The plate of spagbol arrived, wafting beneath me as it was lowered to the table, and I thought there must have been some mistake. The damn thing was huge. The white, gleaming plate was UFO size, the vast pool of meaty spaghetti staring at me. I wouldn’t be able to finish this. Were they giving us some nonsense banquet communal-eating thing? Then I remembered that I was on drugs.
Well, one drug in particular. Ozempic, semaglutide, the miracle weight-loss cure you’ve heard of but whose name you can’t remember. The once-a-week injection (it’s a light prick, like any given senior AMA member) has become the drug du moment, with private doctors besieged by people willing to pay $800 a month for an alternative-use prescription to shake off 10 kilos or so. Demand made the drug unobtainable in Australia for months.
Which was bad news for people like me, who use it for its intended purpose: type 2 diabetes. We get it on the pharmaceutical benefits scheme at about $60 a month. But there’s very little scope to restrict its alternate use; it’s not a restricted schedule drug like amphetamines, which can be tightly controlled.
Weight loss has been one of its stated effects and prescribing purposes when it was first released — albeit for very overweight people at high risk of tipping into diabetes. So hey, why not start when you’re carrying eight kilos too many? And if that coincides with beach season at Port Douglas, well… The resulting therapeutic mess shows how in need of serious reform our pharmaceutical system is, and how unprepared we are for running a health system in a changing world.
First, the shortest possible primer. Type 2 diabetes, “diabetes yoursus faultus”, develops from obesity, age, poor organ function, or all three. In type 1 diabetes, the body’s immune system attacks the pancreas and kills the beta cells that produce insulin, which when released into the bloodstream binds with sugar (all non-fat, non-protein, non-fibre foods) and allows it to enter muscles and the brain. Type 2 people are those who have released too much insulin for decades, leading to insulin resistance by muscles, as well as fat accumulation that occludes and exhausts beta cells.
Type 1s need insulin, and nothing much else as treatment, to stay alive. Type 2s can reverse their diabetes early on with diet control and weight loss, then a variety of pills, and then drugs like Ozempic. Ozempic limits the operation of the pancreas’s alpha cells, which signal the liver to release sugar into the bloodstream (this is a necessarily oversimplified account). In healthy people, beta and alpha cells act in extraordinarily precise synchronisation to keep blood sugar stable. In type 2s, the alpha cells continue to pump the sweet stuff — especially if you’ve reached the stage of needing to use insulin.
This family of “inhibitors” have been around for about 20 years, and they’re a godsend. They allow for sharp reductions in insulin use. The downside? They make food taste like garbage, like dirt. This aids weight loss, but fairly crudely. That’s how they worked, until the last iteration of them, out about 10 years ago. It was noticed these drugs also reduced appetite, and appetite of all types — both the basic stomach hunger and the gnawing “head” hunger, the desire, usually for sweet stuff, that many people with the yoursus faultus condition feel as an uncontrollable drive for food.
Then Ozempic was released and… it is freaky. It is not an appetite suppressant, it is a mind and self re-shaper. It dulls the taste of food slightly, but one suspects that it is actually taking taste into a more normal range — possibly evidence for the old theory that people with a bit of yoursus faultus actually taste food more, get a bigger neurological oomph out of it. Since taking Ozempic, I’ve been eating more curries and chilli’d foods that were hitherto overpowering, but now simply give the necessary kick.
The drug changes one’s entire orientation and appetite. Appetite cuts off sharply, and may do so mid-meal, as with that plate of pasta. Appetite for yoursus faultus people usually never does that, because the whole system is out of sync. Too much food looks disgusting, as thin people, hitherto bewilderingly, say it does. You forget to eat whole meals.
You have a desire for a chocolate bar, ask yourself if you really need it, and feel no more than a slight tug of desire, easily resisted — and not the roaring, mind-drilling absolute desire that would have you (personal memory) crossing in front of two trams to get to a 7-Eleven for a Snickers. And, as I said, the plates suddenly loom a wholly different size. Freaky.
This is why the drug, and its variant Wegovy, have been such hits with non-diabetics, where previous versions have excited little interest. And there are new variants on the way, promising ever more subtlety of effect. But the effect for months has been serious and potentially disastrous for many diabetic users.
The sudden non-availability of Ozempic exposed the utter lack of any sort of coordinated approach to such sudden supply issues. The health departments at both federal and state levels appeared to barely regard it as an issue for their response at all. Different pharmacists and hospital departments began devising ad hoc regimes for supplying known patients, known diabetics, etc. But there are, reasonably, limits to what pharmacists can do; they can’t just refuse service to someone with a valid prescription like it was a bar.
This all got worse, as people responding to the “miracle weight loss” cure stories began seeking it out, and then seeking out its predecessor, Trulicity, which is less effective and slightly more dulling of taste, but still pretty good. So that ran out too. At that point, one could retreat to their precursor Byetta, which has no significant appetite modification effect and works solely as an inhibitor.
Which is why, haha, they’ve now stopped making it, as it approaches the end of its patent life. Because everyone will be switched to Ozempic, which is produced by Novo Nordisk in one factory in Denmark. So as a discontinued drug, doctors aren’t supposed to prescribe it. I knew they might stop, and got a supply as a stopgap. Other people are just going without.
This situation is insane. It is mad. It will, on a global scale and in Australia, result in unnecessary early deaths, blindness, kidney failure and amputations. These once-a-week drugs are particularly good for people from cultures — or educational and social backgrounds — with low levels of health self-management tendencies. A once-a-week injection is thus a real advantage.
This is simply one example of the growing disarray of necessary drug supply across the West. As the Global South brings forth a new global urban working class and middle class, the demand for drugs available only to the West a couple of decades ago — basic blood pressure, cholesterol, diabetes and pain management medications — has skyrocketed, and supply hasn’t kept up.
One of the reasons for the lag is the private structure of pharmaceutical supply. Good enough drugs go out of production when something much better comes along, and in the gap, the whole treatment profile of a population can go back to zero. This problem won’t go away. It is especially risky for Australia, since we produce almost none of our own medications.
One saw the immediate effects of this during COVID. One also saw the sudden panicked realisation that, lo and behold, in situations in which China decided it might need to keep the whole supply, we couldn’t just order what we needed from Shenzen because we’re white and Western. Nothing seems to have been quite so effective at making clear the utter folly, the absolute history of stupid of the neoliberals, as destroying what was once an effective homegrown pharmaceutical industry, and the world-class local research that went with it.
We need to do what other nations made peripheral by neoliberalism are doing, and create our own state capacity for producing generic versions of patent-ended medications, with a capacity for rapid upscaling in emergencies.
This should be a part of the preparation for the next pandemic. You know, the one that doesn’t have a 1% mortality rate mostly for those 85-plus, but which kills kids, like good old fashioned diseases are meant to do. The one with a 5% mortality rate, sufficient to require emergency social reorganisation of something more than a few lockdowns. Oh, but that’s right, COVID was a once-in-a-century thing, right?
This is plain common sense, but the deeply embedded neoliberal mindset — which now takes in most Labor MPs, their advisers, the top of the public service, and the universities that train them all — renders such a sluggish capacity to respond to real conditions that we will sleepwalk to disaster because the assumption, in the country of the inventor of penicillin, is that drug development should be in the hands of companies with whole departments devoted to thinking up ever-weirder names for mildly differentiated drugs.
Don’t hold your breath waiting. If you do, try Omphagalos, the new breath-holding basic molecule, which our PBS will pay a US company tens of millions to supply us with in a shiny box.
Whether I will continue with Ozempic now that it is slightly more reliably available is another question. It’s something for another time, but I’m concerned that the drug is, psychologically, too subtle in its changes and effects. I’m not sure I want my desires reshaped if the effect is general — and there are signs that Ozempic may assist in overall impulse control.
I don’t want my overall impulses controlled, and I suspect that the drug may thus be part of the great wave of SSRI anti-depressants, anti-anxiety drugs, ADHD meds and the like that people are flocking to because they’ve given up on the challenge of being fully human, the unique rewards of it, in order to medicate the blinding pain of its frequent absence in the world that neoliberalism has produced. I have no doubt that Ozempic will eventually be prescribed for behaviour modification too.
Very happy to have the urge to eat a spagbol and then a pizza and then a pack of Tim-Tams capped. But I want to keep the desire to set fire to things at parties, destroy promising career opportunities and inadvertently break up marriages.
Happy to take medication for that, but only if it encourages it. I have no doubt that in that I am in the very great minority.
Does Australia need to rethink its drug supply network? Let us know your thoughts by writing to letters@crikey.com.au. Please include your full name to be considered for publication. We reserve the right to edit for length and clarity.
