Fat Profits or a Fat Lip for Novo Nordisk?

Annual continuing professional development (CPD) is a requirement for most professions including pharmacy. Keeping up-to-date with our art and craft is essential to keeping our customers and patients safe. There is considerable freedom for individual pharmacists to choose what subjects they wish to complete in the required 30 hours of CPD in a given year and drug manufacturers have always been a useful and convenient source of lectures and seminars.

The Sunday Times (Feb 5th 2023 p11) reports that a row has broken out over questionable weight-loss seminars. The Association of the British Pharmaceutical Industry (APBI) which oversees pharmaceutical companies has instigated an investigation against one of its members Novo Nordisk who allegedly used weight-management seminars to pharmacists to promote and market its medicine Saxenda. The thing is the current chair of APBI is also CEO of Novo Nordisk which is difficult so he has chosen to stand down. The core of the allegation is that the company failed to properly list side effects of its drug and this potentially impacted patient safety.

Interestingly last summer a locally-based investment manager asked my views on Novo Nordisk a Danish-based Company. He had spotted an interest in the company among key investors due to the launch of Saxenda its anti-obesity medicine.

My reply to him was positive. Novo Nordisk is a great company with its origins in the discovery of insulin. August Krogh a Danish academic and Nobel Laureate visited the US for a lecture tour in 1922 and, when there, met; Banting, Best and McLeod who had just discovered insulin and its role in diabetes. From them, Krogh secured permission to manufacture, back in Demark, the new life-saving hormone. This is the origin of Novo Nordisk which was set up on a foundation structure so that profits could be used for the benefits of mankind with an emphasis on improving public health through research and development.

Modern understanding of the complex cascade of hormones, and feedback systems, that regulate metabolism generally and the metabolism of glucose specifically has allowed companies, particularly Novo Nordisk to develop more specific drugs to improve diabetes management. Obesity is off course the main risk factor for Type 2 diabetes that represents 90% of all diabetes and sadly it is rising year on year as our population gets fatter.

Obesity is a major public health challenge and is the leading cause of; amputation, blindness and kidney disease as well as a major contributor to heart disease and reduced life expectancy. It’s also a huge cost for the NHS and will bankrupt the service if not managed. Sadly our public health efforts to reduce the incidence of obesity by dietary restriction and increased activity have been largely ineffective. The processed and fast-food industries and our dependence on labour saving devices have conspired to create an obesogenic environment that few of us seem strong enough to counter. So if we cannot employ a life-style strategy then the logic is that the answer is in a medicine and as it so happens Saxenda might just be that solution.

This drug, and other, known as GLP-1 agonists, stimulate insulin secretion and slow down the release of glucose, therefore, improving diabetes control. GLP-1 agents also help weight-loss by reducing appetite and increasing satiety. They can reduce weight-loss by about 4.7 Kgs in six months. So good, but not that good and all weight returns when the drug is stopped.

Big Pharma has always been keen to exploit the lucrative obesity market but medicine regulators have been more cautious. Weight-loss drugs generally have not had a good track-record and were mostly associated with serious side-effects. The chemical dinotrophenol, for example, is a very effective weight-loss agent but if you use it there is a high chance you will die. Likewise for amphetamines. Acomplia, a cannabis-blocking drug, launched in the early 2000s was based on the observation that cannabis smokers get the “munchies”. It is an effective weight-loss agent but side-effects include suicide so it was withdrawn.

Medicine regulators are very strict with any medicine submitted for an exclusively weight-loss license. The regulators require studies to demonstrate body-weight loss of at least 10% in six months and that’s a big ask. Most companies don’t bother and those that have patented GLP-1 agents opt for a diabetes license with the added advantage of weight-loss of a few pounds which can only be good.

The GLP-1 are not without side-effects the most common being nausea, vomiting and low blood glucose. More serious, less common, side-effects include effects on the pancreas and gallbladder and rarely suicidal thoughts.

Saxenda did get an exclusively weight-loss license and the market changed. There has been an explosion in private clinics providing the drug on a commercial basis at about £300 a month. This is also getting celebrity attention which is increasing usage and causing shortages of the drug.

Hopefully the APBI censure might give the company a fat lip and force it to rethink its business strategy for Saxenda and return to its century old commitment to improving public health and patient safety. But the fat profits it is now enjoying from what is a legal supply of this drug and which allowed my investment friend to realise 34% increase in share value for his clients since June 2022, will I fear will only encourage more to enter this area and, in the long-term, if history is any indicator, will have only a negative impact on public health.

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