Maker of Wegovy, Ozempic showers money on US obesity doctors

Dr. Lee Kaplan took the stage with an urgent message, telling fellow physicians they have a powerful weapon to fight the American obesity crisis: their prescription pads. Counseling on diet and exercise alone has failed for decades, he told about 400 doctors taking his annual obesity course at a Boston-area hotel. Kaplan, a leading U.S. obesity specialist, urged them to turn to a new generation of weight-loss medicines, including Wegovy from Novo Nordisk, that could help tens of millions of overweight Americans. Obesity, he said, should be treated as aggressively as other chronic diseases such as high blood pressure or diabetes – with lifelong prescriptions. “We are going to have to use these medications,” he said at the June gathering, “for as long as the body wants to have obesity.” Kaplan’s solution for America’s weight problem closely tracks Novo Nordisk’s financial ambitions for Wegovy. The Danish drugmaker, long known for diabetes medicines, is transforming itself into the world’s biggest weight-loss company. Novo tells investors its target market is the 764 million people with obesity across the globe. Its most lucrative region is the United States, where more than two-thirds of adults are overweight or have obesity and drugs frequently command the highest prices worldwide. Novo charges U.S. customers $1,300 a month for the weekly injection. Kaplan, the chief of obesity medicine at Dartmouth College’s medical school, is a powerful standard bearer for Novo’s case. Until last year, the 69-year-old gastroenterologist led the Obesity, Metabolism and Nutrition Institute at Massachusetts General Hospital and taught at Harvard Medical School. He’s also a highly paid messenger: Novo has spent $1.4 million on Kaplan for consulting work and travel between 2013 and 2022, according to a Reuters analysis of federal data. Those payments are part of a campaign to convince U.S. doctors to make Wegovy one of the most widely prescribed drugs in history – and to persuade skeptical insurers to pay for it. Novo spent at least $25.8 million over the past decade on U.S. medical professionals to promote its two obesity drugs, Wegovy and Saxenda, the analysis found. That total includes only payments that Novo reported it made specifically related to those two drugs; it sometimes paid far more to obesity specialists without naming any drug in the federal data. The money Novo reported paying Kaplan, for instance, included just $262,038 that the company classified as directly related to the two drugs, and $131,624 for an older diabetes medicine with the same active ingredient as Saxenda. Novo paid Kaplan $976,019 more without specifying any drug. Experts who study these industry payments say drugmakers have latitude on how to classify their spending on doctors. Reuters examined Novo’s payments for speaking, consulting, food and travel, while excluding those for research. The analysis also excluded payments related to Ozempic, a Novo diabetes drug that is also wildly popular for weight loss because it has the same active ingredient as Wegovy. Overall, at least 57 U.S. physicians each accepted at least $100,000 from Novo in payments associated with Wegovy or Saxenda over the period. They were an influential group: Forty-one were obesity specialists who run weight-management clinics, work at academic hospitals, write obesity-treatment guidelines or hold top positions at medical societies, according to a Reuters review of their credentials and publications. Another speaker at the Cambridge conference was Dr. Donna Ryan, a Louisiana researcher and former president of The Obesity Society, a prominent group of clinicians and researchers. She has accepted more than $1 million from Novo over the last decade, including $600,691 related to Wegovy and Saxenda, the analysis found. Ryan was instrumental in persuading the U.S. Office of Personnel Management to cover Wegovy and similar drugs for millions of federal workers, an agency official told Reuters. Pharmaceutical company payments to physicians for drug promotion, speeches and consulting are legal and common in the United States. Critics of the practice have long argued it encourages doctors to put corporate interests ahead of patients’ well-being. Ryan and Kaplan said their work with drugmakers is essential to advancing care for a woefully undertreated chronic disease. The newest drugs are highly effective, they said, and drugmaker money does not compromise their medical advice. “I don’t kowtow to the companies,” Kaplan said. “If I can’t defend what I’m doing as being both appropriate and ethical, then I shouldn’t be doing it.” In a statement to Reuters, Novo said its work with medical professionals goes beyond drug marketing. “To prevent and defeat a serious chronic condition like obesity, we need to do more than supply the right medicine,” Novo said. “This is why we work with medical professionals, institutions and other experts to conduct research and educate and raise awareness about obesity, a condition that has long been underrecognized and misunderstood.” Kaplan, Ryan and other Novo-financed colleagues have pushed for urgent prescribing of Wegovy and similar medicines to a large proportion of patients with obesity and for comprehensive coverage by government and private insurers. The company and some of its paid experts have called denying coverage tantamount to discrimination against people with obesity, rooted in the faulty notion that they are to blame for their condition. The need for mass prescriptions and expansive coverage of these drugs remains a subject of fierce debate. Reuters interviewed 10 clinicians or researchers with obesity expertise who questioned the wisdom of dispensing these drugs so broadly, especially to the many overweight people without other weight-related conditions. They argue the medicines have serious side effects and require more study, and that wide adoption of such expensive drugs would impose crippling costs on the U.S. healthcare system. Wegovy and similar drugs can cause severe nausea, muscle loss and the potential for intestinal blockages. They are being scrutinized by U.S. and European regulators over a possiblelink to suicidal thoughts. Some doctors warn that overprescribing these powerful drugs unnecessarily exposes patients to unknown risks that may take years to uncover. Some specialists advise a more cautious approach, prescribing the drugs first to patients with severe obesity or serious weight-related conditions. The United Kingdom’s National Health Service has adopted that strategy in limiting eligibility. For these patients, the potential benefits outweigh the drugs’ risks and staggering costs, said Dr. Robert Lustig, a professor emeritus of pediatrics and endocrinology at the University of California at San Francisco. “I’m not against the drugs; what I am against is the indiscriminate use of the drugs for everyone,” said Lustig, who has studied obesity for decades. “But that’s what the drug company wants, because that’s where the money is.” The excitement around these drugs, collectively known as GLP-1 receptor agonists, is understandable amid soaring global obesity rates. Originally developed for diabetes, the medicines mimic a natural hormone that slows digestion and makes patients feel more full after eating. Novo is the first company to win approval to market GLP-1 drugs for weight loss. The U.S. Food and Drug Administration (FDA) approved Saxenda for that purpose in 2014 and Wegovy in 2021. Wegovy, in conjunction with diet and exercise, helped people lose an average of 15% of their body weight in clinical trials. That’s far more than with previous drugs, including Saxenda, another injection with a different active ingredient, liraglutide. Novo also touts trial findings showing a 20% lower incidence of heart attack, stroke or death from heart disease among patients taking Wegovy compared to a placebo. Such results have sparked a rush on Wegovy and Ozempic. Both drugs are in short supply. The booming sales have made Novo Europe’s most valuable company, worth about $420 billion euros. Novo said less than 1 million U.S. patients were taking Wegovy as of early November, a number constrained by shortages, spotty insurance coverage and the fact that many people seeking weight loss take Ozempic, which has seen monthly prescriptions rise sharply in the past two years. Others take cheaper knock-offs. Still, these drugs are a hard sell to many insurers, employers and government agencies. They’re reluctant to pay Novo’s steep price for a drug the company insists should be taken indefinitely. Novo’s trials showed patients who quit usually regained most of the weight. That’s where Kaplan and other Novo-financed doctors play a role. The Reuters analysis provides unique insight into Novo’s campaign to recruit many of the country’s leading obesity specialists over a decade. Their advice, in training courses, medical conferences and publications, shapes how thousands of physicians treat patients nationwide. Doctors often take Kaplan’s course, which lasts a few days, to satisfy continuing-education requirements or to prepare for certification in obesity medicine. Novo contributed $10,000 for Kaplan’s course this year. Wegovy’s U.S. prescribing label, approved by regulators, recommends the drug for anyone with a body mass index (BMI) of 30 or higher, the threshold for obesity. The recommendation also extends to patients with a 27 BMI and at least one weight-related medical condition. In all, that would cover about 46% of American adults — about 120 million people. Reuters examined data from the federal Open Payments database, created more than a decade ago by the Affordable Care Act. Pharmaceutical and medical-device firms are required to report payments to doctors, other medical professionals and teaching hospitals for consulting, speaking, research, travel or meals. The intent of the reporting requirement was to shed light on these financial relationships and to help prevent conflicts of interest that can contribute to unnecessary care and costs. The increased transparency hasn’t stemmed the flow of industry money. Companies’ annual payments have surged from $6.5 billion in 2014, the first full year data were collected, to $12.6 billion last year. Some doctors said Novo’s payments exemplify how the flood of industry money can dominate decision-making about care and coverage. Dr. Arthur Kellermann, a health administrator and former dean of the Uniformed Services University of Health Sciences, the U.S. military’s medical school, reviewed Reuters’ findings on Novo’s spending. The company’s large-scale payments to doctors, he said, illustrate a longstanding problem in the drug industry. “The pharmaceutical industry still sees value in paying medical thought leaders to promote their products, and too many of them are happy to sign up for a six- or seven-figure check,” he said, calling such lavish payments “morally and ethically way over the line.” “As sales grow, Medicare and the insurance industry come under intense pressure to pay for these hugely expensive drugs,” Kellermann said. “The end result is that everybody’s healthcare costs go up.” Kaplan, Ryan and other Novo-financed obesity experts dismissed any suggestion that they are pharmaceutical-company mouthpieces. Kaplan said he accepts money from numerous companies and that he’s not beholden to any one drugmaker. Reuters found that Novo accounted for 64% of the $2.1 million he received overall from medical companies since 2013. Kaplan said that’s because Novo has been one of the few large drugmakers working in obesity for years. He said some of the money paid expenses for a half-dozen obesity courses Kaplan provided for hundreds of Novo employees. “There is so much need for better education and what I like to call ‘obesity literacy,’” said Kaplan. Ryan makes no apologies for taking industry money. She said the gravity of the obesity epidemic demands that doctors work closely with companies to help spur medical advances and expand treatment. “Being a purist isn’t helping anyone,” she said in an interview. “I’m proud of the work I’ve done on behalf of patients with obesity.”