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This transcript has been edited for clarity.
There’s never been anything like the revolution in the treatment of obesity that we are now living through. Historically, there’s always been calorie counting and diets. Now, after a burst of interest in gastric bypass surgery, we have the amazing world of injectables. We all have heard about Ozempic, Mounjaro, and Wegovy.
These are being used by millions of Americans at this point, some on prescription for conditions like diabetes and some to bring about weight loss in prediabetes, or in some instances — as is often seen on American television — weight control or weight loss by people who just want to look better. Celebrities getting behind these injectables has really powered an explosion of use.
There still are ethical issues out there for practitioners. For one thing, there are some forms of semaglutide, a key ingredient in some of these injectables, that are made by compounding pharmacies. They’re not the name-brand prescription injectables made by large companies. They’re brewed up, if you will, by a specialty pharmacy trying to mimic the ingredient.
What we’ve seen in recent weeks is an explosion of overdoses. When a person uses one of these compounding pharmacies, usually in association with a spa or sometimes online sales of weight loss injectables, they’re not always certain about how to dose themselves, how much to give, and what to take. They could misread the instructions. The more that it’s up to them to determine the dose, the more there’s risk for error. Reports show as much as 1500% increases in poisoning of people who took, instead of a 10th of a milliliter, 10 mL of these compounded versions of the injectable drugs.
Everybody needs to be alert, and not only for adverse events from the prescription injectables. It is important to track that, make sure that people aren’t getting into trouble, and have contact with the FDA if you have a patient who reports some kind of adverse event they attribute to injectables.
It’s important to realize that there’s this generic, cheaper path, but it’s a more dangerous path. People need to know this if they’re going to try that route. Doctors should be aware of it. People should be ready to call the poison control center number in their area to make sure that they know what to do if they overdose on this stuff.
My own inclination is to try to discourage its use. I think it’s still too dangerous to have people self-dosing with ingredients that really are not yet FDA approved in terms of knowing that they’ve been tested in clinical trials.
The other big issue, aside from this Wild West world outside of prescribed injectables, is what to say to people who are obese or trying to manage their weight. I think people need to know all their options. It’s pretty easy to just say, “Let’s put you on one of these injectables” and prescribe it. For one thing, they may not be able to get it; there’s such huge demand that there are some shortages out there.
We don’t really know the long-term consequences of decades-long use of these drugs.
I think people should hear their options and maybe try something less invasive to begin with. If that doesn’t work, then move on to the injectables. It isn’t so clear to me — given the cost, some of the unknowns of long-term use, and some of the dangers of people sneaking around and trying to get things cheaper on the side — that going straight to injectables is our best answer.
I do think doctors should talk about weight with their patients, carefully, with the patient’s consent. Make sure there’s no stigma. Make sure we’re not doing anything to raise anxiety as we talk about this condition. After all, it is seen as a disease.
Then, maybe enter your way gradually into interventions, seeing if lifestyle change is possible. It’s cheap and easier to implement: better diet, better exercise, or calorie counting. Some people succeed. When they don’t, we should move on, but realize that we’ve got the equivalent of a black market. We need to encourage patients, if they use injectable weight loss drugs, to tell doctors so that they can be on alert about the dangers and risks of overdose.
Dr. Caplan is Director, Division of Medical Ethics, New York University Langone Medical Center, New York City. He disclosed an unpaid position with Johnson & Johnson’s Panel for Compassionate Drug Use, and serves as a contributing author and advisor for Medscape.
A version of this article appeared on Medscape.com.
This transcript has been edited for clarity.
There’s never been anything like the revolution in the treatment of obesity that we are now living through. Historically, there’s always been calorie counting and diets. Now, after a burst of interest in gastric bypass surgery, we have the amazing world of injectables. We all have heard about Ozempic, Mounjaro, and Wegovy.
These are being used by millions of Americans at this point, some on prescription for conditions like diabetes and some to bring about weight loss in prediabetes, or in some instances — as is often seen on American television — weight control or weight loss by people who just want to look better. Celebrities getting behind these injectables has really powered an explosion of use.
There still are ethical issues out there for practitioners. For one thing, there are some forms of semaglutide, a key ingredient in some of these injectables, that are made by compounding pharmacies. They’re not the name-brand prescription injectables made by large companies. They’re brewed up, if you will, by a specialty pharmacy trying to mimic the ingredient.
What we’ve seen in recent weeks is an explosion of overdoses. When a person uses one of these compounding pharmacies, usually in association with a spa or sometimes online sales of weight loss injectables, they’re not always certain about how to dose themselves, how much to give, and what to take. They could misread the instructions. The more that it’s up to them to determine the dose, the more there’s risk for error. Reports show as much as 1500% increases in poisoning of people who took, instead of a 10th of a milliliter, 10 mL of these compounded versions of the injectable drugs.
Everybody needs to be alert, and not only for adverse events from the prescription injectables. It is important to track that, make sure that people aren’t getting into trouble, and have contact with the FDA if you have a patient who reports some kind of adverse event they attribute to injectables.
It’s important to realize that there’s this generic, cheaper path, but it’s a more dangerous path. People need to know this if they’re going to try that route. Doctors should be aware of it. People should be ready to call the poison control center number in their area to make sure that they know what to do if they overdose on this stuff.
My own inclination is to try to discourage its use. I think it’s still too dangerous to have people self-dosing with ingredients that really are not yet FDA approved in terms of knowing that they’ve been tested in clinical trials.
The other big issue, aside from this Wild West world outside of prescribed injectables, is what to say to people who are obese or trying to manage their weight. I think people need to know all their options. It’s pretty easy to just say, “Let’s put you on one of these injectables” and prescribe it. For one thing, they may not be able to get it; there’s such huge demand that there are some shortages out there.
We don’t really know the long-term consequences of decades-long use of these drugs.
I think people should hear their options and maybe try something less invasive to begin with. If that doesn’t work, then move on to the injectables. It isn’t so clear to me — given the cost, some of the unknowns of long-term use, and some of the dangers of people sneaking around and trying to get things cheaper on the side — that going straight to injectables is our best answer.
I do think doctors should talk about weight with their patients, carefully, with the patient’s consent. Make sure there’s no stigma. Make sure we’re not doing anything to raise anxiety as we talk about this condition. After all, it is seen as a disease.
Then, maybe enter your way gradually into interventions, seeing if lifestyle change is possible. It’s cheap and easier to implement: better diet, better exercise, or calorie counting. Some people succeed. When they don’t, we should move on, but realize that we’ve got the equivalent of a black market. We need to encourage patients, if they use injectable weight loss drugs, to tell doctors so that they can be on alert about the dangers and risks of overdose.
Dr. Caplan is Director, Division of Medical Ethics, New York University Langone Medical Center, New York City. He disclosed an unpaid position with Johnson & Johnson’s Panel for Compassionate Drug Use, and serves as a contributing author and advisor for Medscape.
A version of this article appeared on Medscape.com.
This transcript has been edited for clarity.
There’s never been anything like the revolution in the treatment of obesity that we are now living through. Historically, there’s always been calorie counting and diets. Now, after a burst of interest in gastric bypass surgery, we have the amazing world of injectables. We all have heard about Ozempic, Mounjaro, and Wegovy.
These are being used by millions of Americans at this point, some on prescription for conditions like diabetes and some to bring about weight loss in prediabetes, or in some instances — as is often seen on American television — weight control or weight loss by people who just want to look better. Celebrities getting behind these injectables has really powered an explosion of use.
There still are ethical issues out there for practitioners. For one thing, there are some forms of semaglutide, a key ingredient in some of these injectables, that are made by compounding pharmacies. They’re not the name-brand prescription injectables made by large companies. They’re brewed up, if you will, by a specialty pharmacy trying to mimic the ingredient.
What we’ve seen in recent weeks is an explosion of overdoses. When a person uses one of these compounding pharmacies, usually in association with a spa or sometimes online sales of weight loss injectables, they’re not always certain about how to dose themselves, how much to give, and what to take. They could misread the instructions. The more that it’s up to them to determine the dose, the more there’s risk for error. Reports show as much as 1500% increases in poisoning of people who took, instead of a 10th of a milliliter, 10 mL of these compounded versions of the injectable drugs.
Everybody needs to be alert, and not only for adverse events from the prescription injectables. It is important to track that, make sure that people aren’t getting into trouble, and have contact with the FDA if you have a patient who reports some kind of adverse event they attribute to injectables.
It’s important to realize that there’s this generic, cheaper path, but it’s a more dangerous path. People need to know this if they’re going to try that route. Doctors should be aware of it. People should be ready to call the poison control center number in their area to make sure that they know what to do if they overdose on this stuff.
My own inclination is to try to discourage its use. I think it’s still too dangerous to have people self-dosing with ingredients that really are not yet FDA approved in terms of knowing that they’ve been tested in clinical trials.
The other big issue, aside from this Wild West world outside of prescribed injectables, is what to say to people who are obese or trying to manage their weight. I think people need to know all their options. It’s pretty easy to just say, “Let’s put you on one of these injectables” and prescribe it. For one thing, they may not be able to get it; there’s such huge demand that there are some shortages out there.
We don’t really know the long-term consequences of decades-long use of these drugs.
I think people should hear their options and maybe try something less invasive to begin with. If that doesn’t work, then move on to the injectables. It isn’t so clear to me — given the cost, some of the unknowns of long-term use, and some of the dangers of people sneaking around and trying to get things cheaper on the side — that going straight to injectables is our best answer.
I do think doctors should talk about weight with their patients, carefully, with the patient’s consent. Make sure there’s no stigma. Make sure we’re not doing anything to raise anxiety as we talk about this condition. After all, it is seen as a disease.
Then, maybe enter your way gradually into interventions, seeing if lifestyle change is possible. It’s cheap and easier to implement: better diet, better exercise, or calorie counting. Some people succeed. When they don’t, we should move on, but realize that we’ve got the equivalent of a black market. We need to encourage patients, if they use injectable weight loss drugs, to tell doctors so that they can be on alert about the dangers and risks of overdose.
Dr. Caplan is Director, Division of Medical Ethics, New York University Langone Medical Center, New York City. He disclosed an unpaid position with Johnson & Johnson’s Panel for Compassionate Drug Use, and serves as a contributing author and advisor for Medscape.
A version of this article appeared on Medscape.com.