Ozempic: There’s Good News and Bad News

A new study leverages millions of patients to find the effects — and side-effects — no one is talking about.

I’m really the last person to call something a miracle drug, but when it comes to the new weight loss drugs — formally the GLP-1 receptor agonists like Ozempic — I’m hard-pressed to think of a different term.

Remember, these were designed as diabetes drugs. They were supposed to lower blood sugar. And they do. But it turned out they had profound affects on appetite, leading to substantial weight loss in the range of 10–20% of body weight. And I feel a bit like a late-night infomercial host here — because whenever I talk about these drugs I’m like “and that’s not all”. Studies have also shown that they curb other appetites. People taking them are more likely to quit smoking, drinking, and gambling. They do less compulsive shopping even. I’ve written about this before, referring to these really as “anti-consumption” drugs, and considering them more or less the antidote to the central problem of our current culture — over-consumption.

But I’m not an unabashed optimist. When I teach interpretation of the medical literature to students, I remind them that if you think something sounds too good to be true — it probably is. What other effects do these drugs have that we don’t know about? The problem is — lots of medical research is hypothesis-driven. You come up with a hypothesis — “GLP-1 drugs increase the risk of pancreatitis” and then you design a study to prove that hypothesis false or true. But these drugs have so many diverse effects. Is there a way we could possibly check for all of them? At once?

Actually, you can. By shifting the frame from hypothesis-driven studies to something called “discovery” studies. The idea being to look for any signal of benefit or harm across a huge range of datapoints. It’s sort of like searching for extra-terrestrial intelligence. You can either point your telescope at some interesting nebula or planet to see if there is anything out there — or you can just sort of listen broadly to the entire sky at once.

Of course, to do discovery research, you need a huge number of people to study. Ideally, those people need to have all their data collected in…