Big Pharma Versus the Capital Vices

What if you could cure mental illness by changing the chemistry of a patient’s brain? This was the motivating question for Arthur Sackler, patriarch of the Purdue Pharma dynasty, as posed in Patrick Radden Keefe’s 2021 tome Empire of Pain.

It was a proposition that spurred an entire industry of drugs intended to treat mental conditions, from Valium for anxiety to selective serotonin reuptake inhibitors (SSRIs) for depression. And it is a proposition that was recently thrown, at least in part, into serious question. “The chemical imbalance theory of depression is dead,” announced the Guardian last year, in reporting the news from a new medical paper that concluded there was “no evidence to support the idea that depression is caused by disturbance of the brain’s serotonin system.” But, the reporter was quick to add, this does not mean SSRIs aren’t effective. It just means we don’t know why they work.

A similar question has been raised lately by Eli Lilly, this time not about depression, but weight loss. Can chemistry cure gluttony? The pharmaceutical company that created the SSRI Prozac is now joining Novo Nordisk in using a Type 2 diabetes drug as a weight loss tool, to the tune of a $300 billion market value for Lilly. The long term effects of such usage are unclear, but that hasn’t stopped Hollywood and its concentric circles of microcelebrities from hoarding these drugs, to the point of shortages of the chemical compounds that compose them, as users resort to taking the compounds straight up.

At a chemical level, the way drugs such as Novo Nordisk’s Ozempic and Wegovy work is straightforward. Formed of semaglutide, which mimics GPL-1, a hormone in the gut that naturally causes the release of insulin, they help patients release more insulin when they eat, thus reducing blood sugar levels. This also has the effect of delaying gastric emptying, which reduces users’ appetite—both for food and apparently for other dopamine-seeking activities, such as online shopping (my husband perked up at this). Thus the weight loss, and thus the ensuing craze. Already, a quick Google search of either semaglutide or tirzepatide comes up with studies and articles about its benefits for weight loss, its use for diabetes having faded into the background.

These drugs aren’t just in Hollywood, however, and they aren’t just for the morbidly obese. One writer at the New Yorker describes being prescribed a semaglutide when she expressed her wish to get rid of 15 pounds of post-baby weight, despite wearing a women’s size four. The same writer reports that Lilly and Novo Nordisk are working on a combined dozen more similar weight loss drugs, and are spending roughly $10 million annually on lobbying—not to mention Nordisk’s estimated $100 million spent in advertising Ozempic last year.

In particular, the pharmaceutical companies want to see Congress pass the Treat and Reduce Obesity Act, which would require Medicare to cover “chronic weight management drugs,” among other treatments. (And yes, for those keeping track, these are the same drugs the American Academy of Pediatrics recommended, along with surgery, to treat obesity in children as young as 13.)

Though similar to Ozempic, however, Lilly’s new drug Mounjaro is reportedly several degrees stronger, composed of tirzepatide rather than semaglutide. To describe the difference between the two drugs, Julio Rosenstock, a veteran diabetes doctor, explains that he nicknamed Ozempic the “gorilla” because it had been the most potent GLP-1 containing drug up to that point, the Wall Street Journal reports. “But tirzepatide is really a King Kong,” Dr. Rosenstock said.

It is not hard to see why a successful weight loss pill would have something like a Midas touch in the pharmacy business, even if that pill was actually an injection, and even if it came with some pretty nasty side effects, from sagging skin and hair loss to nausea and vomiting and gastrointestinal problems. America is too chronically obese, and Americans are too chronically over-confident in medical cure-alls, for the drug industry to leave it all on the table for lame exercise campaigns and Michelle Obama’s school lunches. There is even allure in the injection itself, for some. It’s edgy, cool.

But this new mother’s little helper is not so different from the old one. Perhaps Mounjaro won’t be addictive like Valium; perhaps it won’t have damaging long-term side effects like the weight gain, impotence, and sleep problems SSRIs produced. But one thing is for certain: It will not cure obesity. It won’t even mitigate it. Rather, it will mask it.

The problem with SSRIs was not simply that the serotonin theory of depression was wrong, but that doctors and pharmaceutical companies purported to solve with a pill—a product—a problem with unavoidably spiritual components. So too with Ozempic, which has already led users to believe they have gotten their appetites under control, when in reality they have merely delegated responsibility to a drug for that which they failed to rule.

For many of the people running to Ozempic, Wegovy, and Mounjaro, that appetite may not even be an insatiable desire for food per se, or even just for unhealthy food, but for a certain physical appearance. The injections feed that appetite, while suppressing the other, so that without the traditional manifestations of an eating disorder, men and women may persist in a disordered attitude toward eating.

“It’s a bit of a pleasure to not be so hooked to this stuff,” one user told New York Magazine—meaning food, not Ozempic. “You’re suddenly a normal human being. I don’t need to eat this giant haunch of dead flesh.”

Appetites, even those that may not in themselves be bad, have a habit of growing when we feed them. There was a reason gluttony was included in the seven capital vices—“capital” meaning a head, from which hundreds of other sins spring, and which must be decapitated in order to kill the others. This unhealthy relationship with food, obsessive in nature, leads to a number of vicious tendencies, including both the insatiable gourmand and the wheedling calorie counter, the one who claims to be above such things yet cannot eat a meal without psychoanalyzing it.

Even if Ozempic and other such drugs are not addictive in themselves, what of the sensation of losing weight, or of appearing impossibly skinny, or of, quite simply, being in control?

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