Feb 15, 2023 - Podcasts

Hyped weight loss drugs raise equity concerns

In 2022, more than 5 million prescriptions were written for diabetes drugs to be used for weight loss. The demand spiked because of social media influencers and celebrities touting the benefits. But widespread off-label use of diabetes drugs is raising concerns about cost and shortages.

  • Plus, last week’s earthquake becomes Turkey's deadliest in 100 years.
  • And, human intervention is keeping manatees alive in Florida – but for how long?

Guests: Axios' Tina Reed and University of Miami's Dr. Jill Richardson.

Credits: Axios Today is produced by Niala Boodhoo, Alexandra Botti, Naomi Shavin, Fonda Mwangi and Alex Sugiura. Music is composed by Evan Viola. You can reach us at [email protected]. You can text questions, comments and story ideas to Niala as a text or voice memo to 202-918-4893.

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NIALA: Good morning! Welcome to Axios Today!

It’s Wednesday, February 15th.

I’m Niala Boodhoo.

Today: last week’s earthquake becomes Turkey's deadliest in 100 years. Plus, human intervention is keeping manatees alive in Florida – but for how long? But first, hyped weight loss drugs are raising supply and equity concerns. That’s today’s One Big Thing.

Hyped weight loss drugs are raising supply and equity concerns

NIALA: In 2022, more than 5 million prescriptions were written for diabetes drugs like Ozempic to be used for weight loss. That's up from about 230,000 in 2019. The demand spiked because of social media influencers and celebrities touting the benefits. But the widespread off-label use of these diabetes drugs is raising concerns about cost and shortages. Axios’ Tina Reed has been covering the story.

Tina, how do drugs like Ozempic work for weight loss?

TINA REED: So, these are a class of drugs that are known as glucagon-like peptide-1 agonists or GLP-1 for short. And they're basically, um, drugs that mimic a hormone in the body that can regulate appetite and blood sugar levels. These drugs were initially approved by the FDA for use in Type 2 diabetics with the side effect of being able to help people lose weight. They were so effective in helping people lose weight that they were later approved in a different formulation that was also approved by the FDA for weight loss.

NIALA: And how did it gain popularity for people who don't have diabetes to use it?

TINA: So this actually became one of Hollywood's worst kept secrets. And a lot of doctors in general actually were so impressed by the safety profile of these drugs and their effectiveness that a lot of non endocrinologists were actually starting to prescribe these. They got really popular on social media. That played a large role with people posting stories about their weight loss with before and after photos, and touting their benefits.

NIALA: So some of those before and after photos also talk about this so-called ozempic face, people get?

TINA: Yes, essentially people have lost weight so quickly that it almost creates a facial drooping, a gaunt look in the face. People have talked about this actually being a bit numbing in their face and, and kind of a weird sensation. This is just one of the side effects that can be quite disturbing for people on these. They can cause nausea, diarrhea, so these drugs are not without side effects when people are taking them.

NIALA: They're also expensive. Ozempic can cost up to $1,400 a month out of pocket without insurance. The FDA has put it on their list of shortages. I know for diabetics, this has been a really effective drug for lowering people's A1c’s. What are the equity concerns around access here?

TINA: The equity concerns are actually pretty complicated. On one hand, there is a concern that people who don't need these drugs as much as perhaps a Type 2 diabetic and maybe using them for cosmetic reasons, are able to basically buy these out of pocket if they can afford it. While somebody who may be a Type 2 diabetic may depend on getting these drugs via insurance and might not be able to access them because of the short supply. Bigger picture, this gets a bit convoluted because when you think about treatment of obesity, there are people saying that in itself is a serious condition that is connected to so many comorbidities, including diabetes, including heart disease, including cancer. And for these people, this has been seen as a true game changer where it can help them lose, you know, on average 15% of their body weight.

NIALA: So what's being done to fix supply shortages?

TINA: One of the things I heard from folks was it's the supply is most likely going to catch up quickly. So that also raises some very real concerns about healthcare coverage and what that would mean if everyone who would benefit from these drugs actually got them covered, creates a really tricky situation.

NIALA: Tina Reed is the author of Axios Vitals newsletter. Thanks, Tina.

TINA: Thank you, Niala.

Last week’s earthquake becomes Turkey's deadliest in 100 years

NIALA: An update on last week’s earthquake in Syria and Turkey.

Turkish President Recep Tayyip Erdoğan said yesterday the death toll in his country had surpassed 35,000 people, making it now the deadliest earthquake Turkey has experienced in a century. In northern Syria, officials there say the death toll there has reached at least 3,600.

Syrian President Bashar al-Assad permitted earthquake aid to travel from Turkey into rebel-held areas of northern Syria yesterday. This came after the UN and other aid groups faced criticism for a slow response in that region.

And in Turkey, Erdogan has also faced criticism for his government’s response. That’s especially after years-old clips have begun to circulate in Turkish media of Erdogan boasting of permitting builders and contractors to sidestep regulations in order to build more housing… here’s one example from Duvar media in Turkey:

[Erdogan speaking in Turkish]

That’s Erdogan saying that the so-called construction amnesties have “solved the problem” - of residents there. Critics are now alleging those building code “amnesties,” contributed to shoddy construction and the high death toll in last week’s disaster.

For more news and updates on the fallout of the earthquake, go to Axios.com.

In a moment: feeding programs are saving manatee lives in Florida.


Human intervention is keeping manatees alive in Florida – but for how long?

NIALA: Welcome back to Axios Today. I'm Niala Boodhoo.

I've been hosting from my hometown of Miami for much of the last few weeks, and every couple of days I get a glimpse of manatees swimming through the canal just outside my place. Yesterday I saw four different manatees, including a mom and her baby, and it's a heartening site because a record 1100 manatees starved to death in Florida in 2021.

So Florida wildlife officials have for the second winter in a row, set up a feeding program at Cape Canaveral. This winter, Florida Fish and Wildlife have already fed more than 175,000 pounds of romaine lettuce to manatees, and so far, 48% fewer manatees are dying this winter compared to last year at the same time.

Dr. Jill Richardson is a marine biologist with the University of Miami's Rosenstiel School. Welcome to Axios Today. Thanks for being with us.

DR. JILL RICHARDSON: Thanks so much. Thanks for having me.

NIALA: Dr. Jill, can you remind us how things got so bad for manatees?

DR. JILL: Okay, so their number one need is access to sea grasses. It is above and beyond the most nutritious plants they consume, so they're actually the only marine mammal that is fully herbivorous, so they eat only plants. And seagrasses provide a level of nutrition that other plants can't. So when we lose seagrasses, manatees are forced to feed on other types of plants, which are much less nutritious and oftentimes harmful to them.

NIALA: And why are we seeing less seagrasses?

DR. JILL: The general answer is poor water quality. So as water quality in these shallow water ecosystems deteriorates. Typically as a result of runoff, from fertilizers and we, what we call eutrophication or nutation of the water column, as well as sedimentation of the water column that blocks the light that seagrasses needs to grow. We start to see massive declines in seagrass beds and thus the loss of the manatees' primary source of sustenance.

NIALA: So how much has the feeding program, the Florida Fish and Wildlife set up, how much has that helped?

DR. JILL: It's helped quite a bit and it's totally unprecedented. That decision to provision or feed wild manatees was not one that was taken lightly. Because of course we want to mention to the general public that they should not feed or water manatees because it's illegal under the Marine Mammal Protection Act. But with these trained experts, the decision was made to provide them with a supplemental resource during periods in which they might not otherwise survive.

NIALA: Is this a sustainable solution when we think about the West Indian manatee population in Florida?

DR. JILL: Unfortunately, I have to say no and If we don't get working hard on improving water quality in our shallow water bays and shallow water coast ecosystems, it's like putting a bandaid on a really big problem. So yes, we're able to sustain them through a harsh winter, but long term, I don't believe this is a viable solution.

NIALA: So I feel like as a native Miami and a Floridian, you learn a lot about manatees as a kid, and that's probably why I love them so much. But why do they matter to the broader ecosystem?

DR. JILL: They're actually considered in science, what we call environmental engineers or cultivation grazers. They, through feeding on seagrass beds, tend to feed on the faster growing species of seagrass, which then opens up space for more slow growing, more nutritious species of seagrass to grow. So in essence, they're on some level maintaining the, the diversity of seagrass beds and also providing themselves with the nutrition that they need.

NIALA: Dr. Jill Richardson is a marine biologist at the University of Miami's Rosenstiel School. Thanks so much, Dr. Jill.

DR. JILL: Thank you.

NIALA: That’s it for us today! There are so many ways to get in touch with us. You can reach our team at podcasts at axios dot.com. You can also text me at (202) 918-4893 - and I’ve got a video up on my Instagram story of some manatees I saw yesterday morning.

I’m Niala Boodhoo - thanks for listening - stay safe and we’ll see you back here tomorrow morning.

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