aggressive. You know, somewhat argue that it has mixed results, given that we often see a lot of us TV here anyway. But right the end of the day is that, you know, you do, you often see these very vague, weird kind of ads and you know, with a drug like Ozempic, I don’t think anyone needs to ask what it does.I think we, we all kind of have some preconceived notions of what it does at this point. Yes, this is, I guess, the hot drug on the market right now.

Jordan Heath-Rawlings As I mentioned, the commercials are extremely vague. Let’s just start there. What is Ozempic? What was it designed to do before we get to what it’s being used for?

Carly Weeks Ozempic is the brand name of a drug called Semaglutide. So it’s treated, it’s, it’s approved to treat type two diabetes, and so it, uh, it accidentally got, it’s without getting too technical. A GLP one like receptor. That’s essentially, it’s a hormone that is in the gut and it helps control blood sugar, but it also helps people control their weight. And this is something that became pretty apparent when people started taking it. In clinical trials. They were reporting as a sort of a side effect weight loss. So before too long, the Novanortis had marketed a separate drug or created a separate drug called Mug ove. Specifically designed to treat obesity.

Jordan Heath-Rawlings Hmm.

Carly Weeks And that, that drug was approved in Canada last year, but has yet to arrive because it’s basically in a huge worldwide shortage.

Jordan Heath-Rawlings We’re gonna spend most of this interview talking about using Ozempic to treat obesity, not type two diabetes. And so maybe just to begin to give us a sense of who’s taking this, who’s trying to take it, tell me a little bit about Crystal Foy, just because she seems like such a great example of, of how and why this drug gets.

Carly Weeks Crystal is a mother who lives in Alberta that I interviewed several months ago about her experience. She’s living with obesity and she is in pain a lot of the time. She has difficulty getting upstairs. She has a 10 year old son that she really is so limited in what she can do with him, you know, that she wants to take him to the park. She wants to play with him. She struggles with her weight and she’s always struggled with her weight. She’s been on a wait list for bariatric surgery, which up until now was the only sort of other really effective treatment available for people with obesity. So it’s a pretty, it can be pretty extreme. The surgery is safe, but the wait lists are long and obviously undergoing surgery, you know, as opposed to taking a medication is, is not, not the ideal scenario. And so she’s been waiting to take, she’s been waiting for surgery, she’s struggling with the pain that. Experiencing and the stigma that she sort of faces on a daily basis from society.

Jordan Heath-Rawlings Mm-hmm.

Carly Weeks So she has attempted to get Ozempic. Her doctor has actually prescribed it to her for the treatment of obesity, but her insurance claim was denied at work. And so she works at a company and her colleague, actually, her claim was approved for Ozempic that her colleague does not have Type two, but diabetes was prescribed ozempic and had her claim approved. But Crystal’s claim has been, The drug costs, you know, it can vary, but let’s say approximately $300 a month for a patient. And that’s simply too much for Crystal and her family to afford on an ongoing basis. And this is a drug that you have to take, you know, for a long time, as long as you want to keep that weight off. And so she is someone who’s struggling. She can’t get access to this drug that she knows will help her. And she’s, you know, described to me living the. Of someone else. You know, her life is being stolen from her that she hasn’t tried everything to lose weight. She’s limited calories, she’s walking. Her step counts. She’s doing what she can, but nothing is working. And she’s sort of out of options until she can get surgery.

Jordan Heath-Rawlings So what do we know about Ozempic specifically relating to its use for obesity? You know, weight loss is a side effect in the initial use of it, but how does it work for weight loss? And you know, I guess, How well does it work?

Carly Weeks This is a drug that mimics a hormone that triggers the brain to sort of experience a feeling of fullness. So it acts on the gut. It helps promote the feeling of fullness. There’s a lot of things that, you know, are sort of unclear on exactly how it works and some of the mechanisms, but essentially that’s what it does. And that’s why a lot of people say, you know, they just, they forget to eat or they’re no longer hungry when they take. Medication because it essentially is a, a gut hormone, a, a synthetic or a replacement gut hormone, telling your brain that you’re full.

Jordan Heath-Rawlings And what do we know about the long-term use of it? Because you mentioned that, that people are gonna be on this for years. Do we know anything about side effects? Uh, what happens when you go off it, et cetera?

Carly Weeks That’s a great point, and there has been a lot written about that in the last couple of months. And I would say that a lot of the reporting I’ve seen hasn’t been great from a patient standpoint. A bit more fear-mongering than perhaps needs to be according to the experts that I’ve interview. When we talk about semaglutide or you know, ozempic in particular, there are some things that you need to be watching out for. Primarily, a lot of the side effects tend to be gastrointestinal in nature, right? Which, you know, makes sense because this is a medication that’s acting on your gut. So, one doctor I spoke to said a lot of these side effects can be managed with proper guidance. From a health practitioner. So for instance, um, you know, someone who’s on this drug may not feel hungry. They wake up in the morning, they don’t eat, and then later in the day they do experience that feeling of hunger and they overeat and have gastrointestinal distress. So they’re basically urging patients or, you know, sort of guiding patients on when to eat throughout the day so that you don’t experience that, that symptom. There is also another symptom that, that patients are told to watch for because in trials, some. Trials. Um, some of the animals develop thyroid tumors, so it’s unknown if that can happen in humans. So anyone who’s on the drug is, is sort of told to watch for any changes in, you know, their ability to swallow anything going on with their throat, which could indicate a thyroid problem. But so far that’s not a proven link yet.

Jordan Heath-Rawlings How popular is this drug? What do we know about just, you know, how many people want to be on it. You are a health reporter, I imagine you get questions from everyone, you know when something like this blows up.

Carly Weeks Yeah. This, this drug is, is huge. Um, and I don’t think in my career I recall any sort of one drug that coming on the market that. Been so huge for so many. I mean, there’s certainly been other medications that have been real game changers for patients, but this one seems to be everywhere. And I think it, when it comes down to it, it really is because it, it is about weight, which is such a loaded topic in our society. And so the demand for Ozempic and you know, similar medications, we can get to that in a bit, is huge. And growing. You know, people want to be on this drug to help them lose weight. They’re hearing about celebrities that are taking it for weight loss. You know, the interesting sort of wrinkle here is that because it’s approved for type two, And not for obesity. You know, a lot of people who are taking it sort of off-label for weight loss and not for diabetes are sort of being accused of, you know, stealing it, you know, essentially robbing people with diabetes of, of an important medication.

Jordan Heath-Rawlings Mm-hmm.

Carly Weeks And so there’s a whole bunch of different issues here and then discussions about obesity and whether it needs to be treated. And it really brings to the fore for me, and a lot of the people I interview, Just how sort of judgemental we can be as a society when it comes to weight and you know, how this has evolved. I mean, if we were talking about a medication that helped lower people’s blood pressure in a really effective way, you know, I don’t think we would see just as much interest in, in sort of the salacious coverage as we’re seeing with Ozempic. Speaking of quote unquote stealing these drugs from people who need it.

Jordan Heath-Rawlings Can you explain briefly, I know your colleagues have also covered this, what’s been happening with Americans who want this drug?

Carly Weeks Uh, British Columbia and I guess a physician out in Nova Scotia? Yes. This is a really interesting case. So, and as I said, you know, this drug is in shortage. It’s can be difficult to get your hands on. So what was happening in British Columbia is. The officials there noticed that a huge number of people that were seeking prescriptions for Ozempic were actually coming from the United States. And when they did an investigation, all I think all like basically all of those prescriptions could be traced back to one single physician in Nova Scotia who’s writing those prescriptions. They were being. Filled in pharmacies in BC and creating a big problem for patients there who wanted to get access to ozempic either for, you know, treatment of diabetes or for weight loss. You know, and there’s been a number of regulators and, and governments like, uh, who are, are in a number of different ways restricting how Canadians can access these drugs. Um, so even if you’re, you get a prescription, you know, then you have to make sure that your insurance will provide it, or you know, that you’re actually able to get a healthcare practitioner to give you a prescription in the first place. A number of different access barriers here. And so now there’s been sort of this crackdown in British Columbia trying to reduce the number of Americans who are coming in to seek this prescription. Speaks to how highly sought after this medication is right now.

Jordan Heath-Rawlings How are insurance companies grappling with this? You know, you told us about Crystal and I imagine in general it just brings up huge questions of, you know, everybody wanting this and wanting them to cover it, but also like just treating obesity, which I, I guess they probably haven traditionally gone after.

Carly Weeks Yes. And that’s a great point. So the fact that this is being talked about so much, I think is, is ironically gonna make it even more difficult for a lot of people to get claims approved for ozempic to treat obesity. So, you know, we know from research that has been done by some Canadian regulators that was published last August. That a huge number of people that were on prescriptions for Ozempic were taking it not for diabetes. And that’s something that researchers were able to do if they looked back at drug claims people had made in the past. So people that had no prior claims for anything related to diabetes were assumed to not have diabetes, and therefore they could safely assume that most of the people are a large chunk of people taking ozempic in Canada. In fact, don’ people with iabetes and are looking for this drug to help them lose weight because they have obesity or because they want to lose weight. So this whole idea of, you know, what is obesity? Should it be treated like, that’s a whole, it’s such a loaded issue. Typically, obesity medications have not been widely covered by insurance plans, by public plans, and depending on who you have with your private insurance, by private plants either. And I think that now that there’s such scrutiny of Ozempic. I think that it’s be becoming my sense and my, what I’ve been told is that it’s becoming more difficult for people to have their ozempic claims approved if they don’t have diabetes. But there’s a huge number of people taking it that don’t have diabetes because they don’t have any other option. And some people are living with obesity and are really struggling. And then we come back to this idea of how you even diagnose OB obesity, how it’s seen, and you know, To put a really fine point on it, you know, obesity is not, even though it is a chronic illness, it’s not recognized as a chronic illness by many people, by many healthcare providers. A lot of people who live with the condition face stigma from, you know, society and from their practitioners, people living with the disease. Tend to not even seek treatment. And you know, they face so many barriers that, you know, they’re likely not getting the treatment they need. And so I, I, you can assume that ozempic the same sort of thing may be happening, especially with all of this attention, the sort of finger wagging and shaming of people that are seeking Ozempic.

Jordan Heath-Rawlings Let’s talk about that stigma for a minute and not necessarily, in the media and in popular culture because I think anybody who’s watched network television or consumed any of that culture understands those stereotypes and, and the fact that they exist, even if we don’t like them. But you mentioned stigma from healthcare practitioners when people are trying to get help with this, why would that occur? And how often does it happen when you, when you talk to people who are, you know, working, either advocating for this or, you know, just in medical associations?

Carly Weeks Exactly. I mean, I, I’ve spoke to a number of physicians, um, as well as patients and advocates who say that this. Stigma is very much a real thing that’s encountered by people with obesity on a regular basis in the medical profession. And it’s not necessarily because, you know, doctors are, you know, out to get those patients or are just so biased. But there’s, I think, in society a lot of sort of, you know, fat shaming and pointing the finger at people who have obesity. It’s just so ingrained in our culture. There is a lot of that judgment. Mm-hmm. And then the flip side of that, you may. Be as a patient reluctant to bring up your weight to a doctor because of your pa, your past experience. Physicians at the same time, because of all of the stigma and shame around weight, they may not bring up the subject either. They might avoid it all together. And so it’s not necessarily, the physicians are sort of, you know, fat shaming their patients, but they may not. Even feel equipped to have that conversation. I think, you know, from what I’ve been told, more medical colleges and groups are trying to encourage those conversations to happen, especially as there are actual now treatments available to help people not just, you know, go out and exercise, which is outdated advice that simply doesn’t work to treat a disease.

Jordan Heath-Rawlings When we talk about that stuff, I guess my question, and the reason I asked about insurance companies earlier is because at least for them you can kind of understand that they’re playing a zero sum game, and my question then is why wouldn’t they want to cover this stuff? Why wouldn’t doctors want to prescribe it when, you know, regardless of what stigmas are attached to obesity, I think we all know. The medical risks of it, which are, you know, I guess higher blood pressure, more chance of a heart attack, et cetera, et cetera. Like there are, there are real downsides, health-wise here that this could fix.

Carly Weeks Definitely. I think one of the reasons is that it comes back to what this drug does other than how people lose weight. And we’re at a point right now where the clinical research is not yet there. It just doesn’t exist yet. Still pretty new to be studied, um, in patients with obesity to show that not only does this drug help people lose weight, but it also reduces the incidence of heart attack or stroke or, you know, you name it. And so those studies are underway, but that’s one of the reasons why one of the Canadian regulators recommended. That insurance companies not reimburse this drug for people that have diabetes or I should say the, the obesity version of the drug. So when that drug came on the market, the consensus was this should not be reimbursed because you know, it’s simply, yeah, weight losses. They didn’t come out and say that weight loss is sort of a lifestyle thing, but that until you can show us that it does more than simply help people lose a significant percentage of their.

Jordan Heath-Rawlings Wait, we can’t justify covering that cost given just how, how cost for drugs are soaring across the board. Should everybody who wants it for weight loss be able to have it. And I ask this because I’m interested in where we draw the line you mentioned. It’s tough to diagnose obesity. I don’t know much about it, but I understand that B M I is pretty darn outdated at this point. And, and can it be difficult to even pin down who qualifies as obese, thus might be eligible for it or not?

Carly Weeks Yes. This is a hugely complex area. I should also just, you know, point out briefly that there are those who reject the notion of that obesity is a medical condition and that you know that it simply, A body size that is being stigmatized into sort of being a medical disease that doesn’t exist. Hmm. Now research overwhelmingly shows that people who are carrying excessive amounts of body weight are more likely to encounter some of the serious health outcomes. Like, you know, high blood pressure, stroke, heart attack, arthritis, other types of cancer and, and other problems. So, you know, when you think about it from that perspective, there’s an argument to be made that everyone who wants access to ozempic. Similar, uh, you know, weight loss injections should be able to get their hands on them. I’ve spoken to physicians who, who argue that, you know, the use should be restricted more to people who are struggling with obesity. And again, those things are very hard, as you say, to diagnose. So, b m I is one tool that sort of is your, you know, your height and weight put into an index. And that is still used, but it can only be used when combined with other measures such as, you know, other health challenges that you’re facing as a result of carrying extra weight. So if you’re having joint pain, if you’re, if you have high blood pressure, that makes it more likely that you are going to be approved for something like Ozempic. But at the same time, I think that we’re, we as a society, as more of these medications come to the market, and they should be sometime this year and certainly next year, I think that we’re gonna have to confront those issues head on. And, and if someone. To, you know, get this medication and they can, you know, either afford it or have an insurance claim that’s covered, why are we denying it to them? And it, it really, the answer I think really comes back to, you know, we have this whole. Idea that, you know, weight loss is a moral issue, right? Obesity is a moral disease, and that if you want to lose weight, you should do it yourself the hard way. You shouldn’t take the easy way out, quote unquote.

Jordan Heath-Rawlings This is a fascinating moment and I wonder what you’ll be looking for over the next few months. I guess first in terms of the shortages or other drugs like this coming on the market, but then also just in terms of yeah, are we at a tipping point?

Carly Weeks I think we’re at a huge tipping point. There’s a drug that has recently been approving Canada called Tze Peptide, or the brand name is Manjaro that is supposed to be coming here at some point. I, it’s hard to say right now these drugs are actually very hard to manufacture as well. That drug is supposed to work even better than Ozempic in clinical trials. And so once you know we have steady supplies of the, that drug of Ozempic, of others in that class that are coming to market. I think that this conversation will just evolve naturally in that, you know, hopefully we get to a stage where we stop, you know, shaming. And I think that’s gonna be the biggest thing I’m watching for, in addition to, you know, the shortages and whether or not insurers start to cover some of these more, whether they start to recognize that these are valid medications for a valid medical issue.

Jordan Heath-Rawlings Carly, thank you so much for this.

Carly Weeks Thank you for having me.

Jordan Heath-Rawlings Carly Weeks Health Reporter for the Globe, and. That was the big story. For more, you can go to the big story podcast.ca. You can find every single episode we’ve ever done. I’ve even tried scrolling back to the beginning. That is more than 1,250 episodes. You can listen to them all if you want. I’d appreciate it. Give us a lot of advertising money. Have some fun with that. You can also talk to us on Twitter at the big story. F P N. You can of. Call us and leave a voicemail. 4 1 6 9 3 5 5 9 3 5 and you can email us to suggest a story, get mad about a story, say thank you for a story. That would be nice. Whatever you want to do. We all read them. Always The address is hello at the Big Story podcast. Dot ca if you are listening to this episode on a podcast app that gives you an opportunity to rate or review or recommend it to a friend or anything, we always love it when you do that. Thanks for listening. I’m Jordan Heath-Rawlings. We’ll talk tomorrow.