Best of Big Technology: How Ozempic Changes Our Bodies, Minds, and Economy — With Johann Hari

Johan Hari is a New York Times bestselling author and has a new book, Magic Pill, about his experience with weight loss drugs. Hari joins Big Technology to discuss the impact of Ozempic on our relationship with food and the economy. Tune in to hear how these medications work, their benefits, and their potential risks. We also cover the science behind these drugs, economic implications, and ethical considerations. Hit play for an in-depth conversation on the future of weight loss drugs and their broader societal effects --- Enjoying Big Technology Podcast? Please rate us five stars ⭐⭐⭐⭐⭐ in your podcast app of choice. Want a discount for Big Technology on Substack + Discord? Here’s 25% off for the first year: https://www.bigtechnology.com/subscribe?coupon=0843016b Stop online threats before they become real-world attacks. Visit ⁠ironwall.com/BIGTECHNOLOGY⁠ and request a free Risk Assessment to see exactly how exposed your executives are. Learn more about your ad choices. Visit megaphone.fm/adchoices

• 0:00Speaker 00

  GLP-1 agonists like Ozempic are having a profound impact on our bodies and economy. The weight loss drugs are showing an impact that extends beyond suppressing appetite, lessening, in some cases, the desire for alcohol, nicotine, among other things. So where does this lead us and our economy? With Big Technology Podcast Friday Edition on break this week, let's go back to my 2024 interview with author Johann Hari, who tried the drug for more than a year and went to its inventors to find the truth about its capabilities. It's one of my favorite interviews so far on the feed, and it's coming up right after this. This episode is brought to you by Genesis. What does it actually take to put agentic AI to work across an entire enterprise?

• 0:43Speaker 00

  I recently spoke with Genesis chairman and CEO Tony Bates about why orchestration is emerging as a competitive advantage in customer experience and what companies need to get right in the AI era. Then I sat down with Adam Mitchell, head of enterprise business solutions at Voya Financial, to go inside a large-scale agentic CX transformation, including the business decisions, trade-offs, and lessons along the way. You can watch both conversations now on my YouTube channel today. It's never been more challenging to get frontier compute. How do you know where to look, who to trust, or how much to pay? Akash is an open cloud that provides easy access, flexibility, and peace of mind.

• 1:24Speaker 00

  That's how companies like Razor were able to cut their inference cost by 15 times. Visit akash.network/alex for free consultation. That's akash.network/alex for free consultation. Welcome to Big Technology Podcast, a show for cool-headed, nuanced conversation of the tech world and beyond. Today, we're diving into health, specifically about Ozempic and the other range of weight loss pills, weight loss medicine, that's starting to make its way into our society and do it fast and change, really change our relationship with food and change our economy effectively. We're going to talk about how that's going to happen, and then also the pros and cons of these drugs. We're joined today by Johann Hari.

• 2:07Speaker 00

  He's a New York Times bestselling author, and his new book, Magic Pill: The Extraordinary Benefits and Disturbing Risks of the New Weight Loss Drugs, is out in any bookstore you could hope for, and I've read it, it's a terrific book. Johann, welcome to the show.

• 2:22Speaker 01

  I'm really excited to be with you. Thanks so much.

• 2:24Speaker 00

  We're going to talk a little bit about the effects of the economy, but I really want people to understand sort of what this drug does and what it's up against. The way that I think we should do that is talking about the Cheesecake Park or the Cheesecake Rats. It's an example that you have in your book about basically the way that the food industry addicts us to food that's not really good for us. And there's a, there's this story about the rats that basically find themselves gorging themselves on cheesecake and can't stop that, you know, my wife and I have now started to take and we've started to, when we're eating dessert nonstop, we just look at each other and we're like, oh no, cheesecake rat. So what is the cheesecake rat in the cheesecake park?

• 3:06Speaker 01

  Well, we're in this incredible position. Forty-seven percent of Americans want to take these new weight loss drugs because they produce an incredible amount of weight loss that I'm sure we're going to unpack. And in a way, when you first hear that, it seems like a kind of mind-blowing moment, the first time in human history that almost half of us would want to take a drug in order to stop ourselves from eating, right? So you think, well, how did we get here? What happened to us? And actually, understanding how we got here is very important to understanding the later question of how these drugs work. And I guess the way I would get into explaining the experiment you're alluding to is I would say to everyone, just stop for a moment, pause this podcast, and Google something for me.

• 3:48Speaker 01

  Google photographs of beaches in the United States in the year I was born, 1979, and just look at them for a minute and then come back. So you will have noticed about those beaches, something that seems really strange to us. Everyone in those pictures pretty much looks to us like what we would call skinny, right? Or jacked. And you look at it and go, well, huh, where was everyone else on the beach that day in 1979? But it turns out that's just what Americans looked like in 1979, right? Obesity was extremely low in the year I was born, and it has exploded in my lifetime. Between the year I was born and the year I turned 21, obesity doubled in the United

• 4:30Speaker 01

  States, and then in the next 20 years, severe obesity doubled again. So we're in this bizarre situation. You have, human beings exist for about 300,000 years, and obesity is very rare. And then from looking at you, I'm guessing you're pretty similar age to me. In our lifetimes, obesity exploded. Why? What happened? We know the answer, the most important part of the answer. Obesity explodes everywhere that makes one change. It's not where people suddenly lack willpower or become lazy. It's where people move from mostly eating a diet based on whole, fresh foods that they prepare on the day they eat them, to mostly eating a diet of processed and ultra-processed

• 5:15Speaker 01

  foods, which are constructed out of chemicals in factories in a process that isn't even known as cooking, it's called manufacturing food. And it turns out this new kind of food that's built out of chemicals affects us in a completely different way to the whole fresh foods that human beings ate about 300,000 years before that. And, and one of the ways it affects us, one of the most important ways, is processed and ultra-processed food undermines our ability to ever feel full, our ability to ever feel we've had enough and then want to stop eating. And I go through loads of evidence for this in my book, and the many different ways in which processed food has this effect on us. But you allude to an experiment that, to me, just totally nailed the effect. I nicknamed it Cheesecake Park. It's not the official title.

• 6:00Speaker 01

  This is an experiment that was done by a brilliant scientist named Dr. Paul Kenny, who's the head of neuroscience at Mount Sinai in New York. And Dr. Kenny grew up in Dublin in Ireland, and he moved to the United States in the 90s to San Diego to continue his scientific research, do his PhD, in fact. And he quickly noticed, huh, Americans don't eat like Irish people did at the time, right? They ate, Americans at the time ate much more, and now, obviously, ate much more processed and ultra-processed foods. And like many a good immigrant, Dr. Kenny assimilated and quite quickly became, you know, gained a huge amount of weight, even gained 30 pounds in a year or two. And he started to feel like this food he was eating wasn't just affecting his gut,

• 6:42Speaker 01

  it was affecting his brain, it was affecting how he felt and what he wanted. So he designed this experiment to test it. He raised a load of rats in a cage, and all they had to eat was the kind of natural whole foods that rats evolved to eat over thousands of years. I mean, that's all, I mean, that's all they had. The rats would eat when they were hungry, and then they would stop when they were full. They had some kind of natural nutritional wisdom that said, hey, guys, you've had enough now. They never became overweight, they never became obese. Then Professor Kenny introduced them to the American diet, the stuff I'd been eating all my life, too. He fried up some bacon, he bought some Snickers bars, crucially, he bought a load of cheesecake, and he put it down alongside the healthy food.

• 7:25Speaker 01

  And the rats went ape shit for the American diet. I don't know if rats can go ape shit, if that's a mixed metaphor.

• 7:31Speaker 00

  Yeah, no, you could.

• 7:31Speaker 01

  The rats went crazy for the American diet. They would dive into the cheesecake and eat their way out and emerge just completely slicked with cheesecake. They ate and ate and ate and ate. The way Dr. Kenny put it to me was, within a couple of days, they were different animals. That kind of natural nutritional wisdom that they'd had when they had the kind of food they evolved for vanished, and they all became severely obese. Then Professor Kenny tweaked the experiment again. He, he took away all the American food in a way that feels to me pretty cruel as a former KFC addict, and he left them with nothing but the healthy food they'd evolved to eat that they'd had when they were growing up. And he was pretty sure he knew what would happen.

• 8:14Speaker 01

  He thought they would eat more of the healthy food than they had before, and this would prove that exposure to junk food expands the number of calories you eat in a day. That is not what happened. Something much weirder happened. Once they'd had the American diet and it was taken away, they refused to eat the healthy food at all. It was like they no longer recognized it as food. They would rather starve than eat that food. It was only when they were literally wasting away that they finally went back to eat it. Now, I would argue we are all living in a version of Cheesecake Park now. We are living in an environment from when we're very young, where we're fed foods that physically change us and undermine our ability to ever feel full and know when to stop eating.

• 8:59Speaker 01

  And it's not the only thing going on, but it's the key reason why we have this huge obesity crisis and why there is such enormous demand for these new weight loss drugs.

• 9:07Speaker 00

  Yes, I feel like whenever I'm just like about to finish a pack of cookies in one sitting, I'm just like, oh yeah, here I am, cheesecake rat. And I'm curious how they've been able to engineer the food. I mean, obviously, we're going to talk about Ozempic as an answer to this. But before we get into that, how have they been able to engineer the food to make us never feel full? Is it intentional? Or is it just a byproduct of the type of food that exists when it's manufactured, as you mentioned, versus whole foods?

• 9:41Speaker 01

  I think the honest answer to your question is a bit complicated. What's definitely not happening is they're not like James Bond villains going, wow, how can we make everyone as obese as possible? That's, that's not happening, right? That would be a stupid way of thinking about it. It's in some ways much more simple. If you're the head of a KFC, Kraft, any of the food companies, you have a fiduciary responsibility to your shareholders to maximize profit. So how do you maximize profit as a food company? You sell as much food as possible, right? So they are constantly figuring out ways to maximize the amount we eat, right? So if there's two foodstuffs, one that makes us feel full and we stop eating after having half of it, and one that makes us want to eat five packs of it, they're going to go

• 10:26Speaker 01

  for the one that has five packs. And I don't blame those individual companies. I mean, they do things that are unethical, like employ lobbyists to rig the rules or advertise to children. There are certainly lots of things I would condemn about them. But actually, it's the job of the rest of the society to regulate those companies, right? Those companies are doing what those companies are meant to do. The democracy needs to do what it's meant to do and regulate them to prevent them from harming our children and screwing up our bodies and harming our health. There's lots of ways in which processed food undermines our sense of fullness, some of which are not by design. So for example, processed food has a very low amount of protein in it, much on average. Of course, there's some processed foods that have high protein, but on average, as a class, processed foods have quite low levels of protein.

• 11:09Speaker 01

  There's a brilliant scientist at the University of Sydney called Professor David Raubenheim, who's done a lot of research on this. He's shown, we all know we have hunger for calories, obviously, we all know that. But your body also has a hunger specifically for protein because your body knows you need protein to do things like build your bones. So if you think about, if you have a diet that's dominated by processed foods, as mine has been almost all my life, to get, your body needs a certain amount of protein. If you're eating processed foods which are low in protein, you have to eat a lot more of those processed foods to get the amount of protein your body needs. He's done lots of experiments that show this. If you give people low protein food, they will eat a lot more of it to meet their body's underlying hunger for protein itself.

• 11:54Speaker 01

  There's loads of factors like that going on here with processed and ultra-processed food, I go through them in the book, which explain why it leads us to so massively overeat and why it so profoundly undermines our sense of satiety, our sense of being sated, of having had enough and not wanting more.

• 12:12Speaker 00

  Right, and it's interesting how you talk about this is what the companies are meant to do, and it's the job of societies to regulate them. And that's why I think this is almost as much of an economic story as a health story. Because you do have these food companies processing food, manufacturing food in a way that make people not feel full and eat as much as possible. So that's one big industry. And then you have the pharmaceutical industry on the other side with their answer and something that can effectively deliver to their shareholders. And that is Ozempic. And not just Ozempic, but a full family of new drugs that is going to help people feel a little bit more full. So you're on it for a year and five months to date.

• 12:51Speaker 01

  One thing about that, because you're not doing this, but I just want to be clear. Sometimes that link that you're presenting is presented as an intentional link, right? You've got, you know, the food companies making us fat and then the pharmaceutical companies stepping into profit as if, as if they're kind of acting in concert or in collaboration. I want to be clear, that is not the case, right? That's not how competing forces work in a capitalist economy. It's just a misunderstanding of what's going on, right? But you're absolutely right. As Professor Michael Lo put it to me, who's a brilliant expert on hunger at Drexel University in Philly, been researching this for 40 years. He said, "These new weight loss drugs are an artificial solution to an artificial problem", right?

• 13:34Speaker 01

  These processed and ultra-processed foods created this extraordinary hole of hunger inside most of us. 67% of the calories the average American child consumes in a day come from processed and ultra-processed foods. Staggering figure, right?

• 13:50Speaker 01

  And what these drugs do, and I'm sure we're going to get into how, is they artificially boost your sense of satiety, your sense of fullness.

• 14:02Speaker 01

  To a degree that is bizarre to me, like, I realize now, I had never felt full until I took Ozempic, not really. I'd felt stuffed, but that was different to feeling full, right? I'd never really felt sated, or perhaps that's an overstatement. I had rarely felt sated until I took Ozempic in a way that I now feel sated every day, right? So yeah, this has been a really profound, profound effect.

• 14:26Speaker 00

  Yeah, and so I'm curious to hear, you know, we hear a lot about the studies, but you like have looked at the scientific literature and also have taken the pill, or sorry, the drugs, it's an injection, right?

• 14:36Speaker 01

  It's pills for some people, but yeah, mostly injections at the moment.

• 14:39Speaker 00

  Right. So talk a little bit about how Ozempic counters this insatiable hunger that we end up being left with from processed foods. And what's your experience like been like in the year and five months that you've used Ozempic?

• 14:53Speaker 01

  Well, so if you ate something now, it doesn't matter what it is, after a little while, your pancreas will produce a hormone called GLP-1, along with some other hormones. And GLP-1 is basically your body's natural signals going, hey buddy, you had enough, stop eating, right? It's the brakes. But natural GLP-1 only stays around in your system for a couple of minutes and then it's washed away. What these drugs do is they inject you with an artificial copy of GLP-1 that instead of sticking around for a few minutes, sticks around in your system for a whole week, which has this incredible effect. I'll never forget, second day I took Ozempic, I was lying in bed, just behind where my laptop is now, if I turn my laptop around, you'd see it.

• 15:37Speaker 01

  And I woke up and I thought, huh, I feel something strange, what is it?

• 15:45Speaker 01

  And I couldn't locate what it was, what I was feeling. And it took me about five minutes to realize I had woken up and I wasn't hungry. That had never happened to me before.

• 15:56Speaker 01

  And I went to this diner just up the street that I used to go to every morning. And I'm slightly embarrassed to say, I ordered the thing I used to get every day, which was a huge chicken mayo sandwich with loads of chicken and mayonnaise in it. And normally I would eat that really quickly and I would still want some potato chips. And I had like three, maybe four mouthfuls of this sandwich and I was full. I just didn't want any more.

• 16:21Speaker 01

  And that's how it was from then on. I just felt very full, very fast. So what this, what these drugs do is they hugely boost your sense of satiety. And it's really important for people to understand, this isn't a gimmick, this isn't a fad, this isn't some new fad diet drug. This is a profound scientific breakthrough. As one of the scientists who was, played a key role in developing these drugs said to me, "We've cracked the code of what regulates appetite and it's simulating and manipulating gut hormones, right? There are all sorts of gut hormones that are created when you eat. If you inject people with artificial copies of those gut hormones, you massively reduce the amount they eat."

• 17:02Speaker 01

  It's why I went from eating 3,200 calories a day to about 1,800. It's why I lost 42 pounds in the first year. It's, it's

• 17:11Speaker 00

  That's incredible.

• 17:12Speaker 01

  Yeah, it's a dramatic effect. The average person who takes Ozempic with Govey, they're the same thing with different labels, loses 15% of their body weight in a year. With Mounjaro, so Ozempic and Govey work on one gut hormone, GLP-1. Mounjaro works on two gut hormones, it's GLP-1 and GIP. The average person who takes that loses 21% of their body weight in a year. And for Triple G, which will be coming online probably next year, which acts on three gut hormones, the average person loses 24% of their body weight, which is only slightly below bariatric surgery. And there are now more than 200 of these drugs in development because we know there's over 40 gut hormones that affect appetite.

• 17:53Speaker 01

  So this is a staggering breakthrough, which will have staggering effects on human health, how we move, how we look, on the economy. You mentioned this at the start, but you know, Barclays Bank commissioned a very sober-minded financial analyst, Emily Fields, go away and look at these drugs to guide their future investment decisions. Do they have any implications for our future investments? And she came back and said, "If you want a comparison for what these drugs are going to do, you've got to look at the invention of the smartphone."

• 18:23Speaker 00

  Right, that's what, it's the iPhone in some ways, but sorry, go ahead. Explain how.

• 18:28Speaker 01

  In some ways, it's, in some ways, I think it's bigger. I mean, this is the biggest cause of death in the United States. Professor Gerald Mand at Harvard, yeah, obesity. Professor Gerald Mand at Harvard calculates that obesity and food-caused illnesses cause 680,000 deaths every year in the United States. We don't usually think of it that way, right? Maybe your aunt died of cancer, you don't think she was killed by obesity, but obesity massively increases the risk of cancer. Maybe your uncle died of a heart attack, you think, oh, he had a heart attack, but you don't remember, obesity, or we, we know it, but we don't quite put it together as often, obesity massively increases the risk of heart disease. But obesity increases over 200 known diseases and complications, either causes or increases.

• 19:13Speaker 01

  Basically, everything we fear from stroke to dementia.

• 19:18Speaker 01

  This is an opportunity to radically reverse that thing that is the biggest killer in our society, by far. I mean, almost 10 times more people are being killed by obesity than by gun violence, for example. And rightly, we talk about gun violence a lot, you know, compare that to how little we talk about obesity.

• 19:35Speaker 00

  Gun violence is such a good comparison because there's a lot of gun violence in the US, worldwide, but I guess no one does it like we do here, unfortunately.

• 19:44Speaker 01

  Only the Brazilians are matching you, yeah.

• 19:46Speaker 00

  Yes, so, but there's a very strong lobby that says, yeah, you know, a lot of people get killed, but this is important for our businesses and in the US at least, and I think worldwide, business really holds sway. And I was speaking with someone, an entrepreneur in the pharma industry, right before we got on, and there's what this person said, told me 60% of the US GDP is consumption. So what happens when, and by the way, this is, these are the stats he gave me, you have 40% of people in the US that are obese, 2/3 of people are overweight. What happens when these people start consuming less than half

• 20:28Speaker 00

  in the food alone, right, food, because it might extend beyond food? What happens when these people are consuming less than half of the food that they were eating before? And even Walmart, this person told me, as in their board meeting, discussed the effects and their concerns. So you have concern with food, concern with retail. I guess, like, are we being set up for, and you know, I kind of said we have, you know, food versus pharma, but really, you know, are we being set up for like a pretty big fight that between, let's say, you know, this in this effectively an economy that relies on consumptions and consumption and the pills that might stop consumption? Are we being set up for an NRA

• 21:09Speaker 00

  style battle here where like you're going to have, you know, folks for like the food rights or whatever it is against people for a safer future?

• 21:18Speaker 01

  Yeah, well, The Washington Post has reported that the big food industry is already funding body positivity pushbacks against, against some of this. I mean, covertly, just like the cigarette companies covertly funded denial about lung cancer and just like the oil companies covertly for many decades funded global warming denial. Yeah, I think we are, and there's going to be a huge tension there. And just the economic consequences are just, already we're seeing, we're seeing so many of these kind of unpredictable effects. I mean, think about, you mentioned the food companies, the head of Nestle, Mark Schneider, has been making very nervous noises about their confectionery Dunkin' Donuts, you know,

• 22:00Speaker 01

  sorry, Krispy Kreme Donuts, rather. Forbes magazine, interview load of experts who said that their stock was being downgraded and then their stock's still in.

• 22:08Speaker 00

  I mean, yeah, because Ozempic goes right after their target market.

• 22:11Speaker 01

  Exactly, exactly. I mean, literally, I was their target market, at least two of my chins are due to Dunkin' Donuts Krispy Kreme, and now I don't eat it anymore, right? The loss of my customer loan must have caused some of that plunging stock value. And yeah, and just think about the unpredictable cascading effects. Jeffrey's Financial just did a big report about a year ago to the American Airlines, saying you're going to have to spend a lot less money on jet fuel, pretty soon, because it takes so much less jet fuel to fly a radically thinner population. And bear in mind, this is the case now, when these drugs are extraordinarily expensive in the United States. But eight years from now, Ozempic goes out of patent, at that point, it will be a daily pill, it will be a dollar a day. If the 12 big risks

• 22:53Speaker 01

  that I warn about in relation to these drugs don't bear out, or are not as, are not super bad, then my prediction is that more than half of the population will be taking them when it's a daily pill that's a dollar a day. The effects on the economy and the society at that point are enormous. You know, my book is called Magic Pill, because there's three ways these drugs could be magic, right? The first is the most obvious, it could just solve the problem, right? And there are days when it feels like that. I've got to be honest with you, my whole life I've overeaten, now, once a week, I inject myself in the leg, I don't overeat anymore. It feels like magic. The second way it could be magic is more disturbing, it could be like a magic trick, it could be like a conjurer who shows you a card trick

• 23:34Speaker 01

  while picking your pocket. It could be that over time, the 12 big risks associated with these drugs that I describe in the book outweigh the benefits. I do not rule that out, that is perfectly conceivable. But the third way it could be magic is to me actually the most likely. If you think about the classic stories of magic that we grew up with as kids, like Aladdin, say, how do they go? You find the lamp, you rub it, the genie appears, your wish is granted, and your wish comes true, but never quite in the way you expected. There's all sorts of unpredictable effects. And I think we can see that, some of them will be enormous, some of the anticipated and indeed proven positive effects are enormous. You know, think about effects on heart disease, reduces your risk of heart disease, heart

• 24:18Speaker 01

  attack or stroke by 20%, right? That could well save my life. I'm older than my grandfather ever got to be. He died when he was 44 of a heart attack. Loads of the men in my family have heart problems. My dad had terrible heart problems. My uncle died of a heart attack. For people like us, it could be transformative. At the other end of the spectrum, for people with eating disorders, I really fear it will be lethal. I can go into more detail on that if you want, but I think we could, an opioid-like death toll of young girls who use these drugs to starve themselves. It's one of the reasons we need to tighten the regulation around these drugs urgently. So, you know, we came up with the smartphone comparison, or rather, the Barclays analyst did. If we'd been talking in 2007, I think it was April 2007, when Steve

• 25:00Speaker 01

  Jobs first unveiled the iPhone, we would not have been able to predict TikTok and Me Too and, you know, DoorDash and all these things that have transformed our lives, right? But here we are, they've changed our societies profoundly. And I think these drugs are going to, it's not hyperbole to talk about these drugs in the same breath.

• 25:22Speaker 00

  Yeah, and I think it bears repeating. I mean, 60% of an economy, consumption. And if there's a president that allows GDP to be flat, they get thrown out of office. This country, this, the world doesn't tolerate negative growth, but we're looking negative growth in the face. And I try to not be like, I mean, I'm definitely trying not to be conspiratorial, but like, how is society, like, it just seems like there are powerful forces that are going to really come in opposition to this stuff. And we can't say right now.

• 25:50Speaker 01

  Powerful forces here, haven't you? You've got the food industry and you've got pharma. So yeah, there'll definitely be friction between those two forces going forward.

• 25:58Speaker 00

  Let me talk a little bit about how we might happen, how it might happen in the short term. I mean, you mentioned that 2030 is when the patent comes off of Ozempic, but actually in China, that patent's off now. And there are compounding pharmacies that are effectively putting Ozempic together on their own, sort of off-label. Maybe they add B12 in to say, okay, it's actually something different. And that's where lots of people are getting this drug from. And the only reason that they're able to get it from these compounding pharmacies is because Ozempic right now is on some sort of shortage list, which means that they're able to get it from these supply chains, or from these supply chains. And there's a chance within the next couple of years that it's going to be removed from

• 26:41Speaker 00

  those shortage lists. And I'm sure the food industry and all the, you know, anyone who's concerned about GDP would want it removed, even though like it's not going to be good for, for global health. So what do you think is going to happen on that front? And how, how impactful do you think it might be if you have, let's say, millions of people taking the effectively the same drug as Ozempic, and then all of a sudden it goes from an affordable drug to what it, what it is now, if you want to get it like name brand, which is 1300 a week?

• 27:13Speaker 01

  It's 1300 a month, but yeah, the.

• 27:15Speaker 00

  1300 a month, yeah.

• 27:16Speaker 01

  Just to, I would just pull back for a moment. I think it's a really important question. I would just pull back for a moment and say, if, I guess, a few things. The first is a question of drug prices. As you can tell from my weird Downton Abbey accent, I'm in fact, British, and I spend a lot of my time in the US, a lot of my time in Britain. And I've got to tell you, it constantly stuns me, the degree to which Americans are ripped off when it comes to drug prices. So I buy my Ozempic here in Britain, it's the equivalent of $250 a month. When I, I've had to get it in Vegas a few times, it's like $1,000 a month, right? It doesn't magically transform as it crosses the Atlantic. This happens for

• 27:57Speaker 01

  a reason. In, in the United States, Big Pharma employs armies of lobbyists to rig drug regulation in the United States, right? All drugs, almost without, you don't have to go so far away as Britain, just cross the Canadian border. All drugs are radically more expensive in the United States than they are in Canada or Mexico, right? Not because the drugs are different, it's because the American political system doesn't work, it's not properly democratic, and it allows the ripping off of American citizens at every stage. By the way, both parties take massive amounts of money from Big Pharma. So that's the first thing you have to say. Now, there's an issue around these drugs, there's the issue of the benefits of these drugs and the risks of these drugs, and I'm sure we're going to dig more into

• 28:41Speaker 01

  that. And I don't believe everyone who's overweight or obese should be taking these drugs, there's some people who shouldn't be. And I hope my book is a kind of guide to, so people can think this through in a very personalized way.

• 28:53Speaker 00

  Does a very good job with that.

• 28:54Speaker 01

  Oh, thank you, thanks. But, but, but, but what I'd say is we're in this nightmare situation where the people who do, at the moment, only a very small elite of people can access these drugs. So we have a situation where the, the Real Housewives of New Jersey get to be bone thin, while the real schoolchildren of New Jersey get diabetic at the age of 12, right?

• 29:17Speaker 00

  And the number I heard is that only 2% of obese people, or the obese market is on these GLP drugs, right? These Ozempic-style drugs where if you're severely overweight, 20% are doing this bariatric surgery to shrink the stomach.

• 29:32Speaker 01

  Much riskier, much, much riskier. Yeah. I mean, I think there's just a huge.

• 29:39Speaker 01

  Huge issue around that. And so you raise compounding. So for people who don't know, yeah, when a drug is, when you can demonstrate a medical need for a drug, but there is a shortage of that drug, as there is at the moment. And it's worth explaining why there's a shortage. Every person who takes Ozempic, Wegovy, Monjaro, becomes a walking advertisement for that drug, right? I think a lot about a guy, an interview called Jeff Parker, lovely guy, 67 year old, retired lighting engineer in San Francisco, who was very severely obese. He was in quite a lot of physical pain as a result. It was difficult for him to walk. He had gout, he had liver and kidney problems. He was taking fistfuls of pills every morning. He started to take Monjaro. Actually,

• 30:20Speaker 01

  he was getting a compounded version from China, like you say, lost an enormous amount of weight, came off all his pills, all his medical conditions went into reverse. Now he walks his dog over the Golden Gate Bridge every day and said to me, I feel like I'm going to enjoy my retirement. Now, everyone who knows Jeff looks at him and goes, whoa, what happened to Jeff, right? He looks completely different. So one of the reasons there's these shortages is that everyone then becomes a walking ad. And so demand produces demand, produces demand, produces demand in this cascading effect. So although they have been, Novo Nordisk and Eli Lilly, the companies that make these drugs have been massively, to be fair to them, expanding

• 31:00Speaker 01

  production. Of course, they want to, they want to make the money. They're racing to get to a finishing line that's just getting further and further away because the more they race, the more people want it, right? So lots of companies are producing compounded copies of these drugs. There's inherently risks in that. They're not made in FDA labs. In Austria recently, there was a big problem where people bought what they thought was compounded semaglutide, the active component of these drugs. They weren't, they went into comas, they were horribly injured. There's an inherent risk in compounded versions for obvious reasons.

• 31:36Speaker 01

  But I understand why people are doing it, right? So yeah, there's a complexity. And I think you're right that Big Pharma will be pressuring to close those loopholes pretty soon. I mean, they're already sending out lawyers letters to

• 31:49Speaker 00

  Right. And if that happens, I mean, you could abruptly, you could abruptly have people thrown off the medicine, whereas like they can afford the compounded drug, they cannot afford 1300 a month. So what happens if you get abruptly tossed off the drug?

• 32:02Speaker 01

  Well, it's a really important question. So I want to explain what the drug companies say, and I want to explain why they're probably right, but we need to take it with a small pinch of salt. What the drugs say, what the drug companies say is these drugs are like statins or blood pressure meds. They work for as long as you take them. And when you stop taking them, they stop working. So you regain the weight pretty rapidly. And they have funded studies that, a study that seems to demonstrate this, the vast majority of people regained the vast majority of their weight within a year. There's a small pinch of salt in that, in that, of course, they have a vested interest in telling us that we have to take them forever because they make money forever. There do seem anecdotally to be some people who take them for a shorter period, use them to radically

• 32:44Speaker 01

  change their habits, and then seem to stay at a lower weight, although I suspect there are a minority. There'll be more research on this soon. But yeah, if you're thrown off, you'll almost certainly regain the weight.

• 32:56Speaker 00

  Right. And that could be a very big issue as we see again, these opposing forces sort of try to jockey for position here as this drug takes off.

• 33:05Speaker 01

  It could be worse. We don't know. And there's a lot of things we don't know about these drugs. One is, so we know if you gained a load of weight now and then went on a diet and lost weight, and it just through calorie restriction and exercise, so not using these drugs, we know that slows down your metabolism over time. It makes it harder to keep weight off, right? If you yo-yo diet, if you gain weight, lose weight, gain weight, lose weight, it can really wreck your metabolism. So you actually burn calories very slowly. We don't know if taking these drugs and then coming off them slows down your metabolism. Probably does. Most other forms of weight loss do. In fact, all other forms of weight loss do. So that's another concern as well. Could you actually end up fatter than you were if you hadn't taken the drug? We don't know,

• 33:50Speaker 01

  but it's a concern.

• 33:51Speaker 00

  And one of the things that I found so interesting in your book was this concept of a set point, that your body basically figures out the weight that you are, the weight that you should be. And if you try to move too far off of it, at least, you know, in terms of the negative, it will try to bring you back up to that set point of weight.

• 34:08Speaker 01

  Well, this is really interesting because, so there's the way people used to think about this in the 60s and 70s, and there's the way we understand it now. So in the 60s and 70s, scientists thought that your weight was basically set from birth, or even in utero, that basically from when you're born, you have a certain fat percentage that's kind of innate to you, right? So think about your temperature set point as an analogy. We have a natural set body temperature. If you go higher than that, your body works very hard to bring it down. It makes you sweat. It makes you really want to get into the shade. If you go lower than that, your body works really hard to bring it up. It makes you shiver. It makes you seek warmth. And it was

• 34:50Speaker 01

  thought that, so it's very hard to stay out, basically, you can't stay outside your safe temperature level, your temperature set point for very long, right? Your body really works to keep you there. And if you do stay out of it for long, you get very unwell. So it was thought that there was something similar with your weight, that you had an innate set point that just sort of regulated. You could go a little bit above or a little bit below, but it was basically set and regulated. And then the obesity crisis happened, mainly starting in the early 1980s, late 70s, early 80s, when I was born. I'm not blaming myself. I'm not like Damien in The Omen, couldn't cause it. But, and that seemed to blow set point theory up,

• 35:32Speaker 01

  right? Well, what's going on? If it's set, if it's innate and biological, how come it changed so much so quickly? But what scientists realized, this is contested, but I think it's quite persuasive, is actually what happens is you do have an innate set point, but as you gain weight, your set point rises. This is really important for understanding why the alternative to these drugs, diet and exercise, does not produce sustained weight loss for about 85% of people who try it. So let's say that you now gained 40 pounds, and you try to lose that 40 pounds through calorie restriction and exercise. Because your innate set point has risen, your

• 36:14Speaker 01

  brain is trying to hold you at that higher weight. All sorts of physical and biological changes will happen in your brain and your body to try to stop you going down. It will make, it'll slow your metabolism down, so you burn calories more slowly. It'll make you crave more sugary, salty foods. All sorts of changes happen. And there's lots of evidence for that, overwhelming evidence about metabolic slowdown, for example. And I remember when I first learned that, thinking, well, that can't be true. Because why, obesity is really bad for your health. Why would evolution endow us with the desire to hold on to, or biological mechanisms to hold on to obesity, given that obesity is so bad for us? It's so maladaptive. It doesn't

• 36:56Speaker 01

  make sense to me. And it was explained to me by Professor Michael Lowe, who I mentioned before at Drexel. The best way of thinking about this, I think, which is, you've got to think about the circumstances where human beings evolved. In the circumstances where human beings evolved, the situation we live in now essentially never happened, or vanishingly rarely, which is where you have infinite abundant calories all around you, far more than you could consume, and they last your whole life, right? That just never happened. So evolution did not prepare us for that scenario. The scenario that did happen quite frequently, that evolution did prepare us for, is the exact opposite, famine. Famine was very common, right? In the circumstances where

• 37:39Speaker 01

  human beings evolved, that it was quite likely there would be a famine in your lifetime. If you think about it in that context, it makes perfect sense that if you gain weight, your body fights to hold on to the weight, right? If there's a famine, the fattest man at the start is the last man standing, right? There was a famine, the version of me from three years ago is going to still be alive at the end, whereas Timothy Chalamet will die in week one, right? And I'll cry over his body, but he'll bury him and we'll have to move on, right? Rest in peace, Timothy Chalamet, exactly. So you can, so you see, set point, this innate set point is preparing us for a famine that now is never going to come, right? So that explains why diets don't work. It also explains one theory, this is significantly more contentious.

• 38:24Speaker 01

  There's a huge debate about what these drugs, so we now know these drugs are primarily working not on your gut, but on your brain. You have GLP-1 receptors, not just in your gut, but in your brain. They're profoundly changing our brains from interviewing the cutting edge neuroscientists, as I did in my book, this is very clear.

• 38:41Speaker 01

  And it's so disconcerting to interview the leading neuroscientists and you say to them, "Well, what is it doing to my brain?" And they kind of go, "Yeah, come back and ask us in a few years. We don't really know." But one theory about what it may be doing to the brain is they may, it may be lowering your biological set point.

• 38:58Speaker 01

  The equivalent of, this is a very crude analogy. I suspect the scientists I interviewed would think it was overly crude, but it's a bit like taking your set point, you know, to the, resetting your iPhone to the factory settings, right? It lowers your set point for the duration that you take the drugs. So again, you see,

• 39:17Speaker 01

  the debate about what causes obesity is intimately related to the debate about how these drugs work in all sorts of fascinating ways.

• 39:25Speaker 00

  Yep. And you mentioned brain chemistry. That's something that I definitely want to talk about. I just want to talk about whether kids should be taking these drugs. I think the kids, the US at least has approved kids as young as 12 taking these drugs. And we're going to do that on the other side of this break, back right after this. This episode is brought to you by Apppoint. Everyone's racing to roll out AI right now. Co-pilots, chatbots, agents doing real work. But here's the part nobody loves talking about. All that AI runs on your data and most teams have no single way to see it, secure it, and prove it's under control. That's exactly what Apppoint does. For 25 years, they've been the trusted layer beneath the world's most demanding data, now extended across your entire

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• 41:31Speaker 00

  Learn how to stop online threats before they become real-world attacks. The link's in the show notes.

• 41:40Speaker 00

  And we're back here on Big Technology Podcast with Johann Hari. He's a New York Times bestselling author. You can grab the new book, Magic Pill: The Extraordinary Benefits and Disturbing Risks of the New Weight Loss Drugs, in a bookstore near you. Great book. I've finished it. I think it's terrific. Let me ask you this, Johann. You know, one of the things that I think was really fascinating that you tackle in the book, of course, you talk about the risk, like there's a slight uptick in your risk in getting thyroid cancer from this, but not a massive. It's not like you're sure to get thyroid cancer if you take this. It's a little bit more of an increase in your risk there. But the thing that really struck me as the risk was you talk about how it could potentially dull people's

• 42:21Speaker 00

  emotionally a little bit to pleasure and like physical rewards. For instance, like people start to drink less, but there's concern that it might just make everything in life less pleasurable. Can you talk a little bit about why that might be?

• 42:37Speaker 01

  So I want to stress, this is, all the scientists who've expressed this concern, expressed that it's speculative and we can't be sure. So some scientists have argued that these drugs seem to be causing depression or even suicidal thoughts in a minority of people who use them. That in itself is contested. It did not persuade the European Medicines Agency, although the FDA in the United States does have a warning about potential suicidal ideation from these drugs. And there's a huge debate about why that might be. Some of it relates to the question about the brain effects. So a different theory about how these drugs may work in the brain and on the brain, is that in your brain you have something called your reward systems. Reward systems are what motivate you to do anything

• 43:22Speaker 01

  that propagates life, right? We eat because we get rewards from it. We have sex because we get rewards from it. We engage in social behaviors because we get rewards from them. They all make the reward centers of the brain hum.

• 43:35Speaker 01

  One theory about how these drugs work is they may be dampening your reward systems. So it may be that I no longer feel the urge to eat a Big Mac over a salad because I get less reward from the Big Mac than I did before. There does seem to be some evidence that there's lots of people report losing their pleasure in eating after taking these drugs, although not everyone. And I actually, it actually increased my pleasure in food, but I'm unusual. I can talk about why if you like. But you don't have to think about that problem for long to realize, okay, if it's dampening your reward system for food, is it dampening your reward system more generally? Is it dampening your reward system for, in

• 44:15Speaker 01

  my case, reading or writing, the things I love, right? Would it be doing that? So that's a huge debate. It's, we don't know, is the honest answer. I actually think, though, there's something much more basic and more easily grasped, actually, that is going on for lots of people. And I felt it happen to me. So for the first six months I was taking the drugs, I mean, I was in this slightly weird position where I was getting what I wanted. I was losing loads of weight. And all sorts of good things happened. But I actually didn't feel better emotionally. Actually, I felt slightly worse. And it's hard to generalize from any individual. Maybe it's just other stuff that was going on in

• 44:56Speaker 01

  my life. But I had a real epiphany about this in Vegas, where I spend a lot of my time. I was, I was in Vegas. It was seven months into writing the book and I was there.

• 45:11Speaker 01

  I was researching the murder of someone that I knew and loved for a different book that I'm writing. And as you can imagine, that was a very painful and difficult thing to do. And so one day I did what I've done a thousand times on autopilot. I went to the KFC on West Sahara and I ordered a bucket of fried chicken, as I would have done before I was taking Ozempic. And I had one of the chicken drumsticks and I suddenly looked at the chicken, the bucket of chicken and I thought, "Oh shit, I can't eat this." And I remember Colonel Sanders was on the wall. It was like he was looking down at me going, "Hey, what happened to my best customer?"

• 45:46Speaker 00

  I thought we were friends.

• 45:47Speaker 01

  Exactly. Best friends. Talk about a share price decline. And I had an epiphany in that moment where I realized, so what these drugs do is they interrupt your eating patterns radically. Obviously, that's key to how you lose weight and is obviously a good thing in many ways. But there's scientific evidence for five reasons why we eat that I go through in the book. Only one of them is, you know, to sustain our bodies. All the rest is psychological, right? In my case, I realized from when I was very young, how much of my eating was driven by desire to comfort myself, to numb myself, to manage my emotions. And I couldn't eat that way on Ozempic, right? If you try to overeat on

• 46:32Speaker 01

  Ozempic, you will literally vomit. You can't do it. It would be awful.

• 46:39Speaker 01

  And so these feelings kind of came to the surface. It was very conscious in my mind. I remember just thinking, "Oh, you're just going to have to feel like shit today then, right?"

• 46:45Speaker 00

  Right.

• 46:46Speaker 01

  Now, that can be a good thing. Bringing those emotions to the surface can help you find a better way to deal with them. Clearly, there are better ways to deal with sadness and grief than Colonel Sanders.

• 46:58Speaker 00

  But some people find worse ways, right? Like they, when they stop having that food addiction, they go to alcohol or other things that harm them even more.

• 47:06Speaker 01

  Yeah, exactly. So I think, and we know this with other forms of, I often think the best way of understanding the effects of these drugs is actually to compare them to bariatric surgery. People have only been taking these drugs for obesity for a couple of years now, but when it comes to radical weight loss, the most reliable method up to now has been bariatric surgery. Things like stomach stapling, gastric sleeves, gastric bands, and so on. So when we look at bariatric surgery, what do we see? I mean, first thing we know is that it's a fucking horrible operation, right? One in a thousand people die in the

• 47:48Speaker 01

  operation. It's no joke. It's grim. But why do people go through that? Well, they go through it because they get extraordinary benefits. So bear in mind that they obviously had to be really quite obese to get the surgery in the first place. But if you have bariatric surgery and the seven years that follow, you are 56% less likely to die of a heart attack. You are 60% less likely to die of cancer. You are 92% less likely to die of diabetes-related causes. In fact, it's so good for your health that in those seven years, you're 40% less likely to die at all of any cause. So we know it has extraordinary benefits. But also, we know, interestingly, after bariatric surgery, your suicide risk almost quadruples.

• 48:30Speaker 00

  Which is crazy.

• 48:30Speaker 01

  Which is, I mean, I want to stress, it remains low. Suicide is

• 48:34Speaker 00

  But a 4X, yeah.

• 48:36Speaker 01

  But that's a huge increase, right? And you think, well, why would that be? Some of that is possibly the actual physical effects of dealing with the surgery, which, as I say, is grueling. But I think it's much more this, this kind of thing, right? You can't comfort eat. And as Professor Correl LaRue, who's done a lot of work on both on bariatric surgery and on these drugs, said to me,

• 48:56Speaker 01

  Part of it, I think, is a lot of people who are obese tell themselves, if only I was thinner, my life would be great, right? And then you lose all this weight and your husband's still an asshole and your boss is still a prick.

• 49:13Speaker 00

  Yeah.

• 49:14Speaker 01

  And here you are, right? So I think there's all sorts, I'll go through a lot more in the book, but there's all sorts of complicated psychological phenomena that are going on. A lot of women who've been sexually abused consciously or unconsciously gain a huge amount of weight in the aftermath to make themselves safer. You're less likely to be sexually assaulted if you're obese, although it can still happen. It's more rare.

• 49:36Speaker 01

  And they experience losing weight as actually becoming severely and suddenly vulnerable. There's all sorts of complicated things going on.

• 49:44Speaker 00

  Right.

• 49:45Speaker 01

  Yeah.

• 49:45Speaker 00

  So we have, we have about one minute left, so I just want to ask you this question quickly and would be eager to hear your thoughts on it and then we can sign off. So here's my question about kids. The US just approved, I think, kids at 12 years old can start taking these medicines. Is this a good idea?

• 50:06Speaker 01

  The debate about children is the thing I find most difficult and it takes the core debate about these drugs and dials it up, dials it up to 12 as far as I'm concerned. Because what you have to weigh is two competing risks.

• 50:21Speaker 01

  The risks of obesity, which are enormous. If you're obese when you're 18 years old, you have a 70% chance of developing diabetes in your life and diabetes, type 2 diabetes knocks 15 years off your life on average. And that's one of the effects of being obese. There's more than 200 of them and they are horrendous. You've got to weigh those risks against the risks of these drugs, which are significant. And particularly with children, the most worrying risk about these drugs, which is that we don't know the long-term effects of these drugs. No one's been taking them that long. And if you're a six-year-old and you're given these drugs and Novo Nordisk is currently doing a trial on giving them to six-year-olds, if you're a six-year-old and you take these drugs, we're presumably saying you're going to take these drugs for 80 years. We have no idea about the long-term effects.

• 51:04Speaker 01

  So I interviewed parents who've given their children Ozempic. I have a lot of feeling for them. It is a horrendous dilemma. What it makes most clear is we should, we should not tolerate our children having to choose between a risky medical condition and a risky drug. We don't have to accept that choice. I went to Japan where there is no childhood obesity. That's not an overstatement. There are statistically no childhood obesity. I've got to tell you, it's a really weird thing to walk around schools with a thousand children and realize there is not one fat child in that school. Why is that? It's because they didn't allow processed food to fuck their kids up, right? And I talk in the book about how Japan achieved that. Japan was not a healthy country 100, 100 years ago had one of the worst diets in the world, right?

• 51:49Speaker 01

  This was done by absolutely concerted government policy. We can do that too. Obviously, we need to do that, but at the moment, we're in a trap, right? And these drugs are a risky, rusty trapdoor. I don't blame any parent who makes any decision on that. We've got to deal with the wider forces that have got us into this shitty situation in the first place. And then parents have to make that agonizing choice. I hope my book will help them make a more informed choice, but I really empathize with them because that is the hardest of the hard questions that are brought up in my book, Magic Pill.

• 52:22Speaker 00

  The book is Magic Pill, The Extraordinary Benefits and Disturbing Risks of the New Weight Loss Drugs. You heard a little bit about it here. I really suggest you go and pick it up, whether you're thinking about taking it or whether you're just interested in what the broader effects are going to be. It's a great book. Johann Hari, thank you so much for joining us.

• 52:37Speaker 01

  Oh, thank you so much. I meant to say as well, all my publishers taze me. You can get an audiobook as well, which is read by me. If you go to magicpillbook.com, pretty much anywhere, you can get the book, the physical book, the ebook. I meant to say you can get it from all good bookstores, but you can get it from lousy bookstores as well. I've really enjoyed this. What great questions. Thank you.

• 52:54Speaker 00

  Thank you so much. We'll see you next time on Big Technology Podcast.

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