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PORTSIDE CULTURE

MAKER OF WEGOVY, OZEMPIC SHOWERS MONEY ON U.S. OBESITY DOCTORS  
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Chad Terhune and Robin Respaut
December 1, 2023
Reuters

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_ Drugmaker Novo Nordisk paid at least $25.8 million to an elite
group of U.S. obesity specialists who advocate giving its expensive
weight-loss drugs to millions of Americans. Payments also go to
persuade skeptical insurers to pay for it. _

Dr. Donna Ryan, a researcher and former president of The Obesity
Society, has received money from Novo while promoting broader
treatment and insurance coverage for obesity, REUTERS/Brian Snyder

 

Dr. Lee Kaplan took the stage with an urgent message, telling fellow
physicians they have a powerful weapon to fight the American obesity
crisis: their prescription pads.

Counseling on diet and exercise alone has failed for decades, he told
about 400 doctors taking his annual obesity course at a Boston-area
hotel. Kaplan, a leading U.S. obesity specialist, urged them to turn
to a new generation of weight-loss medicines, including Wegovy from
Novo Nordisk, that could help tens of millions of overweight
Americans.

Obesity, he said, should be treated as aggressively as other chronic
diseases such as high blood pressure or diabetes – with lifelong
prescriptions. “We are going to have to use these medications,” he
said at the June gathering, “for as long as the body wants to have
obesity.”

Kaplan’s solution for America’s weight problem closely tracks Novo
Nordisk’s financial ambitions for Wegovy. The Danish drugmaker, long
known for diabetes medicines, is transforming itself into the
world’s biggest weight-loss company. Novo tells investors its target
market is the 764 million people with obesity across the globe. Its
most lucrative region is the United States, where more than two-thirds
of adults are overweight or have obesity and drugs frequently command
the highest prices worldwide. Novo charges U.S. customers $1,300 a
month for the weekly injection.

Kaplan, the chief of obesity medicine at Dartmouth College’s medical
school, is a powerful standard bearer for Novo’s case. Until last
year, the 69-year-old gastroenterologist led the Obesity, Metabolism
and Nutrition Institute at Massachusetts General Hospital and taught
at Harvard Medical School. He’s also a highly paid messenger: Novo
has spent $1.4 million on Kaplan for consulting work and travel
between 2013 and 2022, according to a Reuters analysis of federal
data.

Those payments are part of a campaign to convince U.S. doctors to make
Wegovy one of the most widely prescribed drugs in history – and to
persuade skeptical insurers to pay for it. Novo spent at least $25.8
million over the past decade on U.S. medical professionals to promote
its two obesity drugs, Wegovy and Saxenda, the analysis found.

That total includes only payments that Novo reported it made
specifically related to those two drugs; it sometimes paid far more to
obesity specialists without naming any drug in the federal data. The
money Novo reported paying Kaplan, for instance, included just
$262,038 that the company classified as directly related to the two
drugs, and $131,624 for an older diabetes medicine with the same
active ingredient as Saxenda. Novo paid Kaplan $976,019 more without
specifying any drug. Experts who study these industry payments say
drugmakers have latitude on how to classify their spending on doctors.

Reuters examined Novo’s payments for speaking, consulting, food and
travel, while excluding those for research. The analysis also excluded
payments related to Ozempic, a Novo diabetes drug that is also wildly
popular for weight loss because it has the same active ingredient as
Wegovy.

Overall, at least 57 U.S. physicians each accepted at least $100,000
from Novo in payments associated with Wegovy or Saxenda over the
period. They were an influential group: Forty-one were obesity
specialists who run weight-management clinics, work at academic
hospitals, write obesity-treatment guidelines or hold top positions at
medical societies, according to a Reuters review of their credentials
and publications.

Another speaker at the Cambridge conference was Dr. Donna Ryan, a
Louisiana researcher and former president of The Obesity Society, a
prominent group of clinicians and researchers. She has accepted more
than $1 million from Novo over the last decade, including $600,691
related to Wegovy and Saxenda, the analysis found. Ryan was
instrumental in persuading the U.S. Office of Personnel Management to
cover Wegovy and similar drugs for millions of federal workers, an
agency official told Reuters.

Pharmaceutical company payments to physicians for drug promotion,
speeches and consulting are legal and common in the United States.
Critics of the practice have long argued it encourages doctors to put
corporate interests ahead of patients’ well-being.

Ryan and Kaplan said their work with drugmakers is essential to
advancing care for a woefully undertreated chronic disease. The newest
drugs are highly effective, they said, and drugmaker money does not
compromise their medical advice.

“I don’t kowtow to the companies,” Kaplan said. “If I can’t
defend what I’m doing as being both appropriate and ethical, then I
shouldn’t be doing it.”

In a statement to Reuters, Novo said its work with medical
professionals goes beyond drug marketing. “To prevent and defeat a
serious chronic condition like obesity, we need to do more than supply
the right medicine,” Novo said. “This is why we work with medical
professionals, institutions and other experts to conduct research and
educate and raise awareness about obesity, a condition that has long
been underrecognized and misunderstood.”

Kaplan, Ryan and other Novo-financed colleagues have pushed for urgent
prescribing of Wegovy and similar medicines to a large proportion of
patients with obesity and for comprehensive coverage by government and
private insurers. The company and some of its paid experts have called
denying coverage tantamount to discrimination against people with
obesity, rooted in the faulty notion that they are to blame for their
condition.

The need for mass prescriptions and expansive coverage of these drugs
remains a subject of fierce debate. Reuters interviewed 10 clinicians
or researchers with obesity expertise who questioned the wisdom of
dispensing these drugs so broadly, especially to the many overweight
people without other weight-related conditions. They argue the
medicines have serious side effects and require more study, and that
wide adoption of such expensive drugs would impose crippling costs on
the U.S. healthcare system.

Wegovy and similar drugs can cause severe nausea, muscle loss and the
potential for intestinal blockages. They are being scrutinized by U.S.
and European regulators over a possible link to suicidal thoughts.
Some doctors warn that overprescribing these powerful drugs
unnecessarily exposes patients to unknown risks that may take years to
uncover.

Some specialists advise a more cautious approach, prescribing the
drugs first to patients with severe obesity or serious weight-related
conditions. The United Kingdom’s National Health Service has adopted
that strategy in limiting eligibility. For these patients, the
potential benefits outweigh the drugs’ risks and staggering costs,
said Dr. Robert Lustig, a professor emeritus of pediatrics and
endocrinology at the University of California at San Francisco.

“I’m not against the drugs; what I am against is the
indiscriminate use of the drugs for everyone,” said Lustig, who has
studied obesity for decades. “But that’s what the drug company
wants, because that’s where the money is.”

‘Lifelong treatment’

The excitement around these drugs, collectively known as GLP-1
receptor agonists, is understandable amid soaring global obesity
rates.

Originally developed for diabetes, the medicines mimic a natural
hormone that slows digestion and makes patients feel more full after
eating. Novo is the first company to win approval to market GLP-1
drugs for weight loss. The U.S. Food and Drug Administration (FDA)
approved Saxenda for that purpose in 2014 and Wegovy in 2021.

Wegovy, in conjunction with diet and exercise, helped people lose an
average of 15% of their body weight in clinical trials. That’s far
more than with previous drugs, including Saxenda, another injection
with a different active ingredient, liraglutide. Novo also touts trial
findings showing a 20% lower incidence of heart attack, stroke or
death from heart disease among patients taking Wegovy compared to a
placebo.

Such results have sparked a rush on Wegovy and Ozempic. Both drugs are
in short supply. The booming sales have made Novo Europe’s most
valuable company, worth about 420 billion euros ($457 billion).

Novo said less than 1 million U.S. patients were taking Wegovy as of
early November, a number constrained by shortages, spotty insurance
coverage and the fact that many people seeking weight loss take
Ozempic, which has seen monthly prescriptions rise sharply in the past
two years. Others take cheaper knock-offs.

Still, these drugs are a hard sell to many insurers, employers and
government agencies. They’re reluctant to pay Novo’s steep price
for a drug the company insists should be taken indefinitely. Novo’s
trials showed patients who quit usually regained most of the weight.

That’s where Kaplan and other Novo-financed doctors play a role. The
Reuters analysis provides unique insight into Novo’s campaign to
recruit many of the country’s leading obesity specialists over a
decade. Their advice, in training courses, medical conferences and
publications, shapes how thousands of physicians treat patients
nationwide.

Doctors often take Kaplan’s course, which lasts a few days, to
satisfy continuing-education requirements or to prepare for
certification in obesity medicine. Novo contributed $10,000 for
Kaplan’s course this year.

Wegovy’s U.S. prescribing label, approved by regulators, recommends
the drug for anyone with a body mass index (BMI) of 30 or higher, the
threshold for obesity. The recommendation also extends to patients
with a 27 BMI and at least one weight-related medical condition. In
all, that would cover about 46% of American adults — about 120
million people.

One of the doctors accepting Novo money — Dr. Ania Jastreboff of
Yale University’s Center for Weight Management — bemoaned the
small proportion of overweight Americans taking weight-loss drugs
compared to the 46% of eligible adults. She cited a study from 2016,
before the latest wave of blockbuster GLP-1 drugs, that found just 2%
of that group took weight-loss medicines.

“That is abysmal,” Jastreboff told doctors at the June conference.
“Is it OK to treat 2% of people with heart disease, or 2% of people
with cancer or 2% of people with HIV or any other disease?”

Since 2017, Novo has highlighted that same 2% figure to Wall Street
analysts to illustrate untapped demand.

Jastreboff did not respond to requests for comment. In all, she has
accepted nearly $130,000 in consulting fees and other payments from
Novo since 2014.

“Without a comprehensive lifestyle intervention and proper medical
oversight, these drugs have the potential to do significant harm.”

Dr. Courtney Younglove, medical director of Heartland Weight Loss
clinic in Overland Park, Kansas

At the conference, she emphasized keeping patients on medication
long-term to prevent them from regaining weight. "Obesity is a chronic
disease,” Jastreboff said. “That necessitates lifelong treatment."

Jastreboff has also worked on clinical trials of obesity drugs for Eli
Lilly, which markets a Wegovy competitor. Lilly’s Zepbound, another
GLP-1 drug, was approved in November for weight loss and has the same
active ingredient as Lilly’s Mounjaro, a diabetes drug also commonly
used for weight loss.

In a statement to Reuters, Lilly did not directly address the debate
over how widely GLP-1 drugs should be prescribed and their high costs.
The extent of Lilly’s payments to doctors to promote Zepbound are
not yet clear in federal data because the drug is so new. Lilly said
it works with doctors and other health providers on research, drug
development and education because “obesity is a serious disease that
is often misdiagnosed and mistreated due to misinformation and
stigma.”

“We are proud of this work,” Lilly said, “and committed to
transparency about it to maintain the trust of those using our
medicines.”

Some obesity researchers say Novo’s paid experts go too far in
calling for wide adoption. An estimated 40% of adults with obesity are
“metabolically healthy,” according to a 2021 paper published in
the Journal of the American Medical Association, which echoed the
findings of some other recent studies. That means millions of patients
might carry extra pounds without extra risk of serious conditions.

“There’s growing evidence that suggests a number on the scale
doesn’t lead to poor metabolic health,” said Dr. Ayana
April-Sanders, an epidemiologist at Rutgers University’s School of
Public Health, who wrote a commentary published alongside the 2021
paper.

‘Way over the line’

Reuters examined data from the federal Open Payments database, created
more than a decade ago by the Affordable Care Act. Pharmaceutical and
medical-device firms are required to report payments to doctors, other
medical professionals and teaching hospitals for consulting, speaking,
research, travel or meals. The intent of the reporting requirement was
to shed light on these financial relationships and to help prevent
conflicts of interest that can contribute to unnecessary care and
costs.

The increased transparency hasn’t stemmed the flow of industry
money. Companies’ annual payments have surged from $6.5 billion in
2014, the first full year data were collected, to $12.6 billion last
year.

Some doctors said Novo’s payments exemplify how the flood of
industry money can dominate decision-making about care and coverage.

Dr. Arthur Kellermann, a health administrator and former dean of the
Uniformed Services University of Health Sciences, the U.S.
military’s medical school, reviewed Reuters’ findings on Novo’s
spending. The company’s large-scale payments to doctors, he said,
illustrate a longstanding problem in the drug industry.

“The pharmaceutical industry still sees value in paying medical
thought leaders to promote their products, and too many of them are
happy to sign up for a six- or seven-figure check,” he said, calling
such lavish payments “morally and ethically way over the line.”

“As sales grow, Medicare and the insurance industry come under
intense pressure to pay for these hugely expensive drugs,”
Kellermann said. “The end result is that everybody's healthcare
costs go up.”

Kaplan, Ryan and other Novo-financed obesity experts dismissed any
suggestion that they are pharmaceutical-company mouthpieces.

Kaplan said he accepts money from numerous companies and that he’s
not beholden to any one drugmaker. Reuters found that Novo accounted
for 64% of the $2.1 million he received overall from medical companies
since 2013. Kaplan said that’s because Novo has been one of the few
large drugmakers working in obesity for years.

He said some of the money paid expenses for a half-dozen obesity
courses Kaplan provided for hundreds of Novo employees. “There is so
much need for better education and what I like to call ‘obesity
literacy,’” said Kaplan.

Ryan makes no apologies for taking industry money. She said the
gravity of the obesity epidemic demands that doctors work closely with
companies to help spur medical advances and expand treatment. “Being
a purist isn’t helping anyone,” she said in an interview. “I'm
proud of the work I've done on behalf of patients with obesity.”

Money and influence

Novo’s money has flowed to doctors and researchers with broad
influence over how weight-loss drugs are dispensed and covered.

Reuters examined Novo’s spending among experts involved in crafting
five prominent sets of obesity-treatment guidelines for doctors. Among
the 109 authors and reviewers credited in the guidelines, 53 had
accepted cash or in-kind payments between 2013 and 2022 from companies
that were selling or developing obesity drugs.

Novo accounted for $8 million of the $12.4 million spent on these
authors and reviewers, not including payments related to research, the
Reuters analysis found.

One of these doctors, Dr. Jamy Ard of Wake Forest University, is the
incoming president of The Obesity Society. In that role, he will
oversee the group’s effort to write new “standards of care,”
which primary-care doctors often use as a quick-reference guide, with
advice on Wegovy and similar therapies.

Ard, co-director of the Wake Forest Baptist Health Weight Management
Center, said the new standards should also inform coverage decisions
by insurers and policymakers. Ard told Reuters he believes the
standards should emphasize that the medicines are a long-term
treatment.

Ard has accepted more than $200,000 from Novo, the Reuters analysis
found. He said The Obesity Society will disclose and manage any
conflicts of interest among experts working on the standards, but that
such conflicts are hard to avoid in the relatively small obesity
field.

Ryan, the former Obesity Society president, helped run the Pennington
Biomedical Research Center in Baton Rouge, Louisiana, for more than
two decades. She has also conducted diabetes and obesity research for
the U.S. National Institutes of Health and co-chaired an NIH panel
that wrote guidelines for treating overweight adults.

Ryan was among the experts the U.S. Office of Personnel Management
consulted on whether to change its obesity coverage for millions of
federal employees, said the agency’s chief pharmacy officer, Dele
Solaru.

“She was one of the experts that we reached out to when we were
doing our background study,” Solaru told Reuters. “She is very
well regarded.”

Ryan was eager to expand coverage for federal workers to include GLP-1
drugs because it could influence other major employers to follow suit,
she said at the Cambridge conference. She shared research on the
merits of obesity treatment and connected government officials with
two key groups with drugmaker ties: the Obesity Action Coalition, a
nonprofit advocacy group, and the STOP Obesity Alliance at George
Washington University.

Novo, Eli Lilly and other drugmakers are corporate members of the
alliance, donating at least $25,000 annually. Novo gave an additional
$200,000 for research in 2021, the organization said.

STOP’s medical director is Dr. Scott Kahan, who spoke at Kaplan’s
obesity course and plans to assist Ard on The Obesity Society’s
updated guidelines. Kahan has accepted more than $300,000 from Novo in
the past decade, the Reuters analysis found. He said he has sought to
“minimize conflicts of interest.”

The Obesity Action Coalition also relies on funding from Novo, which
is the organization’s top corporate donor at more than $500,000
annually, according to the group.

Ryan’s advocacy paid off. Government pharmacy officer Solaru said
her agency concluded that the new obesity drugs could be
cost-effective by preventing other weight-related diseases and
boosting workplace productivity. In January, the personnel office told
its health plans they must cover at least one GLP-1 obesity drug for 8
million workers, retirees and family members. The agency hasn’t
provided cost projections.

The Obesity Action Coalition celebrated the federal decision as one of
its top “advocacy successes.” A coalition spokesperson declined to
comment further. Christine Gallagher, research project director at the
STOP Obesity Alliance, said her group cites the federal-workers
coverage policy “as an example to help influence other decision
makers.”

The Office of Personnel Management said agency officials were aware
that Ryan had worked with drug companies, which she discloses in
research papers and elsewhere, but officials did not know she had
accepted more than $1 million from Novo over the past decade. The
agency said it based its decision on an objective review of research
papers, clinical guidelines and trial results.

Mixed results, rising risks

Wegovy has been life-changing for some patients. Rebekah Carl, 47, of
New Columbia, Pennsylvania, called Wegovy a “godsend” after losing
about 90 pounds since October 2021. She now weighs less than 140
pounds.

Carl said at first she had severe nausea, but managed it with another
medication. As her weight came down, so did her blood sugar, blood
pressure and cholesterol. Her chronic knee pain eased. “It really
does affect everything,” she said. “The weight melted off. It’s
so much easier to be active.”

Her insurance just agreed to cover Wegovy for another year, easing her
worries about being cut off because of its cost, which she can’t
afford to pay herself. “I’m absolutely relieved,” she said.

Some patients have not experienced the same success. Jen Wexler, a
31-year-old graphic designer in Florida, is about five feet tall and
weighed 154 pounds when she started the drug in late 2021. She lost
about 25 pounds in six months, but constant nausea and fatigue made
exercise difficult. She didn’t like how she felt or looked; her face
looked gaunt, older.

Wexler has regained 15 pounds since stopping Wegovy but feels
healthier. She now focuses on eating well and exercising, including
weight-lifting. “I’m more muscular,” she said. “I feel so much
better.”

Many others have also tried and quit GLP-1 drugs for weight loss.
Reuters reported in July that only a third of patients who started
Wegovy, Ozempic or similar drugs for weight loss were still taking it
a year later, according to a 2021 analysis of U.S. pharmacy claims.
The study did not explore why people quit, but health experts cite
side effects, shortages, high insurance co-pays and deductibles, or a
failure to lose weight.

More health concerns are emerging as tens of thousands of new patients
try these drugs each week.

Some patients have suffered rare side effects, such as stomach
paralysis and intestinal blockage, from taking medicines containing
semaglutide, the active ingredient in Wegovy and Ozempic, according to
research published in October. In a statement to Reuters, Novo said
the study had limitations and only reflected data collected up to
2020, the year before U.S. regulators approved Wegovy.

In June, the American Society of Anesthesiologists warned that
patients taking GLP-1 drugs were at higher risk of a dangerous
complication: aspiration during surgery. The slower digestion from the
drugs could make patients more likely to regurgitate under anesthesia,
the society said. Novo said its clinical-trial and post-marketing
safety data have not shown a “causal association” between GLP-1
drugs and pulmonary aspiration.

One reason GLP-1 drugs are so effective is because they reach the
brain. That may account for their effectiveness in influencing hunger
signals, but could also increase risks of neuropsychiatric side
effects, medical experts say.

U.S. and European regulators are studying whether GLP-1 drugs can
cause suicidal thoughts. Reuters reported in September that at least
265 reports have been filed with the FDA since 2010 describing
suicidal ideation or behavior in patients taking these drugs.
Thirty-six reports described a death by suicide or suspected suicide.

Another concern stems from clinical trial results showing that
patients taking Wegovy can lose a significant amount of muscle mass.
This can be particularly harmful to older adults by exacerbating an
age-related loss of strength or mobility, according to obesity
specialists including Lustig, the San Francisco researcher.

“Starvation causes an equal loss of muscle and fat,” he said.
“That is what these drugs do.”

Such risks could be managed, doctors say. But some patients are
getting these medicines through telehealth companies and other
providers with minimal screening and follow-up, according to obesity
specialists including Dr. Courtney Younglove, medical director of
Heartland Weight Loss clinic in Overland Park, Kansas. Patients on
GLP-1 drugs, she said, need guidance on nutrition, strength training
and mental health.

“Without a comprehensive lifestyle intervention and proper medical
oversight, these drugs have the potential to do significant harm,”
Younglove said.

Kaplan said that’s why he offers obesity courses to educate
primary-care physicians and other providers. Kaplan acknowledged that
unexpected side effects could emerge as many more patients take GLP-1
drugs.

“But the benefit to people with obesity is absolutely enormous,”
he said. “I don’t think we should shy away from treatment.”

‘Nothing wrong with money’

While Novo pushes for big increases in Wegovy prescriptions, it has
held firm on the drug’s lofty U.S. price. The company charges
American consumers three or four times the price of those in Europe,
where national health systems negotiate better drug prices, in
contrast to the U.S. free-market approach.

Novo did not directly address the price differences but referred to a
previous statement saying it understood many Americans struggled to
pay for its medicines and it was “focused on working collaboratively
toward sustainable solutions.”

U.S. insurers and pharmacy benefit managers usually get discounts and
rebates from drugmakers, but they don’t disclose the amounts.
Wegovy’s cost could still wreak havoc on health budgets and
premiums, even with a substantial break on its $1,300-a-month list
price, according to benefits consultants and health-policy experts.

Vanderbilt University researchers concluded in March that annual
spending on Wegovy alone, with an estimated 23% discount, would total
$27 billion to treat just 10% of patients with obesity enrolled in
Medicare, the federal health program for the elderly. That would equal
nearly a fifth of all current Medicare drug spending, after adjusting
for rebates and discounts.

Novo has said Medicare should cover obesity medicines like it does for
those treating any other serious disease. Failing to do so, it said,
would “validate the stigma and bias that obesity patients face.”

Wegovy, other weight-loss drugs scrutinized over reports of suicidal
thoughts

Most patients using weight-loss drugs like Wegovy stop within a year,
data show

Demand for weight-loss drugs fuels global rise in counterfeits

Some federal officials and researchers question whether Novo’s
promised future savings on weight-related disease treatment will ever
cover the drug’s costs. Congressional Budget Office director Phillip
Swagel challenged Novo’s argument in an Oct. 5 blog post, pointing
to research showing federal spending did not decrease for patients who
lost significant weight from bariatric surgery, an operation that
typically makes the stomach smaller. Wisconsin’s state insurance
board in May rejected a proposal, supported by Novo, for
government-employee coverage after an analysis found that up to $14
million in annual obesity-drug spending would yield only $2 million in
savings if members maintained a lower weight.

Ryan, one of Novo’s highest-paid experts, told doctors at the
Cambridge conference that the emergence of such blockbuster drugs has
been overwhelmingly positive for patients and investors. She cited a
Wall Street firm’s report predicting billions of dollars in future
drug sales, and said she was consulting with telehealth companies
rushing into the field to focus on weight loss.

“There is nothing wrong with money,” Ryan said. “Look, we give a
Nobel prize in economics, right? So money can really help. It can help
promote good in the world.”

Obesity experts travel the world on drugmaker’s dime

Over the past decade, obesity expert Dr. Donna Ryan traveled the
globe, with stops in Paris, Madrid, Vienna and Abu Dhabi, among a
dozen international destinations.

Pharmaceutical giant Novo Nordisk paid for all of it. Ryan took 130
company-funded trips in the United States and internationally from
2013 to 2022. Another obesity specialist, Dr. Ken Fujioka, also took
130 Novo-paid trips during that time, primarily to U.S. destinations.

Ryan and Fujioka are among Novo’s most frequent travelers, according
to a Reuters analysis of spending the company reported to the federal
Open Payments database, which tracks drugmakers’ payments to
doctors.

Overall, Novo paid for at least 3,400 trips by medical professionals
tied to Wegovy and Saxenda from 2013 to 2022, the analysis shows. Most
of the Novo-funded trips taken by Ryan and Fujioka were also
associated with Saxenda or Wegovy, the company’s two drugs approved
for weight loss. Drugmakers don’t have to name a specific drug with
every payment submitted to the federal database. The data do not
include details on travel expenses beyond amounts paid and
destinations.

Drugmaker spending on physicians for travel, speeches and consulting
is a common but controversial practice in the United States, sparking
criticism about conflicts of interest and compromised patient care.

“These highly-paid doctors end up drowning out the voices of people
who aren't being flown around to every medical meeting,” said Dr.
Adriane Fugh-Berman, a professor of pharmacology and physiology at
Georgetown University Medical Center who studies pharmaceutical
marketing practices. “As a result, there’s not a lot of resistance
to the prevailing industry-funded view.”

Ryan and Fujioka said their travel for Novo enabled them to provide
medical advice that’s valuable to patients, physicians and the
manufacturer. In a statement, Novo said the doctors it consults
provide insights on obesity treatment and raise awareness about the
disease. “Responsible engagement between pharmaceutical companies
and the medical community is good for patients and advances care and
science,” the drugmaker said.

As sales soar for new obesity drugs, including Novo’s Wegovy, there
is growing debate on how widely these powerful and expensive
medications should be prescribed and for how long. Many leading
obesity specialists who accept Novo’s money also advocate for
dispensing the medicines to tens of millions of patients, and for
broad coverage by government and private insurers.

Fujioka is director of the Scripps Clinic Nutrition and Metabolic
Research Center in San Diego. At the time he was traveling on Novo’s
behalf, Fujioka worked on obesity-treatment guidelines published in
2016 by the American Association of Clinical Endocrinology. He’s now
a board member at the American Board of Obesity Medicine, which tests
and certifies doctors as specialists. Overall, Novo has spent $715,000
on Fujioka for travel, speaking and consulting fees, Reuters found.

In a statement, Fujioka said it was important to travel and speak
about his and his colleagues’ research to fellow physicians. “Some
of my lectures pertain to a specific product, but others address
obesity treatment in general, including the risks, benefits and
alternatives to pharmaceutical therapies,” Fujioka said.

Fujioka and his employer, Scripps Clinic Medical Group, said he
complies with its policy requiring disclosures of any outside work
that might pose a conflict of interest.

Ryan is a former president of the Obesity Society and worked for more
than two decades at the Pennington Biomedical Research Center in
Louisiana before retiring in 2012. Since then, she said, she has
worked as a consultant to drugmakers, along with other companies and
organizations.

Her international trips spanned Europe, the Middle East, South
America, Canada and Mexico. Novo paid for Ryan’s travel to Denmark,
where the company is based, a dozen times from 2013 to 2022, the
federal data show.

Ryan said the Denmark trips involved meetings with Novo executives and
fellow experts as part of the company’s global advisory board on
obesity. During one trip, about a decade ago, Ryan said she gave a
presentation on obesity to the company’s board of directors as Novo
began to grow its weight-loss business.

Other recent trips to Europe, she said, were tied to her work as a
clinical investigator on Novo’s SELECT trial, which found that
Wegovy reduced the incidence of heart attack, stroke or death from
heart disease by 20%.

Ryan said that Novo and other companies value her input and that
industry-funded trips don’t influence her medical advice. “These
companies hire me because I tell them what they need to know, not what
they want to hear,” she said. “This is my livelihood. I make money
by giving advice and teaching doctors.”

REUTERS INVESTIGATES

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