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Ozempic has been hailed as a miracle drug. It is the most well known of the GLP-1 medications, a class of drugs that can help regulate appetite, digestion, and blood sugar—and help those suffering from obesity or diabetes lose weight. Naturally, these drugs are very much in demand. But now there is a shortage of Ozempic and other GLP-1s, which has led to a swell of clones that purport to offer the same benefits and the same key ingredient, semaglutide, at lower prices. These clone drugs are easy to procure from telehealth providers, even if a buyer needs to lie about themselves a little bit to buy them.
In this brave new weight-loss world, we're still coming to grips with how these drugs fit into our society. Part of that journey is the continued study about how GLP-1 drugs work—much of how they affect us is still unknown—and the continued debate about how much we should regulate and control their use.
This week on Gadget Lab, we talk with WIRED writers Kate Knibbs and Emily Mullin about how GLP-1 medications like Ozempic work and what happens when they don’t. We also talk about the current drug shortage and how that may get resolved.
Show Notes
Read Kate’s story about buying cloned Ozempic online. Read Emily’s story about how Ozempic doesn’t work for everyone. Read all the stories in WIRED’s The Age of Ozempic series.
Recommendations
Emily recommends staying cool this summer however you can. Kate recommends the HBO series John Adams, starring Paul Giamatti. Mike recommends buying a used 35-mm film camera and shooting some rolls to flex your creativity.
Kate Knibbs can be found on social media @Knibbs. Emily Mullin is @emilylmullin. Michael Calore is @snackfight. Lauren Goode is @LaurenGoode. Bling the main hotline at @GadgetLab. The show is produced by Boone Ashworth (@booneashworth). Our theme music is by Solar Keys.
How to Listen
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Transcript
Note: This is an automated transcript, which may contain errors.
[Gadget Lab intro theme music plays]Michael Calore: Hi everyone. Welcome to Gadget Lab. I am Michael Calore, WIRED's director of Consumer Tech and Culture. Lauren Goode is off this week, she's on vacation, and we miss her dearly. But we have two excellent guests, WIRED senior writer Kate Knibbs. Hi Kate.
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Kate Knibbs: Hi Mike. Thanks for having me.
Michael Calore: Of course. Welcome back to the show. And joining us for the first time, WIRED staff writer Emily Mullin. Hi Emily.
Emily Mullin: Hi Mike.
Michael Calore: Welcome.
Emily Mullin: Thank you for having me. I'm excited to be here.
Michael Calore: All this month WIRED is running a special series on our website about the booming business and latest science of anti-obesity drugs. The series is called The Age of Ozempic, and both Emily and Kate have been reporting stories for this series. So I'm really glad the two of you're here today. Now, most all of you listening have heard the brand name Ozempic. It's the name of a drug and the most well-known name in the class of drugs called GLP-1 agonists, Ozempic, Wegovy, and all the drugs like them, mimic the hormone in your body that helps regulate appetite, digestion, and blood sugar.
They're an effective treatment for diabetes and obesity. And people who take GLP-1s typically eat less and they lose a lot of weight. In the second half of the show, we'll talk about the new science behind GLP-1s and what we're still learning about how they work. But first we have to talk about how people are getting their hands on the drugs, because there's currently an Ozempic shortage, so it's expensive and very hard to buy. But Kate, you found that it was pretty easy to buy Ozempic clones on the internet. A lot of people are probably seeing ads for these clones on social media. So why don't we start there?
Kate Knibbs: Yes, so I think anyone who has an account on X or Instagram or TikTok has probably seen at least one of the ads for one of the many, many telehealth clinics that have started selling versions of GLP-1 meds. And there's so much that we don't know about how many people are taking this kind of medication, because I've been reporting the story for weeks on this now and no one has the numbers. Since Ozempic and Mounjaro, and Zepbound, and Wegovy, and all of the other name brand GLP-1 agonists are currently an official FDA shortage. It's legal to create, what's called, a compounded version of these meds, and that is largely what these telehealth companies are selling online. Some of them do sell the official meds, but they're still priced a thousand dollars a month for people without insurance. So they're primarily selling the compounded offerings.
Michael Calore: So these are compounded drugs, but they're not generic versions of the drugs, right?
Kate Knibbs: Yes. And this is something that I think isn't super common knowledge. I didn't know about it until I started reporting this story. A generic version of a drug is when a patent expires and it's legal to manufacture a non-brand-name equivalent. A compounded version, the patents to the brand names haven't expired, it's just because that they're in shortage, there's this provision in the law that allows you to basically custom mix copies. I think I say in my piece, "In essence, it means dupes are legalized." And compounding … This isn't a new thing. Compounding has been around for a long time. It was started because sometimes people would be allergic to an ingredient in a name brand medication, so they wanted to come up with a way that pharmacies could make a version of a brand name that someone was able to take if they might not otherwise be able to take it. But what is happening in compounding right now with the GLP-1 market, is completely unprecedented. We haven't had compounding at this scale before, so it's pretty wild to witness.
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Michael Calore: OK. So you went to these telehealth companies to try and buy some Fauxzempic, and did you have to talk to a doctor or send a note or anything like that?
Kate Knibbs: When we decided to investigate how these telehealth companies are operating, I selected six different companies, basically just off of who I was seeing pop up in my own social media feeds. And I filled out all of their questionnaires and … They all do things … There's little differences, but they basically all required a questionnaire that you fill out online that was yes or no questions about your health history. You would click boxes if you'd had any specific conditions that they listed, then you had to input some of your personal stats. After you did that, I think almost all of them required that I show my driver's license, and a few made me take photos of myself. And then one of them had me do a video chat with a doctor. And then altogether, four of them ended up sending me the meds. None of them asked me for lab work, and I actually did lie on my app because my BMI isn't in the range that is considered appropriate for being treated with this med.
Michael Calore: What's the appropriate range?
Kate Knibbs: They generally … I think the FDA's recommendations is if your BMI is 27 and you have a comorbidity that's weight related, if it is 30, you can just get it. And so I added 25 pounds to my weight, which is a fairly significant amount. And so we were seeing if anyone would notice the discrepancy when I took photos of myself, or if we FaceTimed. We were just curious to see if anyone would catch the exaggeration, especially because I think I'm one of the target demographics for this med, in that I don't meet the requirements to get it through insurance or for any medical reason, but I would like to lose weight, and I am the type of person …
If I was in a different place in my life, I could see myself lying about my weight and actually ordering these meds to take. And I suspect because I'm feeling that way that there's people out there that are doing it. And so that was one of the reasons I was motivated to report this story in this way, because I anecdotally can tell you that people who are around my size, I know personally, have these compounded meds, and I think it's happening probably at a pretty large scale. It's really hard because there's literally no statistics on how many people are taking these drugs. But yeah, anecdotally I am aware that this is happening at least on a small scale. I wanted to see whether they would catch me, pretty much.
Michael Calore: So how does the FDA feel about this?
Kate Knibbs: They are definitely concerned, I'll say. So the FDA has sent out some letters to different professional groups in the healthcare world, advising that compounded semaglutide medications might not be as effective as the name brand versions. And there's also been a lot of concerns about quality control in compounding pharmacies. Some of them are great, and maybe most of them are great, but there's just … Certain compounding pharmacies were using semaglutide salts instead of just regular semaglutide when they were mixing the medications. And the FDA sent out a warning about doing that. And some of the major compounding pharmacies have had issues in the past. So the FDA stance is basically that potential patients should be aware that compounded versions of these medications are not subject to the same approval processes as name brands. The FDA is not evaluating them for safety, quality, or efficacy before they're being sold. So there's just some question marks that they think people should know about, especially considering how popular these drugs seem to be.
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Michael Calore: So I'm guessing you did not take the drugs that you got in the mail?
Kate Knibbs: No. It was purely a reporting effort. We are actually trying to test them. I don't know if this might be spoiling a future story, but I think it's fine, because it turns out it's incredibly hard to test them. But I'm holding onto the samples in the hope that perhaps we can get them tested. If anyone works for a lab and is listening to this, please get in touch. But yeah, it was really just an experiment. And I've also canceled all of my accounts because I used our editor in chief's credit card to buy all of them.
Michael Calore: So they're just hanging out in your fridge?
Kate Knibbs: Yes.
Michael Calore: OK. Well, I hope they stay there.
Kate Knibbs: Yeah.
Michael Calore: All right, let's take a quick break and we'll come right back.
[Break]Michael Calore: I want to shift gears a bit and talk about what we're learning from the trials and the research being done on GLP-1 drugs. Emily, for this WIRED series you reported on the so-called non-responders, the people who take anti-obesity drugs and then lose a little bit of weight, but not as much as they were expecting, and maybe not enough to get them down to a healthy weight. So to understand the response to the drug, or the non-response to the drug, can you just tell us quickly how the drug works and then how people typically respond to it?
Emily Mullin: Yeah. So GLP-1 drugs mimic the effects of a naturally occurring hormone that is produced in all of us called GLP-1, and the body makes this and releases it after we eat. And GLP-1 works in a couple of different ways, and thus GLP-1 drugs work in a couple of different ways. So they work on the gut by slowing stomach emptying and digestion. They also interact with receptors in the brain to increase the feeling of being sated. So they help people feel full faster, and thus people tend to eat less when they're on these drugs, as you mentioned before. And so they really act as an appetite suppressor, is the main way right now that scientists think they are working to help people lose weight. But as you mentioned, there are some people who take these drugs and they lose a little bit of weight, or they might not lose any weight at all.
I actually got an email from a reader a couple of days ago, and he said he gained five pounds while he was on Ozempic for two months. So clearly these drugs don't work for everyone. They work miraculously well for a lot of people, but there are about 10 to 15 percent of people who are non-responders, and this is what researchers are seeing in clinical trials, and it's also what doctors and obesity experts are seeing in their clinics right now, that there are a group of people who just don't respond as well. They may lose less than 10 percent or even less than 5 percent of their body weight, and as you said, never really get to that healthy weight that they want to get to, that their doctors want them to get to.
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Michael Calore: Is there a difference between how much weight men lose on these drugs and women lose on them?
Emily Mullin: Yeah. So I'm glad you pointed that out, because that does seem to be one of the indicators that people respond differently to these drugs. And what some of the clinical trials are showing is that women, for whatever reason, seem to lose more weight than men on these drugs. So one possible reason is that women just have a different fat composition than men. Another reason is that women, on average, are smaller than men, and so when you're taking the same amount of a drug, and it has less places to go in the body, it's maybe more effective than somebody who is bigger and has more weight on them.
Michael Calore: I see. So you can't just take the drug and lose a bunch of weight without also making some other lifestyle changes, right?
Emily Mullin: Yeah, exactly. So in clinical trials of semaglutide and tirzepatide, just so that listeners are aware, semaglutide, we're talking about Ozempic and WeGovy, and tirzepatide, talking about Mounjaro and ZepBound, those brand names. So in clinical trials, of course, these are very carefully designed, and people are taking these drugs alongside a very prescribed diet and exercise plan. So these are the ideal conditions of taking this drug. And of course, in real life people might not be following that quite as well. And another thing is, one of the experts I talked to, an endocrinologist, she very astutely pointed out that there are a lot of different reasons why we eat. We don't just eat because we're hungry, we eat because it's a very social thing. And so if you are one of those people who are in a lot of situations where there are social temptations to go out and eat socially, or we eat just because the food tastes good. I think we can all relate to eating ice cream out of a tub or finishing off a bag of chips, not because we are actually hungry, but because it just tastes good.
Michael Calore: I eat because I'm sad or angry.
Emily Mullin: Maybe that's a discussion for another podcast episode.
Kate Knibbs: I have a question, Emily, for you. Have you talked to any researchers who have been studying the differences in results between people who are taking brand name Ozempic or ZepBound, et cetera, and people who are taking compounded meds? Because that's something that I've been trying to find out, and I haven't found anyone who's studying that yet.
Emily Mullin: Yeah, I haven't run across that.
Michael Calore: Is anybody doing any research at all about any of the compound drugs, like their safety or the composition of them?
Kate Knibbs: Yeah, I've been trying to find studies that are specifically looking at the compounded versions, and it's really hard. A lot of the more well-established telehealth clinics will have their own lab work done, and some of them will share it, but independent researchers, I don't know. If any of them are listening, I highly encourage them to do it, because … And again, this is totally anecdotally, but of all of the people that I know on GLP-1 meds, the majority are on compounded medications.
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Michael Calore: Really.
Kate Knibbs: Yeah. That are willing to talk to me about it. So again, this is totally anecdotal, but we don't have … There's not really any good stats we could be pointing to, but it seems to me like it's a pretty large percentage of the American public who are taking these drugs or taking the compounded versions. And if there's all these studies that are being done on just the brand names, I'm like, "OK, well did those apply to the compounded versions?" I hope so because those are a lot more accessible to people. But it's just a little freaky what a black box it is right now.
Emily Mullin: We know, though, that with any drug, there are differences in response rates, but I think there's been such a spotlight on these anti-obesity drugs, because their results have been really hyped. And you can turn on the TV or read any publication like WIRED, any newspaper and see these amazing weight loss stories. And I think a lot of people go on these drugs expecting to lose a lot of weight, but of course there are also things like differences in metabolism, how people break down food and convert it into energy. And then researchers are also looking into genetic factors that might be at play. One possibility is that people might have genetic mutations in their GLP-1 receptors, that just make them less responsive to these drugs.
Michael Calore: Maybe we can talk about some good news, because I know from reading your stories, that researchers are coming up with all kinds of data that's showing more positive effects of these drugs than just weight loss. Can you talk about some of those?
Emily Mullin: Yeah. So in March, the FDA actually approved a new indication for a WeGovy, or semaglutide, to reduce the risk of cardiovascular death, heart attack, and stroke in adults with cardiovascular disease, who are either obese or overweight. This was a pretty big deal because no medication has really ever reached the status of both a weight loss drug and also a cardiovascular drug. So there are lots of cardiovascular benefits that are being shown with these drugs. Yeah. But as you mentioned, Mike, there are lots of knock-on benefits that we're seeing as well. So in addition to the cardiovascular benefits, there was just a study out that showed a reduction in risk of different types of cancers, and also kidney disease, from people taking these GLP-1 drugs. So what scientists don't really know yet is whether all these benefits are really just due to the weight loss and people shedding pounds, and thus being a healthier weight, or whether there's some other biological mechanism at play.
Michael Calore: OK. So I think the thing that a lot of people want to know, and maybe we can solve this for them, is when is the shortage going to end?
Kate Knibbs: I would also love to know that. No one knows. Some people at Eli Lilly and Novo Nordisk probably have the best idea, since those are the two manufacturers, or those are the two pharmaceutical companies that own the brand names. It could be over in a few months. It could be over in a year. Most drug shortages last a year and a half, and this has been over two years. I think it almost three years for semaglutide. A lot of people that I talked to while I was reporting seemed to think that because there are so many exciting new use cases that are being discovered, there's a world where this drug will go on and off the shortage list repeatedly, indefinitely. So yeah, the path forward is uncertain. It's also very uncertain what is going to happen to all of these telehealth companies when the drug does come off shortage.
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Technically, some of their manufacturers are supposed to cease production immediately. Some of their manufacturers will have 90 days. But then some people have told me they think that they'll be able to finesse a way forward in the regulatory landscape, whether it's by adding vitamins to the compounded versions and saying it's a new thing or … I don't know. There's so many unknowns. That's one of the things that's really fascinating to me about this reporting, is we have this booming industry where all of these telehealth companies are selling compounded GLP-1 meds, and they might have to stop next week. And then what are all the people who are taking the meds going to do? Because the brand names are literally 10 times the amount of money sometimes. It's a unprecedented and wild time in the pharmaceutical world.
Emily Mullin: I think one of the big issues here is that the pens themselves, the injector pens that are used to administer this drug, are difficult to manufacture and produce. And so once we get to a point where there are oral versions of this drug, which Novo Nordisk and Eli Lilly are both working on right now. If there's a pill version, if there's an alternate version, I think that's going to free up the injectable version more. And then I also think once there are more competitors in the market, stay tuned for my next story about this. There's a whole pipeline of more GLP-1 drugs coming, and anti-obesity drugs that target other things completely. So there are more of these on the horizon. And right now we're relying on these two companies to produce the world's entire supply of these drugs. So yeah, there are going to be shortages for the foreseeable future until I think there's more competition.
Michael Calore: Great. See, more good news. It's a good place to end. Let's take a quick break and we'll come right back with recommendations.
[Break]Michael Calore: All right. Welcome back to the end of the show. This is where we go around the room and we ask everybody to offer a recommendation for a thing that our listeners might enjoy, or piece of advice. Emily, what is your recommendation for our audience?
Emily Mullin: I'm just going to recommend staying cool right now because it's really, really hot, and there's some dangerous temperatures. Right now it is in the 90s where I am, and I don't have an AC, so I'm trying to keep cool by keeping my shades shut and with ice cubes and cold drinks and cold compresses, and staying in the shadows like a hermit.
Michael Calore: Sounds like you need a heat pump.
Emily Mullin: Yes. Next on the podcast, or you've probably already covered.
Michael Calore: Oh, yes. We love heat pumps at WIRED. Everybody go back like three or four weeks and listen to our heat pump episode. It helps you stay cool. It's not just about pumping heat. Well, that's too bad. It's right in the middle of the summer and I know a lot of people are suffering. Sorry, I need water.
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Emily Mullin: Electrolytes!
Michael Calore: Kate, what is your recommendation?
Kate Knibbs: OK, well, if you're keeping cool and you're staying inside with the shades drawn, I think you should watch what I'm currently watching, which is the 2008 HBO miniseries John Adams, starring Paul Giamatti as the second president of the United States. I decided to rewatch this in a weird patriotic fit over the 4th of July, because my husband's Canadian and actually still doesn't know that much about American history, and was like, "Who's John Adams?" And I went on this rant, and so now we're on episode six. And honestly, it's good. It's entertaining. It's like if Hamilton had no songs and was kind of boring, but not as—
Emily Mullin: That's not a great pitch, Kate.
Kate Knibbs: It will lower … I feel like if you're hot and sweaty and just looking for something calm, John Adams is going to keep you cool. You might take a nap. Who knows? So that is my rec.
Michael Calore: Is it some good Giamatti?
Kate Knibbs: Yeah, the acting is great. And actually one of the fun parts of rewatching has been… Yeah, because I've already seen it. This is just a casual rewatch. There's a lot of famous people today who pop up, like Andrew Scott, who plays a hot priest in Fleabag is a ne'er-do-well son-in-law of John Adams, and then—
Emily Mullin: I'll watch it just for him.
Kate Knibbs: Yeah. The cousin from The Bear, Ebon, I forget what his last name is. He is John Quincy Adams, aka the sixth president of the United States. It's great. You should check it out.
Michael Calore: Nice.
Kate Knibbs: Mike, what's your recommendation?
Michael Calore: My recommendation is shoot film. I'm an old person and I learned how to shoot film in grade school, junior high school, something like that. And then digital cameras happened and I forgot all about it, and I haven't developed a roll of film in well over a couple of decades. But recently I was just at a flea market and I found a very nice 1979 Minolta automatic camera, a film camera, 35 millimeter film camera, for a very low price. And I bought it and I shot a few rolls on it and I got the results back.
And I'm just blown away at how much fun it is to take pictures and not see what they look like until a couple of weeks later, and then be very pleasantly surprised by the quality of an inexpensive film camera. Photography has always been a hobby of mine. Digital photography is a hobby of mine. If you follow me on Instagram, you know that I'm an excellent photographer, so getting a film camera and shooting different kinds of things is good. It's good for your brain. It's good to put your phone away. It makes you think about things in a very different way. You get to learn a new skill. So yeah, shoot film, that's my rec.
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Emily Mullin: I had a Holga in college, which made me feel very artsy.
Michael Calore: Yeah, that's awesome. Did you ever have a Lomo, the other plastic camera?
Emily Mullin: No. No.
Michael Calore: Oh, yeah. Those things are great. And film, it's pretty expensive, I'll say. Getting one roll of film, buying a roll of film, and then getting that roll of film developed is more than I paid for the camera. If you want to get cheap film, it's around seven, eight, $9 a roll. If you want to get good film, it's closer to like 15, $20 a roll, and then developing it, you send it away and pay for shipping, and then they send you scans via email and it's like, it's about $15 a roll. So it is expensive, but I think it's worth it.
Kate Knibbs: Love that. You got to take our pics when we come to San Francisco later this year.
Michael Calore: I promise I will.
Kate Knibbs: OK.
Michael Calore: All right. Well that is our show for this week. Watch out for the series of stories this month on WIRED.com called The Age of Ozempic. Emily Mullin, Kate Knibbs, thank you for joining us.
Kate Knibbs: Thanks for having us.
Michael Calore: Emily. It's an audio medium. You can't just wave.
Emily Mullin: I gave a thumbs-up.
Michael Calore: Excellent.
Emily Mullin: Well, Kate spoke for both of us. Thanks for having us. No—
Kate Knibbs: Yeah. Yeah.
Michael Calore: And thank you all for listening. If you have feedback, you can reblog all of this on Tumblr. Just check the show notes. Our producer is the superlative Boone Ashworth. Lauren and I will be back next week with a new show. Until then, goodbye.
[Gadget Lab outro theme music plays]