The Nonsense of Asking “Who Deserves Care?”

In a perverse way, there might be some good news in the current frothy coverage about new medicines for obesity and diabetes. We are a bit fed up with nonsense about who “deserves” access to  care with drugs like semaglutide. But it does serve to highlight some of the usually hidden biases about treating obesity. Typically, the idea that people with obesity don’t deserve medical care lurks in the background.

However, this week Rolling Stone came right out and said it. The headline was “Who Deserves the New ‘Miracle’ Weight-Loss Drugs?”

Fueled by an Ongoing Supply/Demand Mess

This conversation springs from supply difficulties that are supposed to be getting better as the year comes to a close. This week, Novo Nordisk CEO Lars Fruergaard Jørgensen came right out and said it. Though the company knew they were launching a product (semaglutide branded as Wegovy) with unprecedented efficacy for obesity, they did not plan adequately for the huge surge in demand it created. Within five weeks of launch, demand for the drug exceeded the levels it took four years to build for their earlier offering – Saxenda. He summed it up:

“We should have forecasted better, which we did not. Had we forecasted that, we would have built a different supply chain.”

Spillover Effects

We will see if the promise of a more adequate supply of semaglutide by the end of the year actually comes true. But the other news this week is that Eli Lilly is starting to restrain access its new drug in this category, the Mounjaro brand of tirzepatide. Though tirzepatide only has an FDA approval right now for type 2 diabetes, the company has gained fast-track status for an FDA review of the drug in treating obesity. And thus, obesity medicine physicians have begun prescribing it for patients with obesity who can benefit from it.

Lilly is only saying that it is restricting its discount program for Mounjaro to patients who are using it for diabetes:

“As we continue to broaden access for patients, we also want to continue to emphasize appropriate on-label utilization of the savings program. Lilly only promotes Mounjaro consistent with its approved FDA indication and label and cannot comment on scripts for the treatment of indications outside of type 2 diabetes.”

Their discount program brings the out-of-pocket cost down from roughly $1,000 per month to $25. But this restriction has led to reports of pharmacies refusing to fill Mounjaro prescriptions for patients who need it to treat obesity – even if they’re prepared to pay the full cost out of pocket.

Nonsense About Who “Deserves” Care

The nonsense of suggestions that a person with obesity is not someone who deserves care has been with us for a long time. But this situation makes it more explicit. We have, now for the first time, a drug that works pretty well for many people with obesity, but the supply is not adequate.

It’s infuriating to hear people frame the question as whether people with obesity deserve care as much as people with diabetes. It’s also absurd. These people can easily wind up being the same people. Obesity medicine physician Beverly Tchang explains:

“Obesity can lead to diabetes, diabetes can lead to obesity. They’re very much intertwined, and to treat one but not the other seems inequitable. It appears people want to ‘save the medication’ for the people who ‘need it,’ and I understand that sentiment. But we need to look at obesity as its own disease that is equally deserving of treatment.”

Amen. All of us need and deserve effective medical care.

Click here, here, and here for more on this ongoing saga of the unmet need for medically sound obesity care.

Old Man of Calcutta, illustration by Edward Lear from The Book of Nonsense / WikiArt

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December 10, 2022