White Coat Black Art26:30Ozempic: The good, the bad and the future
Despite widely publicized reports of rare but severe side effects, obesity doctors say Ozempic and drugs like it have the potential to improve medical help for a chronic illness that patients have been forced for too long to try to cure on their own.
“There are still some aspects of our health-care community that say, ‘this is not important, weight loss is not important; it’s just cosmetic and you’re really not improving the health of these people,'” said Dr. Daniel Drucker, a physician-scientist whose research helped pave the way for Ozempic, one of several brand names for a drug known as semaglutide. “But now I think that argument will be laid to rest.”
Ozempic and other drugs in its class are known as glucagon-like peptides, or GLPs. Because GLPs act to stimulate insulin secretion, the first was approved for use as a diabetes drug in 2005, said Drucker, who is a senior scientist at the Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital in Toronto.
But it was actually back in the late 1990s that Drucker’s lab, as well as that of Dr. Steve Bloom in the U.K., began to publish what they’d observed in clinical trials — that patients treated with GLP medicines for their diabetes were also losing weight.
Now new data shows that semaglutide also reduces rates of heart attacks, strokes and death in people with pre-existing cardiovascular conditions, something Drucker told White Coat, Black Arthost Dr. Brian Goldman he believes will “change the conversation around the importance of treating people with obesity.”
Dr. Daniel Drucker, a physician-scientist whose research helped pave the way for Ozempic, says some members of the medical community still don’t take obesity seriously as a condition for which people need medical help. (Sinai Health System)
‘Not feeling hungry all the time’
Michael Morris, 58, says he’s been wrestling with his weight since he was a teenager.
“I’ve always gone up and down, yo-yo, every diet,” he said. When he needed a CPAP machine for sleep apnea about 18 months ago, he ended up in a program that supported him through some dietary changes to help address the apnea, along with his high blood pressure and cholesterol levels, and pre-diabetic blood sugar status. When Morris met with a doctor, he asked about Ozempic, and the two agreed he could give it a try.
Since then, Morris said he has gradually lost around 40 pounds and seen improvements in his other conditions as well.
Michael Morris says he has lost around 40 pounds since going on Ozempic about 18 months ago. (McLendon Photography)
“It’s like it changes … the way you think about food, like I’m not feeling hungry or ravenous all the time,” he said.
Before Ozempic, Morris said he could never tell when he was full.
“I know that’s probably hard for people to understand. I would eat stuff and then I would just keep eating, and then I got to the point where it made me feel sick. And then I’d be like, ‘Oh, I’m not doing that again.’
“I guess food, it’s like an addiction for me. And if you’re an alcoholic, people don’t say, ‘Oh, I’m just trying not to drink.’ There are programs and stuff.”
Dr. Sasha High, an internal medicine and obesity physician who works in private practice in Toronto, says genes shape how our brains respond to food and contribute significantly to obesity. (ELH Photography)
The genetic component
Dr. Sasha High, an internal medicine and obesity physician who works in private practice in Toronto, says it’s important to understand that not everyone experiences food in the same way.
“We know that 50 to 70 per cent of obesity is genetically determined and the genes involved are central nervous system genes, that means genes that control factors with our brain,” she said. These affect the way the brain responds to the food that’s around us, whether we have cravings for sugar or salty foods and whether we enjoy exercise. “All of that is kind of determined by our physiology.”
When High first started working in obesity medicine, she says there was little more than advice to eat less and exercise more that doctors could offer to patients. (Joel Saget/AFP/Getty Images)
That doesn’t mean weight is set in stone, said High, but it does mean there’s a range of what your body shape is going to look like, determined by your genetics and then by lifestyle choices.
When she started working in the area of obesity back in 2012, High said there wasn’t much doctors could offer beyond telling patients to eat less, exercise more and count calories.
That message is disempowering for people who have contended with obesity for a long time, she said.
“The issue is not that they don’t understand that they need to do that. The issue is that life gets in the way and stressers come and we eat because we are bored and we eat because we’re sad and we eat because it’s 9:00 at night and we’ve had a stressful day.”
Drucker said GLP medications work in two ways to tell patients that they’re not hungry. First, they tell the brain to physically slow the emptying of the stomach, and second, they affect the brain’s hunger signals, suppressing appetite.
Some of Drucker’s research was done in partnership with companies that produce or are working on weight-loss drugs, including Pfizer and Novo Nordisk.
On Nov. 11, the New England Journal of Medicine reported the results of a study on the safety of semaglutide in people with obesity who also had cardiovascular disease, said Drucker. On average, the patients received either semaglutide or a placebo for 34 months.
“It showed not only weight loss but reduced rates of heart attacks, strokes and death.”
However, some patients have experienced serious side effects, including stomach paralysis and malnutrition.
Pamela Cole is one of those patients. The 38-year-old from Marmora, Ont., initially responded well to the medication. But when her doctor increased her dose about eight months in, she started to get flu-like symptoms that escalated from there.
“I continued to get worse to the point I couldn’t eat anything without severe stomach pain,” said Cole. She wound up visiting the hospital four or five times in the space of two weeks, she said.
During the last of those visits, she was treated for severely low potassium levels that were impacting her kidney and liver function. A specialist eventually advised her to discontinue Ozempic, and after doing so, her symptoms resolved.
WATCH� | Semaglutide linked to serious gastrointestinal problems:
Ozempic-class drugs linked to serious gastrointestinal risks, study suggests
1 month ago
Duration 1:59
In a statement, Ozempic manufacturer Novo Nordisk told CBC it stands behind the safety and efficacy of all of its GLP-1 medicines when used by appropriate patients consistent with the product labelling and approved indications.
Drucker said Cole’s experience is atypical next to research findings from eight large cardiovascular safety trials — some with more than 10,000 subjects — that ran over periods of two to six years.
“And what we see generally are favourable results. In those trials, we see a reduction in heart attacks, strokes, cardiovascular death … and we do not see an increase in cancer or an increase in pancreatitis,” he said.
However, he said it’s important to be cautious.
“With the newer, more powerful medicines and the expanding patient population, there is always the possibility to see something that we haven’t before.”
Dr. Nav Persaud, a family medicine physician at St. Michael’s Hospital in Toronto, told CBC in January that it wouldn’t be the first time the side effects of a weight-loss drug turned out to be more serious than anticipated.
“We have seen it happen many times where there were these heralded wonder drugs that turned out not to work or to harm and kill people,” he said.
In France, a diet drug called Mediator that started as a Type 2 diabetes treatment was taken off the market in 2009 after being blamed for thousands of deaths due to heart-valve problems.
Dr. Sean Wharton said that until GLP drugs are less expensive and more widely available, they won’t be able to address obesity on a population level. (Lindsay Palmer)
Dr. Sean Wharton is an internal medicine specialist at Michael Garron Hospital in Toronto and assistant professor at the University of Toronto who researches obesity medicine. He likens the difficulty people face accessing medical help for obesity to the experience many people with mental health issues have with expectations that they should “just be happier.”
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However, until weight-loss medicines become a lot more accessible, he said he doesn’t see them making a big dent in the obesity epidemic. Ozempic has been in short supply since its popularity skyrocketed — more than 3.5 million prescriptions were filled at Canadian pharmacies last year The very nature of an injectable drug that’s expensive to manufacture, ship and store means only people with the financial resources or particularly good drug plans can get their hands on it, said Wharton, who has done paid research for Novo Nordisk.
In September, the New England Journal of Medicine published Wharton’s phase-two trial data showing that a once-a-day pill called orforglipron resulted in a weight reduction of at least 10 per cent after 36 weeks in 46 to 75 per cent of participants.
Drucker said that GLP medicines won’t erase the need to address access to healthy, affordable foods, to design cities that are easier to navigate on foot or bicycle, or to promote healthy habits around diet or exercise.
“But if you’re sitting across the desk from someone who is living with obesity and they have a higher risk of heart disease and kidney disease and liver disease and cancer, you know, I think GLP medicines are a very useful option.”
The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.
It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.
Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”
Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.
Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.
A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.
On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.
Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”
But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”
“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.
Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.
Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.
Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.
“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.
“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”
This report by The Canadian Press was first published Sept. 13, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
