Pearl is a clinical professor of plastic surgery at the Stanford University School of Medicine and is on the faculty of the Stanford Graduate School of Business. He is a former CEO of The Permanente Medical Group.
Dying younger. Living harder. Going broke. It is difficult to overstate the longitudinal effects of excess weight in America.
An estimated seven in ten Americans are overweight or obese. The combination, according to the National Institutes of Health, results in an estimated 300,000 preventable deaths per year with extreme obesity lowering life expectancy by 14 years on average.
Added weight not only makes everyday life more difficult, but it also produces serious health consequences that include cardiovascular disease, diabetes, musculoskeletal disorders and cancer. In total, obesity costs an estimated $260 billion annually in inpatient and outpatient care.
Whether weight gain is caused primarily by genetics, societal influences or individual will, scientists aren’t altogether sure. What’s clear, however, is that most efforts to lose weight ultimately fail.
New Hope In Diabetes Drugs
Ozempic, one of a new class of medications, has been shown in studies to spur significant weight loss. The others include Mounjaro, Rybelsus and Wegovy with several new (and convenient, pill-based) options in development.
A Heavy Price For Weight Loss
Last year, more than five million Americans were prescribed one of these drugs for weight reduction.
The annual price of treatment ranges from $12,000 (Mounjaro) to upwards of $16,000 per year (Wegovy). As a result, most users are either wealthy or have generous health-insurance coverage.
But as more Americans seek these medications for moderate weight loss, not diabetes, insurers have started clamping down. They’ve issued threatening letters to doctors, warning they’ll be referred to state regulatory boards for writing “off-label” prescriptions.
The Ozempic Paradox: Highly Effective But Unaffordable
Ozempic and other medications that help with weight loss are part of an ongoing national debate in which two competing truths collide.
The first truth is that these drugs work, leading to significant and sustained weight reduction: 14 to 25 pounds per individual on average during the medication course. And while they’re not a replacement for proper nutrition, exercise or healthier living, they do reduce the likelihood of heart attack, stroke and cancer.
Second, despite the medical opportunity at hand, making these drugs available to all 100 million obese American adults would prove cost prohibitive for businesses, private insurers and the government.
This means that the medications could drastically rollback the nation’s $260 billion in obesity-related medical expenses each year, but prescribing them at today’s prices would cost more than $1.5 trillion annually—increasing national healthcare expenditures by as much as 25 percent.
What’s more, these medications are considered “forever drugs,” requiring users to either maintain their dosage or regain most of the weight they lost.
Insurers are eager to draw a line between those seeking prescriptions for appearance’s sake and those at heightened risk of disease or death. They’re happy to cover the latter but, as with cosmetic surgery, insurers believe patients should foot the bill for the former.
Lost in this debate is an important question: Why not figure out how to make these lifesaving drugs broadly available and affordable?
The U.S. Government Can Lead The Way
With hundreds of thousands of obesity-related deaths each year, the magnitude of the problem qualifies as an “epidemic” and justifies forceful government intervention.
The current administration, with congressional approval, could initiate a nationwide campaign to fight obesity, similar to Operation Warp Speed. The program, with a $10 billion upfront investment, led to the speedy development of a safe and effective coronavirus vaccine. The government then was able to purchase more than one billion doses at one-third the cost of the vaccine’s current list price.
Here’s how the administration could replicate Operation Warp Speed to fight the obesity epidemic without breaking the bank.
Operation: Slim Provisions
The government would invest $4 billion up front— twice the average R&D cost to bring a new drug to market.
In return for funding and a ten year contract, the first drugmaker to develop a safe and effective weight-loss drug would be required to sell that medication back to the government at $40 per dose (or $2,000 per patient/year), significantly below the retail price of Ozempic and similar drugs. The winning pharma company would benefit financially, earning up to $1.2 trillion in sales over the contract’s lifetime without having to shoulder R&D costs.
With the new medication in hand, government-sponsored health programs, Medicaid and Medicare, would make it available to all obese enrollees (roughly 60 million people) for the next decade.
And by providing the drug to more than half of all obese adults, the government would reduce medical expenses by up to $130 billion annually or $1.3 trillion over 10 years, making the effort cost-neutral for American taxpayers.
Risks vs. Rewards
The only financial risk to the government (outside of defending likely lawsuits) would be failing in its search for a new drug, thus wasting the
$4 billion of taxpayer money. But that’s a relatively insignificant sum compared to the potential healthcare benefits.
The role of government is to protect the health and financial well-being of the nation. Fulfilling that function led to a lifesaving Covid-19 vaccine. Doing so again is the best option our nation has to address America’s growing obesity epidemic.
Old engraved illustration of Ulysses defying the Cyclops.
Odysseus Reimagined: Nolan’s Epic Explores What Makes a True Hero
Who is a hero? More importantly: what is a hero? What attributes are universally admired, inspiring glorious stories, ballads and songs, memorials and movies, all chronicling the hero’s bold adventures?
The Odyssey, a new release written and directed by Christopher Nolan, attempts to answer that question. Based on the ancient tales The Iliad and The Odyssey, written by Homer around 800 BC, the film stars Matt Damon as Odysseus and Anne Hathaway as Penelope, his loyal wife.
Historians have puzzled over the “Homeric question,” that is, who was Homer? We know very little about him, not even when or where he was born; seven Greek cities lay claim to him as their native son. Yet, he is considered the “godfather” of national Greek culture, and his stories are among the earliest masterpieces of literature.
Homer is sometimes romanticized as a blind poet who wandered from town to town reciting his stories. But he, who could express so poignantly the tribulations of Odysseus, was not blind to human nature. He keenly wrote of the attributes as well as the paltriness in his characters and the flaws of his great hero, Odysseus.
The Iliad is the story of the final years of the Trojan War, sparked when Helen, the beautiful wife of Sparta’s King Menelaus, was kidnapped by Paris of Troy. Because the kings had initiated a pact to defend one another, Odysseus was drawn into the fray.
After spending ten years fighting the Trojan War and finally achieving victory, The Odyssey tells of Odysseus’s struggle to return to his kingdom, Ithaca. On his way home, he encounters many dangers and delays. He is pursued by the sea-god Poseidon, must surmount Circe’s spell, and overcome the seductive charms of the enchantress Calypso, and his journey takes him another ten years.
Odysseus’s desires and struggles are universal: his longing for home, yearning for an end to his troubles, for rest after a long and difficult journey. His difficulties reflect the immemorial questions of what it means to be loyal, to belong, what it means “to be” at all. Despite his hubris, which manifests in his propensity to court catastrophe without regard for consequences, Odysseus is an authentic hero, noble and admirable, brave and dedicated.
According to the Greek ideal, a true hero must possess physical excellence and moral virtue. He must, as well, embrace his civic duty. Achieving such status requires “paideia,” a good education; “sophrosyne,” moderation in maintaining physical and emotional balance; and “arete,” an allegiance to the state.
Fictional or real, heroes’ deeds resonate through the centuries and shine a light on what is best in humanity, what matters, what will live on despite our mortality.
Is our digital age really so different from Homer’s Bronze Age? Physical beauty is still adulated, as it was then with Helen of Troy, “the face that launched a thousand ships.” (Marlowe) Power is still king, and wealth is still power.
The years of the Trojan War were harsh and violent. But were they more brutal than the times we live in? Although millenniums have passed and we now have different battlefields, Palestine, Ukraine, Iran, etc., the ravages and the wages of war remain the same: death and suffering. Humanity’s currency is the same, and so, too, is our quest for heroes.
Social scientists claim that after three generations most people are forgotten by even their direct progeny, and after four, remembered only by historical records. So, what then does last? What makes a difference? What is truly beautiful and worthwhile in life?
The universal themes embodied and emboldened by our heroes throughout the ages, the faithfulness of their hearts and the courage of their deeds, these last.
The essential qualities of a hero are manifested in Homer’s Odysseus. Steadfast integrity: “Hateful to me as the gates of Hades is that man who hides one thing in his heart and speaks another.” His deep compassion: “Yet, taught by time, my heart has learned to glow for others’ good, and to melt at others’ woes.” (Both quotes from The Odyssey.)
Nolan’s movie may have created a more virtuous hero than Homer’s works, but the core of the nearly 3,000-year-old-story is intact and as crucially relevant today as it was then. It is the stuff of life: trauma, survival, relationships with others, finding oneself, deciding what is right, choosing a path forward, sometimes, ultimately leading to the honing of a hero.
Just as Odysseus braved storms, temptations, and trials in search of home, we too face a modern sea of civic turbulence, polarization, mistrust, and the fraying of our shared story.
As we live, we too will write our defining stories. How then might we become modern heroes?
By instigating the third Greek ideal of “arete”; embracing our civic duty. By becoming citizens who are open to reflection and debate, who are willing to act with purpose for the betterment of our nation.
In this journey, the work of renewing our democracy can be its own Odyssey, a voyage calling for integrity, courage, and steadfast commitment. Not to return home as Odysseus so desired, but to preserve our home, for the grand and worthwhile purpose of working toward an ever-better future for our country.
With others, we can shape the next chapter of our nation’s collective story.
Amy Lockard is an Iowa resident who regularly contributes to regional newspapers and periodicals. She is working on the second of a four-book fictional series based on Jane Austen’s “Pride and Prejudice."