By Alan Cassels at Brownstone dot org.

Here's a good current example of medical irony: the same week that our drug regulator, Health Canada, approved the first generic version of semaglutide—the active ingredient in weight-loss drug Ozempic—a major medical journal published findings highlighting the medication's troubling connection to eating disorders.

The timing couldn't be more paradoxical: just as this powerful appetite suppressant becomes more accessible and affordable to millions of Canadians, we're learning more about its potential to trigger dangerous psychological relationships with food. What we do know, as the New England Journal of Medicine reminded us, is that these drugs come with a range of troubling side effects, which you can discover if you have the fortitude to unwrap the numbing medicalese they use to describe them. The NEJM article describes the link to eating disorders as well as a range of other troubling effects including "nutrient deficiencies, electrolyte abnormalities, orthostatic hypotension, osteopenia, sarcopenia, thinning hair, and other signs of malnutrition." Then the last spike, unlikely to deliver any discomfort is that "the effects of long-term use are still largely unknown." Amen to that.

This same week, two different generic drug companies, one from India and one from Canada, were given licenses to sell generic semaglutide. This has been called a "long-awaited moment for diabetes and weight management treatment," yet let's not break out the champagne yet. We Canadians are going to be the canaries in the coal mine on this, as we're the first G-7 country to approve the generic version of Ozempic. Up until now it has mostly been sticker shock preventing a lot of people from jumping on the Ozempic bandwagon, but when that barrier is gone? Open the floodgates.

The Canadian media was all over this exciting new development, delivering fulsome praise for the arrival of the cheap stuff which will massively increase the size of the GLP-1 market in Canada. The generic version (which is currently only approved for type-2 diabetes) will probably enter the market at 75% the price of the brand name, but as more and more companies start producing generics, the price could fall as far as a quarter of its current price.

I imagine citizens of the United States have no sympathy for Canadians as the price of our Ozempic is already about one-fifth what it currently is in the US. When the generics hit the market we might be paying about one-tenth of what Americans are paying. Expanding the use of this class of drugs to countless patients previously priced out of treatment might be cheered as a major public health victory, but the triumph is shadowed by emerging evidence about semaglutide's darker psychological effects.

As the New England Journal of Medicine reported, recent studies and clinical reports have documented concerning patterns: Some patients develop restrictive eating behaviors, obsessively monitor their food, and in some cases, develop full-blown eating disorders. The very mechanism that makes these drugs effective—dramatically suppressing appetite and slowing gastric emptying—can apparently trigger psychological responses that mirror anorexia nervosa and other eating disorders.

With one in eight US adults — or approximately 33 million people — reportedly having taken GLP-1 drugs, this proportion translates to more than 420,000 people who could develop a related eating disorder with long-term use. About 3% of Canadians are currently prescribed GLP-1 medications (including semaglutide/Ozempic, liraglutide, tirzepatide, etc.) equating to potentially tens of thousands of cases of eating disorders.

The irony runs deeper than mere timing. Semaglutide medications like Ozempic were originally developed for type 2 diabetes but weight loss soon emerged as the most beneficial (and profitable) side effect. As these drugs gained popularity for cosmetic weight loss—often prescribed off-label to people without ...