Only last month, Health Secretary Wes Streeting was warning us sternly against “killing the NHS with kindness”. This week, true to his principles, he announced an intention to start experimenting upon fat people in partnership with Big Pharma.
The five-year experiment is part of a £279 million deal struck with Lilly, the world’s biggest drug company, and aims to determine whether giving weight-loss injections to the obese will boost the economy. It will have two prongs. On one side, the NHS will identify potential participants for its trial on the basis of obesity, plus some combination of “hypertension, sleep apnea, cardiovascular disorders and unhealthy levels of … cholesterol”. It will then dose them with Mounjaro, Lilly’s competitor to Novo Nordisk’s Wegovy (better known as Ozempic). Meanwhile academics at the University of Manchester will be collecting data about the effects of the drug on “health-related quality of life and changes in participants’ employment status and sick days from work”.
Accustomed as we are to seeing the nation’s relatively poor health as a terrible financial burden, effectively Streeting is urging us to flip the script and see it as a possible goldmine. For ministers and managers desperate for cash injections to help get their most troublesome patient back on its feet, the implicit model must look deliciously appealing. At a price, it seems he is allowing one company exclusive access to a patient population: both to their bodies directly, via the use of a particular product, and apparently to some of their data afterwards. If public health does indeed improve as a result, the crippling financial burden on frontline resources, taxpayers, and employers will ease. Yet even if it doesn’t, sick people might continue to be a source of revenue in future, as companies like Lilly pay for access rights in the search for lucrative remedies and good publicity.
Later on, once voters have got used to thinking of national ill health as an economic resource to offset the drain on public finances, similar initiatives might be rolled out for other expensive UK-wide disorders. Mental health conditions like depression and anxiety appear prime candidates for future government interventions like this one. In Streeting’s imagination, perhaps, biotech companies will start flocking to our shores, lured by the juicy prospect of exclusive access to a centralised pool of patients. Lazarus-like, the NHS will eventually stagger out of the tomb, throwing off its bandages. The economy will boom, replete with newly svelte and mentally balanced workers. Government ministers will dance nimbly in celebration to the sounds of Taylor Swift .
But aside from such grand visions, there are several more mundane questions that might be posed about rolling out Mounjaro as a state-backed strategy. Some of these hinge straightforwardly on what is already suspected about side effects. Vomiting is commonly reported, as are other relatively minor but still unpleasant gastric issues. A bigger issue is that even where nausea is absent, such drugs seem to remove a major source of subjective pleasure in life — namely, delight in eating — for which the satisfaction of once again becoming an efficient source of productivity units may come as scant consolation.
Described as the “King Kong” of weight loss jabs, Mounjara’s key ingredient is terzepatide which, like semaglutide, works partly by causing appetite suppression. According to a former user of the latter “I didn’t even think of (food). … Looking at a bag of Doritos was kind of like looking at a pair of socks”. Another admitted: “Almost immediately I couldn’t eat at all. I couldn’t drink. I couldn’t do anything. Tea and toast in the morning is my go-to and I could not touch it from the very first day.”
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