Will ozempic kill capitalism?
without hunger + desire, the rat race is over
Sometimes, I like to take what I know to be true, and draw wild conclusions—a cheeky little Gedankenexperiment of sorts. For instance, yesterday, I tweeted that Ozempic might kill capitalism, then forgot about it as I pranced into ballet class. (Okay, I lied. I limped because my right calf can’t bear my full body weight at the moment.) In that hour and fifteen minutes, people demanded I explain myself. Well, here we are.
First, a CYA disclaimer because I am a pharma strategist before I am a philosopher: The scenarios and ideas discussed here are purely hypothetical thought experiments meant to spark conversation, not predictions or indictments. They should not be interpreted as actual future events or actions by any organization or government entity.
The GLP-1 market is HOT. I, and every person with a pulse, have spoken about it. That’s because the drugs work. Ozempic is so hot, that drug shortages are keeping people living with diabetes from filling their prescriptions. Clinical trials show that GLP-1 receptor agonists help with weight loss and Type 2 diabetes, which is life-changing for many. J.P. Morgan expects the GLP-1 market will surpass $100B by 2030. Goldman estimates that the GLP1 drug class could help the US economy by lowering health spending and aiding productivity. Healthy people don’t miss work. This won't kill capitalism; it might even fuel it.
The Centers for Medicare and Medicaid Services (CMS) announced plans to cover Wegovy for beneficiaries with cardiovascular disease and obesity. In response, Melissa Barber, Joseph S. Ross, and Reshma Ramachandran published an opinion piece with blue-sky thinking for curbing anticipated Medicare + Medicaid GLP-1 spending (STAT News). They first offered standard drug financing frameworks like subscription models, value-based pricing, and outcomes-based agreements (which I can dive into in future letters). Normal drug dealing. But they threw a curveball: acquisition. They argued that it would be more cost-effective for CMS to buy Novo Nordisk straight-up at its July 23rd market cap ($606 Billion) than covering Wegovy as priced. CMS isn’t allowed to buy Novo. But if journalists can be this speculative on STAT, I’m allowed to be unserious on ‘stack.
NOTHING’S GONNA BE THE SAME AGAIN
We’re learning more about how these drugs work. To clarify, we know they’re safe. Combined, these drugs have solid years of safety and efficacy data. Semaglutide (the key agent in Wegovy + Ozempic) cosplays as a hormone already produced in our bodies, glucagon-like peptide-1. This hormone has many jobs but is known for telling the body when it’s full. The drug works because it helps stimulate insulin (which lowers our blood sugar) and delays our food’s journey from the stomach to the small intestine. This keeps people fuller for longer. Satisfied. We don’t fully know how the drug acts on the brain to (un)consciously uncouple food and pleasure. Patients share that GLP-1s reduce “food noise,” food thoughts, and cravings.
Anecdotally, patients taking Ozempic and its drug-class peers reported reduced cravings for drugs, drinking, and other compulsions. The leading theory? The GLP-1 hormone impacts the brain’s reward system and lowers dopamine (AKA the “feel-good” hormone), blunting the Food-as-a-Pleasure response. Dopamine is also implicated in addiction.
TALK DATA TO ME
For scientists, anecdotes aren’t enough. What does the evidence show?
GLP-1s can reduce alcohol use for people with obesity: Quddos et. al. published two real-world evidence studies in 2023. The first study used social media listening, analyzing GLP-1 Reddit posts with Machine Learning. They found that 71% of posts about alcohol mentioned lower cravings or other negative effects. The second study recruited patients from social media who were taking Semaglutide (Ozempic, Wegovy) or Tirzepatide and compared them to a similar group not on these drugs. They found that people on the GLP-1 drugs drank less overall and were less likely to binge drink vs the non-GLP-1 group.
People using semaglutide for obesity were less likely to start using cannabis for the first time or relapse: This real-world study looked at patient electronic medical records (medical chart information like diagnosis, lab values, etc.) and looked at patients with an active obesity diagnosis and a semaglutide or non-GLP-1 anti-obesity prescription. Then, they looked at whether people used cannabis. Researchers found that semaglutide was linked to a lower incidence of new cannabis use and a reduced risk of relapse in those with a history of cannabis use for patients treated for obesity. They found similar associations for patients with type II diabetes, though the results were not as statistically significant.
GLP-1 drugs may also reduce cravings for things like nicotine and compulsive shopping: This study also relied on Reddit comment analysis, but it’s a good starter to guide future research into curbing compulsive behavior. Randomized Control Trials are the gold standard, but real-world data sheds light on how drugs work outside the standardized trial world.
GLP-1 drugs may help people quit smoking: This study, which F. Perry Wilson (Yale) explained in this Twitter thread, used a target trial emulation study design, (which Wilson unpacks here). Researchers concluded that people using semaglutide to treat their diabetes were more likely to quit smoking than those taking other diabetes drugs.
We’re seeing that this class of drugs influences the reward pathway in our brains that locks us into addiction and consumption loops. We’ll need more research until we know for sure, but people see GLP-1s as an anti-consumption drug. Some of the mess we find ourselves in can be traced back to overconsumption. We all want more. Desire for food, acceptance, love, et cetera drives our choices and keeps us alive. These cravings fuel our productivity and motivation to be a well-behaved and productive cog.
Capitalism, in its current form, thrives on human capital, competition, and profit maximization. We work to earn money to buy things we like. But what if we stop consuming and producing? What if we’re satisfied? Would you still sign onto your laptop to complete some tasks if you’re not getting the same dopamine hit?
Altogether, this signals the death of hunger, desire, and reward. Caroline Polachek wouldn’t scratch the same itch if she sang, “Desire, I want to turn away from you." Without hunger, there’s no brat summer. W. David Marx wrote about how our thirst for status shapes our identity and the cultural zeitgeist, but what happens when we lose our appetite? The capitalist machine may break down.
This letter is dedicated to Lex, because she asked nicely.
xxsem