Hosts
Derek Thompson
Derek ThompsonAbout the episode
For years, scientists worried that medical progress was slowing down. Drug development became more expensive than ever with more complex clinical trials, and even then, many new treatments offered only modest gains. But over the past month, a series of breakthroughs has raised hopes that medicine may be entering a new era.
Researchers unveiled a massively promising new therapy for pancreatic cancer, a gene-editing treatment that could dramatically reduce the risk of heart disease, and an experimental obesity drug that not only produces unprecedented weight loss but also improves a huge range of related conditions. Cancer and heart disease are America’s two biggest killers, but if these treatments fulfill their promise, they could transform public health and extend millions of lives.
Today’s guest is Matthew Herper, senior writer at STAT News. We discuss this remarkable month in medicine, why so many advances are arriving at once, and what they could mean for the future of human health.
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In the following excerpt, Derek and Matthew Herper explore the various effects of the new GLP-1 drug retatrutide and speculate on how the use of this drug might change in the future.
Derek Thompson: So I am so excited to talk about this miracle month in medicine with you, and I think we should start with retatrutide, the new GLP-1 drug that the medical world is buzzing about. I want to round up some of the wins that I saw from phase 3 clinical trial data: weight loss almost double Ozempic, 28 percent versus 15 percent. Huge effects on sleep apnea, inflammation, systolic blood pressure, knee pain, type 2 diabetes, triglycerides, bad cholesterol. There’s phase 2 clinical data suggesting that it reduced visceral fat around the liver by up to 80 percent. Number one, do you buy the hype here? And number two, what in this constellation of benefits really stands out to you?
Matthew Herper: Do I buy the hype? It depends which hype. I think GLP-1 drugs are changing the world. I think retatrutide—or, as we used to call it, triple G, which I really love that name—is the most potent of them that we’ve seen. I think there will be more potent ones coming along. I think exactly who does what is a bit of a question, but there are a lot of these. There are also the oral versions now. Big picture, they are changing. They’re the first really effective obesity drugs. Obesity is bad for you in a whole bunch of ways, and it seems to affect those, and it seems to have other salutary benefits. We haven’t seen drugs that have this kind of broad impact since the cholesterol-lowering drugs called statins. And these are drugs people actually want to be on because they want to lose weight.
They are absolutely phenomenal. The data look great. There are some side effects. They’re not perfect for everybody. No medicine is. But this is a powerful class of medicines, and this is a powerful member of that class. And this is what you see when there is a company like Eli Lilly that is at the head of the pack, and they are making sure to do every single study that they can do to show you how great this medicine is, and they’re all coming up heads.
Thompson: Do you think five to 10 years from now, we’re going to think of this category of drugs primarily as a weight loss category? Or do you think there are so many different positive benefits, positive side effects, it seems, from this drug category that maybe a decade from now there’ll be people taking this drug that have no issue with type 2 diabetes, no issue with obesity, but they look at the effect on cholesterol, they look at the effect on fatty liver disease, they look at the effect on, I don’t know, triglycerides, knee pain, sleep apnea, and you have a lot of people taking weaker versions—lower-dosage, oral versions—of these drugs just because they want the side effect profile even if they don’t want the number one thing that these drugs are advertised for, which is weight loss?
Herper: Well, I think absolutely, but I want to put a caveat on that. And the caveat’s mostly that a lot of those effects are probably mediated by weight loss. Weight gain’s pretty bad for us. We’re not supposed to be running this heavy. We’re supposed to be—I don’t love evolutionary arguments for anything, but we’re supposed to be walking around a lot and be pretty skinny, right? That’s how we’re evolved. There seem to be even more benefits beyond that. There may be benefits for addictions. There may be benefits in psychiatry. Those are very new. I don’t want to be encouraging people to take the medicines for that, but absolutely we could end up in a place where a lot of people are taking these medicines for a lot of things. And one of the big questions is going to be: Do you want a lower dose? Do you want a weaker drug?
I mean, it can be hard to drink water on these medicines sometimes. They’re not always benign. David Kessler has written about trying a lot of them, but a lot of people seem to go—former FDA commissioner. A lot of people do see—
Thompson: Former guest of this show.
Herper: And at a recent STAT event. But people go on and off them, and there’s not great medical data on that, but that may end up being the paradigm. I don’t think we know the paradigm. But, I mean, gosh, we’ve got a class of drugs that are improving all sorts of measures that have hard outcome data for some of the early metrics. Which, for people not following, hard outcome data, I mean they reduce heart attacks and strokes. These are drugs that may be making people live longer. So absolutely these could be medicines that a lot of people end up on, especially as they get easier to take. And if the small molecules, meaning the pills, end up being as great as the peptides that people are injecting, they’re really great drugs.
This excerpt has been edited and condensed.
Host: Derek Thompson
Guest: Matthew Herper
Producer: Devon Baroldi
Additional Production Support: Ben Glicksman