Modern medicine has no shortage of “miracle” treatments whose promises later curdled into something far darker.
Thalidomide remains the starkest example: prescribed to ease morning sickness, it caused catastrophic birth defects. Long before that, mercury was used for centuries as a supposed treatment for syphilis, only to leave patients facing kidney failure, brain damage and agonising deaths.
The Victorians, meanwhile, readily embraced cocaine and opiates as catch-all wonder remedies, brushing aside their addictive and potentially fatal consequences. More recently came OxyContin, the painkiller linked to the deaths of thousands of people in the US.
Yet the appeal is easy to understand. Few ideas are as seductive as the quick fix. Whether the problem is pain, obesity, anxiety, sleeplessness, infertility, depression or ageing, the fantasy is the same: a simple pill, jab or procedure that restores health and happiness without demanding too much in return.
So we turn to SSRIs for anxiety, statins for cholesterol, and blood-pressure medication to shield our hearts from stress, cigarettes or alcohol. We swallow penicillin readily, use hormones to revive waning libidos, rely on IVF to overcome infertility, inject neurotoxins such as Botox in the hope of holding back age, and take stimulants — sometimes giving them to children — to manage ADHD. The catalogue keeps growing.
In many ways, modern life can feel like a gradual and seemingly unstoppable march towards medicalisation. That is not inherently a problem: huge numbers of people are alive today because of the advances of 21st-century medicine.
Still, whenever science and society become swept up in excitement, hype and the promise of transformation, a nagging doubt tends to remain: what if this is not quite the breakthrough it appears to be? What if medicine has misjudged the answer once again?
The latest focus of that question is, of course, the rise of “fat jabs”, or GLP-1 drugs. In simple terms, they act rather like a chemical gastric band and, since first being licensed in the US about a decade ago and more recently in Britain, have been widely hailed as a potential answer to one of the modern world’s greatest health challenges: obesity. An estimated 1.6 million people in Britain are already using them, largely through private prescriptions — and that figure is expected to climb sharply as newer, cheaper pill versions become available.
Fat jabs, also known as GLP-1s, have been hailed as the cure for one of the modern world’s biggest ills – obesity
The jabs are arguably a breakthrough every bit as seismic as the discovery of penicillin or anaesthetics, writes our columnist Sarah Vine
Oral semaglutide (the active ingredient in brands such as Ozempic and Wegovy) has been available since June; and the makers of Mounjaro had their pill, Foundayo, approved this week by the UK regulator.
Unlike the pens, the price of the pills does not increase with the dose, meaning they will end up costing roughly half as much as the jabs. While this still doesn’t make them a giveaway – the Foundayo pill will cost between £100-150 a month, the Wegovy one slightly more – it will nevertheless mean that more people will be able to access them.
This is a huge turning point. Arguably, it is a breakthrough every bit as seismic as the discovery of penicillin or anaesthetics. It will have far-reaching consequences that will impact not only on the medical profession (and the NHS) but also reshape cultural and social attitudes towards obesity.
Assuming, that is, that they are safe.
Every doctor I speak to is convinced that, for most patients, they are. But still. We’ve been here before. In the 1930s dinitrophenol was marketed as a ‘fat-burning’ drug – it was, only it also cooked the body from the inside out, eventually causing organ failure.
In the 1950s and 1960s amphetamines were widely prescribed, suppressing appetite and providing a chemical blast of energy. The only downside was they were highly addictive and left users vulnerable to strokes, heart attacks and severe cardiovascular damage.
In the early 1990s we had ‘fen-phen’, a ‘combination appetite suppressant and energy booster’. Again, this led to potentially fatal lung and heart problems, and was withdrawn in 1997 along with legal damages of more than £10billion.
Or there was ephedra, a ‘plant-based’ cure widely touted in the early 2000s – and quickly banned when it was found to cause heart attacks, strokes, seizures and sudden death. And let’s not forget rimonabant, which worked by inhibiting certain brain receptors but caused profound psychiatric problems.
In the case of the GLP-1s, we know that in some rare cases they can cause severe, sometimes fatal, pancreatitis, as well as increased likelihood of gallstones. Some of the common side-effects can be truly alarming, and there is concern around muscle loss and malnutrition.
Only last week, official figures emerged suggesting that more than 200 deaths in Britain have been linked to weight-loss drugs, as well as 158,000 ‘adverse reactions’.
The clunkily named quango, the Medicines and Healthcare products Regulatory Agency, stressed that these alarming numbers did not necessarily prove that the drugs in question (Mounjaro, Wegovy and Saxenda) had caused the deaths and adverse reactions in the patients, only that they were suspected of it.
But for all that, every doctor I have spoken to about these drugs is adamant that, overall, the advantages outweigh the risks, and that if properly monitored and managed, they will not only save lives but also – in the long run – save the NHS millions.
That’s because, unlike their predecessors, large-scale studies show GLP-1s actually improve heart health. They have also been found to reduce fatty liver disease (a nasty modern killer), improve kidney function, help sleep apnoea and – perhaps most interestingly of all – help control substance cravings, including alcohol, tobacco and opioids.
Just as significant is the potential cultural impact. Fat-shaming has always been one of the nastier aspects of human nature, together with a notion that slim people are somehow morally superior. The ‘cult of thin’ – especially in women – is a tyranny. Some women are naturally slight, but for many, remaining slim past your 20s, with pregnancy, hormonal changes and, later, the menopause, is hard.
Economically, too, there will be a huge knock-on effect. We’re already seeing it: my feed on the second-hand clothes website Vinted (my guilty pleasure) is chock-full of women selling size 16-18 dresses following radical weight loss. Meanwhile, the once-mighty diet industry is on its knees. Poor Marjorie from Fatfighters will be out of a job.
An estimated 1.6million people are using GLP-1s in Britain – but that number is set to increase dramatically as newer, cheaper versions in pill form come on the market
GLP-1s are also beginning to affect restaurants, particularly the fast-food sector. Recent analysis found that 41 per cent of GLP-1 users eat out less often – and when they do, they order less.
You may also have noticed the appearance of ‘nutrient-dense’ ready meals in your local supermarket. Again, these are driven by the need to combat potential side-effects such as hair loss, tiredness and muscle-wasting by eating lots of high-quality lean protein and other essentials. The ramifications are everywhere.
Speaking personally, these drugs have been a revelation. They have not made me super-slim (that was never the intention), but they have helped me maintain a stable weight for the past few years, which had always eluded me.
I feel better, look better, have more self-confidence and – crucially – my blood tests show a vast improvement in all areas of health, while my mental wellbeing, which was always so tied up with feelings of self-loathing around my weight, has never been better.
Small but significant things, like the fact that my knees don’t hurt so much, or that being less heavy means I am more likely to go swimming or do a fitness class, have improved my quality of life.
Like everyone who has benefited from these drugs, I can only hope and pray that my faith in the medical profession is not misplaced.
Nevertheless, the worry remains – that if something seems too good to be true, it generally is.
