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Eli Lilly releases data for a new weight-loss drug to tackle obesity : Shots - Health News : NPR

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This drug is a true gamechanger

In the SURMOUNT-1 study, people who took the highest dose of tirzepatide, most of whom had a BMI of about 30 or higher but did not have diabetes, lost about 21% of their body weight during the 72 week study. As researchers point out, for people who have bariatric surgery, typical weight loss is about 25% to 30% of their weight, one or two years after the surgery. In the tirzepatide study, 36% of people taking the highest dose lost 25% or more of their body weight.

this is comparable to bariatric surgery

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As NPR has reported, when patients can't afford to stay on obesity medications, they are likely to gain much of the weight back.

If I were Eli Lilly and Company, I would invest into food science, trying to make as many different hyperpalatable foods aimed at teenagers and young adults as possible. The more people have BMI of 30 by the time they are 30, the bigger the market for their drug is. Imagine the government first handing out food stamps to poor Americans, then paying for their obesity treatment via Medicaid.

Plenty of companies are already doing that. Doubtful that Eli Lilly's contribution would move the needle much.

By the way, do you have the same reaction to companies that produce cancer drugs -- that they should invest in causing as much cancer as possible to expand their addressable market?

Good question, thanks. I certainly have this reaction to companies that produce ART drugs: I would expect them to celebrate gay lifestyle and talk how the government should treat HIV in IV drug users "for free", but stay silent about distributing clean needles in safe injection centers or combating the overprescription of opioids.

I guess the difference between these two cases and cancer drugs is twofold:

  • obesity and AIDS are "vice" illnesses, while cancer is only partially so

  • cancer treatment either saves you or you die, you aren't expected to have regular chemotherapy for the rest of your life

cancer treatment either saves you or you die, you aren't expected to have regular chemotherapy for the rest of your life

Cancer treatment is extremely expensive and cancer patients (especially those caught after Stage I) are often medicalized for life even in the cases where they live for decades afterward.

Moreover what does the duration of the treatment matter? Why should the pharma company's incentives be different as between a therapeutic that is extremely expensive over the short term and a therapeutic that is moderately expensive over the long term, if the NPVs are the same?

Shouldn't your theory predict, for example, that pharma companies selling expensive therapeutics for lung cancer should oppose smoking cessation efforts?

They wouldn't do that because it would be so obvious conflict of interest that the outrage would follow and the government would simply shut the company or fined them billions.

We have done this to companies for much smaller conflicts of interests. For example, the company that misleadingly advertised opioids as non-addictive got liquidated (https://en.wikipedia.org/wiki/Purdue_Pharma).

Hmm... My model is a bit different.

I think it matters which individuals have control of these things and what their incentives are.

And my model is that if I'm a sociopathic CEO I really only care about maximizing the bottom line for the next few years.

I'm not going to bother to dump microplastics into the water supply because the ROI on the cancer rate increase is way too far in the future to benefit me.

cancer treatment either saves you or you die

The vast majority of cancer therapy will boost your expected lifespan on the order of months to a few years. Cures are quite rare and usually surgical in nature except for some slower growing cancers or newer immunotherapies.

Pharma companies just change their prices accordingly if you're only taking the drug for a few months. It's unfortunately arbitrary and pretty disconnected from actual benefit conferred to the patient.

TIL that "ART" in the context of medicine could mean either "assisted reproductive technology" (like IVF) or "antiretroviral therapy" (like HIV drugs). I feel bad for people with both HIV and fertility issues!