Wes Streeting Wants To Experiment On You

Professor Kathleen Stock writes:

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 apnoea, 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.”

To people of ascetic sensibilities, this might seem a negligible price to pay for health; but then again, ascetics are unlikely to need Mounjaro or Wegovy in the first place. In contrast, we constitutionally sybaritic types tend to place enormous importance in life on the sensory joy and comforting reassurance which food can bring, an enthusiasm which evidently crosses cultures, culinary tastes, and pay packets. Unless you are literally starving, food is practically the one daily pleasure in life you can reliably count on, be the fare grand or humble; and if it wasn’t for the prospect of breakfast, lunch, and dinner, some of us wouldn’t bother getting out of bed at all. Indeed, along with what has become known as an “Ozempic face” and an “Ozempic butt” — both unfortunately drooping — there is now talk of an “Ozempic personality” to match, involving anhedonia, depression, and a loss of libido.

“Unless you are literally starving, food is practically the one daily pleasure in life you can reliably count on.” The counterargument says that obese people are often fed up with obsessing about food in one way or another; and that regaining mobility means they will be free to get out and about, and so discover less one-dimensional sources of personal meaning instead. Maybe so. But testimonies suggest that old fondnesses are not so much permanently extinguished by the drug as temporarily quashed.

The woman who used to think Doritos looked like socks reported that, after quitting the drug, “everything came back full force”; “all the crazy cravings that I’ve struggled with for the sweets, the junk food.” Another said: “Suddenly it was like my body woke up and discovered, ‘Hey, I like bread’”. In some cases, it is thought that people will need to become lifelong Mounjaro users in order to avoid relapsing into enjoying food again — a tragic indictment of late modernity if ever there was one.

Indeed, to me the most interesting issues arise when we consider what kind of society we inadvertently might be creating in future, by introducing such ruthlessly effective weight-loss drugs at scale now. Politicians, it seems, aren’t properly exploring the landscape of nearby possible worlds. If, for instance, without pharmaceuticals such as Wegovy and Mounjaro, just over a quarter of us are likely to become obese at some point — the current figure — then this also suggests that, with access to the drugs, a quarter of us are going to become indifferent to food and perhaps even vaguely nauseated by it, in some cases for life.

What then is going to happen to the nation’s restaurants and pubs? What will happen to regular family meals round the dinner table, nearly a thing of the past anyway as many of us favour mindless mastication in front of the telly? What about luxury food products, presently coveted as obvious temptations and sold to the public as such — and to the companies and industries that produce them? It seems to me you can’t chemically neuter a huge part of the population’s taste buds and not see swingeing social effects elsewhere.

Another interesting question concerns notions of personal responsibility. At the moment, there is still too much emphasis on personal choice for obesity in many people’s minds, with structural features such as addictive hidden sugars and contributory environmental factors being improperly discounted. Equally, it would be an overstatement to say there was nothing an individual could do to change his or her shape.

But with drugs available, obesity will become statistically much rarer. Fatness will become even less socially acceptable than it is now in the eyes of other people, and notions of personal responsibility yet more salient. Obese people who have ready access to the drugs and yet who fail to take advantage will become conceptualised by fellow taxpayers as wilfully stubborn drains on the public purse. They may even be thought undeserving of benefits, or of other NHS help. We have officially moved out of the “kindler, gentler politics” phase into the “tough choices” era, after all.

At the same time, in cases where the NHS positively withholds free treatment from someone in future — maybe, say, after an allotted period of treatment is up — it seems likely that such an individual will then see herself as having extra reason to blame the system for her physical state. Effectively, the NHS’s adoption of Mounjaro at scale will embolden some to equate the state’s failure to prevent obesity in their own case as equivalent to causing it. Already we have Daily Mail testimonies from hard-up private buyers of semaglutide, complaining it is “disgusting” that the jobless might get the medicine for free, when they themselves have to pay. Grievance culture can take many creative forms; feeling hard done by because the government won’t pay for injections that make Doritos look radically unlike Doritos is quite possibly the next one.

In the meantime, slender fashionistas on fashion show front rows are secretly buying Ozempic to make them yet more ethereal; adolescent girls are seamlessly incorporating the drug into their already vast repertoire of ways to mortify the flesh; plastic surgeons are busy informing those with “Ozempic face” about which fillers and surgeries are best to purchase, in order to disguise the sag. The future of weight loss is already hurtling towards us. Rather than focusing on appetising-looking new financial opportunities, we should probably have a proper think about the hidden additives.