When Big Pharma Meets New Media
on semaglutide, online prescribing and the medicalization of everything
Everyone has heard of Wegovy by now. Elon Musk said he took it to lose weight last year; there has been speculation that Kim Kardashian used Ozempic, another version of the same drug, though she would never admit it. TikTok videos alleging that actress Mindy Kaling hosts “Ozempic parties” have amassed millions of views. Chelsea Handler told “Call Her Daddy” host Alex Cooper she unknowingly took Ozempic because her “anti-aging doctor just hands it out to anybody.”
Wegovy and Ozempic are both injectable formulations of semaglutide sold by Novo Nordisk. Semaglutide belongs to a class of drugs called glucagon-like peptide-1 agonists, which were originally developed for diabetes but became popular for causing significant weight loss. In June 2021, the FDA approved the 2.4 mg Wegovy injection for “chronic weight management” in adult patients with a body mass index of 30 kg/m2 or greater, or in those with a BMI of 27 kg/m2 and at least one “weight-related condition,” such as high blood pressure or Type 2 diabetes.
Based on that criteria, most of the celebrities and influencers touting the benefits of semaglutide are not medically eligible to take it. Elon Musk probably wasn’t, Kim Kardashian and Chelsea Handler certainly were not. Off-label prescribing contributed to the explosion of demand for Wegovy in 2022, leading to shortages that have made it difficult for people with on-label indications to access the drug.
Rich people spending thousands on beauty treatments and diet drugs while everyone else struggles to access needed care is certainly not a new concept, but when has one drug been at the center of this divide?
I discussed in my last essay how social media—the perfect man-made ecosystem for a short, intense consumer trend cycle—has normalized a level of beauty work that used to be seen as extreme or reserved for celebrities. If the TikTok algorithm shows me 15 videos about buccal fat removal every day, I may eventually believe that buccal fat removal is something plenty of normal people like me are getting done. This has happened with tretinoin, Botox, lip filler, permanent makeup, laser treatments, microcurrent devices and so on. It’s hard to tell if increased visibility creates the illusion of ubiquity or ubiquity itself, but the illusion alone is enough to raise the cost of beauty.
And we all know that social media is diet culture’s safe space, even as anti-diet discourse enters the mainstream; health and wellness have simply become online euphemisms for thinness and beauty. Young people would throw a fit if they saw influencers promote SlimFast, but how about a gut-healing superfood powder that eliminates bloat and banishes acne for just triple the cost of a diet shake?!
Media Matters for America reported on Jan. 13 that the digital ~wellness~ conglomerate Kilo Group spent $4.3 million on TikTok advertisements between Nov. 1, 2022, and Jan. 7, 2023, mainly to market the Beyond Body “personalized wellness book” and ColonBroom sugar-free psyllium husk powder, making the company TikTok’s largest fitness and weight loss advertiser. The ads hide unrealistic weight loss claims behind peer testimonials and influencer recommendations in order to trap TikTok users into auto-renewing subscriptions. This fits the Better Business Bureau’s definition of a scam.
I first heard the Wegovy buzz on TikTok, naturally. The first five results when I Googled the drug were ads for various online prescribing platforms: “20% Off with Code HAPPY20 - Buy Wegovy glp-1,” “Semaglutide Online Telehealth Consultation and Overnight Shipping!” I clicked on the top result, an ad for Calibrate: “Join Calibrate for doctor-prescribed GLP-1s proven to result in sustainable weight loss. Results, guaranteed: 10% weight loss in one year or your money back. See terms.”
I clicked around the Calibrate website and detected potent Hers/Hims energy. Curology essence, if you will. Nurx vibes. These are all online prescribing platforms with nearly identical websites made for millennials and zoomers who want health care to be as fast and easy as buying sugar-free psyllium husk powder.
This is what the internet-ification of medicine looks like. Yes, it’s worse than WebMD, and yes, it goes beyond gut health. It’s Big Pharma sliding into a scam-infested consumer pathway that has proven to be immensely profitable: social media points out a problem you didn’t know you had and recommends the perfect product to fix it, then SEO gently carries you to an easy-to-navigate website full of diverse models who exude health and empowerment. And look at that, first-time visitors get 10% off after signing up for email and text communications!
This cyclical journey from insecurity to buy-in works for skincare and fast fashion, and it works for pharmaceuticals, too. Our fatphobic and beauty-obsessed culture turns aesthetic problems into health problems, shuttling you to a prescription on the other side of a five-minute quiz and virtual consultation whenever you feel shitty about yourself. Treatment tailored to your needs, a money-back guarantee and 24/7 virtual customer support. Skip the pharmacy lines, take your health in your own hands, free shipping.
The dream is fast, personalized, outcomes-based care. And it’s a good dream to have. In the wealthiest nation in the world, every citizen should have access to personalized care. What alarms me is that online prescribing platforms designed around weight loss drugs are proliferating just as quickly as social media is generating interest and demand, but the regulations around how prescription drugs are marketed have not kept up.
When the FDA first allowed direct-to-consumer advertising in the 80’s, the only big promoters of prescription drugs were pharmaceutical companies, and the media for such ads were television, radio, and print. As a result, advertising regulations for pharmaceuticals are focused on entities that manufacture prescription drugs—most telehealth platforms don’t manufacture the drugs they promote—and they have no box to put influencer marketing in.
In January, the Physicians Committee for Responsible Medicine recently filed a complaint with the FDA calling out CBS for airing a 13-minute promotion of Wegovy that appeared to be a news story. The committee said CBS received advertising payments from Novo Nordisk, only featured experts paid by Novo in the coverage, and used themes that Novo uses in its other ads. It looked like an ad, it smelled like an ad, and it violated the FDA’s “fair balance” requirement by failing to mention the drug’s risks and contraindications. I didn’t hear mention of side effects or risks in any of the ~success stories~ I’ve seen on social media, but that oversight didn’t technically violate any FDA requirements.
Since Wegovy agonizes a hormone produced by the pancreas, the pancreas can get overwhelmed, resulting in pancreatitis. Gallstones, digestive issues, bloating, increased heart rate and serious drops in blood sugar have also occurred. Another risk the media has been glossing over is that Wegovy and Ozempic are meant to be taken continuously, even after users reach their ~goal weight~ or see the health improvements their doctors are aiming for. (To the tune of $1,500 a month, this is music to Novo Nordisk’s ears.) In a 120-week study, patients who stopped taking semaglutide after 68 weeks regained about two-thirds of the weight they lost, and the cardiometabolic improvements seen from week 0 to week 68 reverted towards baseline at week 120.
Metabolic drugs like semaglutide getting the viral-wellness-product-of-the-day treatment points to a dangerous loophole in how pharmaceutical sales are regulated. More importantly, the viral status of weight loss drugs is the inevitable consequence of medicine’s decision to pathologize fatness. Yes, it was a decision: Ten years ago, the American Medical Association declared that obesity is a chronic disease rather than a “problem of personal responsibility.” The goal was to get physicians to talk to their patients without judgement, as if calling obesity a disease would destigmatize it. As if “it’s a disease” and “it’s a personal failure” are the only two options.
(Calling obesity a chronic disease is saying that it requires lifelong treatment. Like weekly injections forever. This is a part of the Wegovy equation that the online discourse doesn’t seem to get—forever isn’t really something that diet culture consumerism can comprehend.)
Clinical obesity is defined not by lipid levels or blood pressure or volume of adipose fat but by BMI, a simple ratio that determines if your body deviates from the average body as it was defined in the 1800s, when eugenicists and insurance companies agreed that average = healthy. After two-hundred years of scientific progress, medicine still bases its idea of health on parameters so simple they can be guessed by a layperson. Obviously, choices like this are not politically neutral: Western control societies align undesirable traits, phenotypes and identities with disease states in order to legitimize the dehumanization of certain people groups.
As a diffused form of control, diet culture encourages people to get as far away from these undesirable identities as possible, for the sake of their health. Hence the constant efforts of white women to be thin, of rich people to be thin—since fatness is aligned with social inferiority, thinness is a reification of social superiority that must be endlessly defended.
According to Forbes, Calibrate’s customers are 45 years old on average and overwhelmingly female. “Three fourths of its members are white, and 52% have reported annual household incomes less than $150,000,” which is a funny way of saying 48% have annual household incomes above $150,000. Calibrate charges $138 per month for its lifestyle coaching, and the GLP-1s they prescribe are managed though commercial insurance. Medicare, Medicaid and TRICARE beneficiaries are not eligible.
Whenever diet culture mutates, there’s a fresh crop of companies growing in symbiosis with it, like those fish suctioning themselves to the side of a shark. The “clean girl aesthetic” mutation was a response to the body positivity movement, and that allowed skincare companies to pull market share away from makeup companies. The retrenchment of fatphobia under the banner of medicine allows companies like Calibrate to join this circus, using diet culture marketing tactics to gain the market share that companies like Weight Watchers and Jenny Craig are losing as people get woke about restrictive diets. Every mutation involves inflation: advertising expenditure increases, products get more expensive, the work gets more invasive.
In the summer of 2021, Forbes reported that Calibrate raised a $100 million Series B round. The company generated $21 million in 2021 revenue and (correctly) guessed that the 2021 approval of Wegovy for chronic weight management would drive major revenue growth. According to estimates from GrowJo (Calibrate isn’t publicly traded so they’re not obligated to release earnings reports to the public), the company brought in $102.9 million in 2022.
On Feb. 1, Novo Nordisk reported that its full-year net profit for 2022 was 55.53 billion Danish kroner, or about $8.15 billion. Sales for the company’s obesity drugs increased 84% to 16.86 billion Danish kroner last year, or about $2.5 billion.
In 2021, the U.S. spent 17.8% of its gross domestic product on health care, almost double the average of 9.6% for high-income countries, according to a report from The Commonwealth Fund. And yet, the analysis suggests that overall health in the U.S. is worse than in other high-income countries. Life expectancy at birth for the U.S. is three years below the Organization for Economic Co-operation and Development Health Statistics 2022 database average, and the obesity rate in the U.S. is about 43%, almost double the OECD average of 25%.
Physicians Committee for Responsible Medicine President Neal Barnard said the committee is concerned that Novo Nordisk’s political action committee has paid more than $250,000 in campaign contributions to members of Congress in an effort to pass legislation making the U.S. government pay for Wegovy via Medicare. Calibrate founder Isabelle Kenyon is also aiming to push the platform into enterprise channels, which could include “the government through Medicare and Medicaid.” When asked about her focus on fast-paced growth, Kenyon said, “Why the focus on speed? Because it all comes down to the same thing: The faster that you reach more people, the faster that you change the way the world treats weight.”
If Medicare covers Wegovy, the drug would certainly reach more people, meaning more revenue for Novo, Calibrate and the like, and more health care expenditure for U.S. taxpayers. But would getting more people on GLP-1s improve national health outcomes in the long-term? Would increased government spending on weight loss drugs lead to decreased spending on treatments for heart disease and diabetes? Doesn’t weight cycling (losing weight and gaining it back) make people more susceptible to disease? Would it be more cost-effective to address childhood food insecurity, which leads to obesity in adulthood? Or to improve access to education, which is related to obesity rates? Would a universal basic income reduce chronic stress, which promotes fat storage? Would it help to break up Big Food monopolies and regulate ultra-processed foods? Would it help to train doctors to understand how genetics, zip code, sleep and trauma relate to weight?
Health is an incredibly nuanced topic, but capitalism flees from nuance. Despite all the scientific and technological progress being made in America’s world-class research institutions every day, many pharmaceuticals remain temporary, incomplete treatments for complex problems. They cost a lot, they help a little. Characterizing obesity as a chronic disease that must addressed only in a medical context further alienates those who struggle to access health care and encourages fatphobia among those who don’t.
For the benediction, a passage from Health Communism by Beatrice Adler-Bolton and Artie Vierkant:
Under capitalism health has been defined to embody many meanings at once: from the hyper-individualistic, biological ‘health’ any one person possesses—always a possession, not an ontology—to global society-level constructs which attempt to give language to chances for survival at the population level. Health is a vulgar phenomenon. A race-and-class-stratified matrix of constantly intersecting regimes of artificial scarcity. A destination, something one must always orient one’s life toward. Healthy physically, socially, economically, and metaphysically. More than a thing, and so often difficult or impossible to describe, health becomes defined by the things it is not. Non-cancerous, dis-abled—as though the purest state of health is to simply not exist.
This is maybe the first really good Substack (not this post, the whole site) I've read in years