Ozempic Expert: Miracle Drug or Health Hazard? The Side Effects They Don’t Tell You | Johann Hari x Mayim Bialik

Johann Hari

01:27:41 — You were able to use one sliver of the psychological component, willpower, to overcome these other factors.

01:27:48 — Huge credit to you. For me, I think the biological… I think the social component was a huge factor, but I was fatter than most of the people around me, so it can’t just have been that. I think the psychological components—about how I grew up in a family where there was a lot of violence and, as I say, a lot of lunacy—were significant. And so, you know, I ate to steady myself and calm myself. For me, that overwhelmed everything else. I’m someone with quite a lot of willpower, right?

01:28:25 — I work really, really hard. If willpower was the only factor—and I know you’re not saying this, I’m not saying this to argue against you—you know, it’s hard to think of anyone in our society who has more willpower than firefighters. They run into burning buildings for a job, right? I could not do that. And yet, firefighters are significantly more obese than the rest of the population. So, if willpower was all it took to not be obese, that wouldn’t compute, right? So, there’s these other factors going on.

01:28:50 — And we’ve got to deal with those factors. And we can deal with those factors. So, these new weight loss drugs give us some way of dealing with it. The way I think about it is: we were raised in a trap, and these drugs are a trap door. They are a risky, rusty trap door. Some of us should go through them, and some of us shouldn’t. And I hope my book is a guide to help people think about that. But also, much more importantly, we need to make sure our kids don’t grow up in that trap, and our grandchildren don’t grow up in that trap.

01:29:18 — And that can sound pie in the sky, but I went to places that have begun to do it. And just before I mention those places, I just wanna say—cause you’re gonna think, yeah, yeah, good luck with that, we can’t do that—I would just get you to think a bit about smoking. I think, if we could take your kids, or my nephews, my niece, my godsons, back to when we were eight years old, I think the thing that would most shock them is that people smoked fucking everywhere.

Mayim Bialik

01:29:44 — On airplanes.

Johann Hari

On the subway. On planes! I remember my doctor—my family doctor—used to smoke while he inspected me, right? There’s a photograph of me and my mother when I’m six months old. She’s breastfeeding me, smoking, and resting the ashtray on my stomach. And when I discovered this photo a few years ago, I thought she’d feel guilty. I showed it to her, and she said, “You were a fucking difficult baby, I needed that cigarette, right?”

01:30:10 — Completely unrepentant. That is what—that’s the, now—but now, if you saw someone breastfeeding and resting the ashtray on their stomach, you would literally call the cops, right? That transformation happened as a result of completely concerted government policy, demanded by ordinary people, that has dramatically reduced the number of smokers. I think the figure—it’s in the book—was something like 55% of Americans smoked when we were like eight or nine.

01:30:36 — It’s now like 12%. And that’s why we have much less lung cancer, staggering.

Jonathan Cohen

01:30:43 — And wasn’t that change also precipitated on we stopped lying to ourselves and the general public about what the effects of that substance and the action was? And that’s where I’m agreeing with you and I want to make sure that it’s clear that I’m not saying everyone should just have willpower, I’m saying people are being lied to actively about just how harmful the types of foods that we’re consuming are.

Johann Hari

01:31:08 — I think you’re totally right, but I think it goes even deeper than that. Even before we’re lied to, more three-year-old children in the United States know what the McDonald’s M means than know their own last name. From when we are so small…

Mayim Bialik

01:31:24 — Well, your last name doesn’t give you a toy. That’s the thing. Your last name doesn’t give you a toy with your fried food. I mean, that’s really what it is.

Johann Hari

01:31:31 — I have a memo in the book—it was a leaked memo from a food industry exec—talking about, these are not exact words, but, “We need to shape children’s tastes when they’re pre-rational. If we get them when they’re young, we’ve got them forever.” So, you know, it’s even before it’s like—because lying almost implies a rational debate. They get us long before we even have any rational thoughts about it, right? Even before we think about it in any way that would mean we could think about truth or lies.

But I think you’re right—we leveled with people about quite how bad smoking was for them, after a long period of profound disinformation. Cigarette companies literally… I mean, my mother—one of the reasons my mother smoked when she was pregnant with me—is because they were told it was good for you, because you’d have a smaller baby and it’d be less painful, right?

Mayim Bialik

01:32:15 — Can you speak a little bit to what people are observing both anecdotally and also increasingly in clinical numbers of other addictions getting better or going away from Ozempic. What’s happening? Is this the mechanism of the drug? Is it that, oh, if I feel better because I look better, I stop doing other bad things? What’s going on?

Johann Hari

01:32:43 — Of all the subjects that I researched and write about in Magic Pill, this is the most contested, so I want to just flag that up to people. But there are a few things we know for sure. I’ll give you an example of a brilliant scientist I interviewed called Professor Elisabeth Jarlhag, who’s at the University of Gothenburg in Sweden. So, you take rats and you get them to drink a shitload of alcohol. Turns out, rats really like alcohol, like humans do. You get them to drink alcohol over a long period of time until eventually their rat cage looks like a dive bar in North Vegas. Then you come along and inject them with a GLP-1 agonist, the active component in these drugs. If you do that, the rats massively reduce the amount of alcohol they consume, and the more heavily they were drinkers, the more they cut back. You think, wow.

But at first, when those experiments were done, they thought, well, maybe it’s just that—because alcohol has calories in it, obviously—maybe what’s happening is that these drugs reduce your desire for calories. Maybe that was what was going on.

01:33:42 — So, Professor Patricia Grigson at Penn State University, who I also interviewed—a brilliant scientist as well—got rats to use heroin and fentanyl pretty heavily. Again, you inject them with GLP-1 agonists, and there is a massive reduction in their use of the drug. Then Dr. Greg Stanwood, who I interviewed, who’s at Florida State University, got loads of mice to use a shitload of cocaine over a long period of time.

01:34:06 — I don’t know why the thought of mice using cocaine is so funny to me, but it is. I sort of picture them as the Al Pacino character in Scarface. But anyway, again, there was a massive reduction in cocaine use. Hugely encouraging. So, we know that in animals, it massively reduces drug use across all categories of drugs, which is extremely unusual. In fact, there’s no other drug, no other substance that does that.

Mayim Bialik

01:34:36 — No, that’s indicating that there’s a larger system that’s being hijacked.

Johann Hari

01:34:42 — Right. Exactly.The second thing we know is anecdotally, so this is much more impressionistic. Lots of people who’ve been given Ozempic for weight loss seem to also be quitting other addictive behaviors. For example, I interviewed a mental health nurse in Canada called Tracy, had had a bad breakup and in the aftermath was obsessively shopping all the time. And I mean, like, like spending the whole of her mortgage payment every month on like buying books she’d never read, clothes she’d never wear.

01:35:12 — She started taking her Ozempic, it just went away. There’s lots of people anecdotally reporting reductions in addictive behaviors. And we now have some very small human trials, which are a bit of a mixed bag. We know that it does significantly reduce cigarette smoking, but only if you combine it with a nicotine patch, go figure. We know that it does reduce alcohol use, but only if you had an alcohol problem. There are now loads of these trials going on, so we’re going to know a lot more soon.

01:35:37 — So, I would say watch this space, it’s encouraging. The most wildly optimistic interpretation of these drugs—I wanna stress, I think this isn’t likely, but I don’t think it’s crazy to talk about it—is that actually, this isn’t a weight loss drug. This is a self-control drug. It’s possible.

I’m just gonna—give me one second—I’m just gonna close this window because my neighbor’s very nice kids are playing outside, and I’m gonna start hearing them, hang on a second. The hot gardener is gone; it’s been replaced by children.

Mayim Bialik

01:36:05 — I thought it was the gardener. I thought it was the gardener and you needed him to sneak a peek.

Johann Hari

01:36:10 — I know, I was just like, wait, it’s not hot enough for him to be shirtless, so it wasn’t, it’s not that much in it for me.

Jonathan Cohen

01:36:17 — This is kind of a two-part question. If it is a self-control drug, that would be a phase two. But let’s just start with the impact on the economy of changing the obesity industrial complex, which is actually a multi-billion dollar industry with everything from kidney dialysis to joint replacement to, like, is Coca-Cola stock gonna plummet? Is McDonald’s stock gonna plummet if people aren’t eating? You know, KFC’s already taken a hit with you. What are we can expect? That’s part one. And then part two, what are people gonna do besides go out for dinner. How are we going to spend our time? So much of our time is consumed by thinking about food, getting food, planning food. If you remove that from society, it’s a strange freedom—an increase in time that we may not know what to do with.

Johann Hari

01:37:17 — In terms of the economy, Barclays Bank commissioned a very sober-minded financial analyst called Emily Field to study these drugs and determine how they should guide investment decisions and advice. She came back and said, “If you want a comparison, you’ve got to look at the invention of the smartphone,” right, in terms of how explosive this is.

Like I say, I think at least half of Americans will be taking these drugs eight years from now, assuming that the 12 big risks I write about don’t turn out to be worse than they seem to be at the moment—which is possible, right—but if that doesn’t happen, it’s enormously transformative. If we’d been having this conversation in 2007, the day Steve Jobs unveiled the iPhone, I think we’d have been like, “I don’t know what, it’s just a phone you can carry around with you.” We would not have been able to game out TikTok, Me Too, and DoorDash.

Jonathan Cohen

01:38:12 — And all these things that have transformed our lives, right? But Johann, there’s a big difference in the smartphone comparison, which I’ve heard in the past. The smartphone was a platform that launched and gave the possibility for all these auxiliary businesses. This is just actually crumbling existing businesses without providing an opportunity to ladder on things and deliver a new economic opportunity.

Johann Hari

01:38:36 — Yeah, it’s a really good point. I mean, it’s a really, really important point. And I think you’re right. There are certain businesses where, if I was in them—Jesus, I’d get out of them. Krispy Kreme stock took a big fall in October; analysts downgraded it. If I was a bariatric surgeon, I would be retraining right now. There’s a company that makes hinges for knee and hip replacements. Their stock is way down because the main cause of knee and hip replacements is obesity, and there’s going to be a lot less obesity.

01:39:08 — Jefferies Financial just did a big report for the airlines—the US airlines—saying, “Get ready to spend a lot less money on jet fuel because it’s going to cost a lot less to fly a thinner population.” Even in LA, where I was just recently, there’s been a big run on jewellers refitting wedding rings because so many people are taking Ozempic, and their hands have shrunk.

Mayim Bialik

01:39:26 —Stop it, stop it right now.

Johann Hari

01:39:30 — Yeah, and their wedding rings don’t fit. Seriously, there are so many unpredictable effects on the economy. I mean, I don’t think we should all stay fat so that the economy doesn’t take a hit, right? Like, I’m not gonna sit here and, you know, be 42 pounds bigger and die of a heart attack so that KFC stock can stay up. But yeah, I think you’re right. It will have a massive economic—by the way, massive economic—boost as well. I mean, if you think about Denmark, where Novo Nordisk makes Ozempic, the entire Danish economy has had a massive boost to its GDP.

Mayim Bialik

01:40:04 — Before this, they were just making licorice. They just had a lot of licorice.

Johann Hari

01:40:08 — They literally—Lego and licorice—that was it. Sometimes they got them mixed up; a child choked, it was very sad. But yeah, that’s basically it, right? I mean, and also being hot, because they are like one of the hottest nations in the world. So, if I was that hot, I wouldn’t even bother with the Lego and the licorice, frankly. Or the Ozempic. I’d just lie around looking at myself in the mirror. But yeah, so I think you’re totally right. The economy stuff is gonna be huge. The second part of your question is also really important.

01:40:40 — And I’m a bit unusual about this. I’ll tell you why in a second. But a lot of people—the worst thing about these drugs for them—is that they lose their pleasure in food. This seems to be quite a common thing that people are reporting. And one of the scientists who was involved in developing these drugs for Novo Nordisk, Jens Juul Holst, said in an interview with Wired magazine that that’s going to kill the drugs because, after a year or two, life is just so boring—you can’t live without the pleasure of food, right? Weirdly, I actually had the opposite effect, but I know I’m unusual.

01:41:16 — After I’d been taking the drugs for—I forget how long—a few months, I went out for dinner with one of my oldest friends. She said to me, “You know, it’s always been a bit weird going out for dinner with you because you eat so much so quickly, but you never seem to enjoy it, right? You just sort of inhale it.” And she said, “Now you actually look like you taste your food.”

01:41:38 — And for me, I was then picked—I dramatically slowed down on how much I eat. Before, I used to eat to stuff myself, to calm myself. The taste and texture of the food were very much a secondary concern to me. I’m not saying I got nothing from it, but it was very little. And now I eat so much more slowly because you can’t stuff yourself on Ozempic. I actually enjoy food much more than I did before. I don’t want to overstate it—I’m not some great foodie—but it’s better than it was, right? So, again, I think that’s gonna be unpredictable.

01:42:09 — I think there’ll be quite a lot of people like me, but there’s going to be more people like that. And I think you’re right—the most primal and ancient bonding rituals are around eating together, sitting together. I also want to say, though, you don’t stop eating when you’re on Ozempic, right? Yeah, I mean, I know Elise London was saying in LA, these people are—but those are people who are taking too high a dose. We don’t want a population that doesn’t eat; we want a population that eats an appropriate amount of calories.

01:42:32 — I don’t think—I think that can be a little bit oversold. I don’t eat one bowl of dust once a week, right? Hey, when I finish with you guys, I’m going to a nice Japanese restaurant with two of my oldest friends. But yeah, we’re gonna go out and have a lovely dinner, and I’ll enjoy that dinner, and they’ll enjoy that dinner. So, it’s not like on Ozempic—I mean, they’re not on Ozempic, but you know what I mean—it’s like on Ozempic, you don’t eat at all. You just don’t eat enormous amounts.

Mayim Bialik

01:42:56 — There are so many other things I want to ask you about, but I wonder if we can, as we kind of end our time together—which is sad; I’d like to keep talking to you forever—but I wonder if you could wrap things up here with some of the risks that you talk about. And I don’t just mean, like, what are the risks of the drug? I mean kind of the larger risks. It’s kind of like risks with a capital R. Can you just highlight a little bit of what you would like to wring your hands about regarding these drugs?

Johann Hari

01:43:32 — Well, I guess if you talk to experts about the risks of these drugs, generally what they say—and it’s an important point, and they’re good scientists, and there’s a lot of truth in this—is that actually, we’ve got quite a lot of medium-term data. So, for people who don’t know, in addition to making you lose weight, these drugs also stimulate the creation of insulin in type 2 diabetics, which is what they need. So, diabetics have been taking Ozempic for nearly 19 years now, right? And so, I’m putting it a bit more crudely than the scientists would, but they basically say, “Look, if the drugs made you grow horns, the diabetics would have horns by now, right?” And that’s a good and important point and should give us some confidence.

But some other scientists said, “Okay, well, if we’re going to base our confidence so largely on the diabetics, let’s do some more digging on the diabetics.” So, for example, there’s a brilliant French scientist called Professor Jean-Luc Fayy, who was commissioned by the French government—who I interviewed—to look at the safety of these drugs for the French market.

01:44:37 — So, he starts looking at the evidence, and he was really alarmed by something in the animal studies. If you give the active component of these drugs to rats, they are much more likely to get thyroid cancer. So, he thought, “That’s a bit alarming.”

He looked at a huge database in France of type 2 diabetics who had been taking these drugs for ages, and he compared them to very similar diabetics who hadn’t been taking these drugs. What he and his team calculated—if they’re right, and this is highly disputed—is that these drugs increase your thyroid cancer risk by between 50% to 75%.

Now, it’s important to understand what that doesn’t mean. If you first hear that, you’re like, “What?” It doesn’t mean if you take the drug, you’ve got a 50% to 75% chance of getting thyroid cancer.

Mayim Bialik

01:45:22 — No, but it does mean that if you have a family history of thyroid tumors or thyroid cancer—they say it’s medullary thyroid carcinoma—you are not supposed to take Ozempic. I wonder how many people with a family history would be like, “Fuck it, I don’t care, it won’t happen to me.”

Johann Hari

01:45:40 — That would be extremely alarming. You’re exactly right. What it means is that whatever your thyroid cancer risk was at the start—if Dr. Fahey and others are correct, which is disputed—then that risk will go up by 50% to 75%. Now, thyroid cancer is relatively rare; 1.2% of people get it in their lives, and 84% of them survive. So, it’s a pretty big increase in a small risk, right?

01:46:06 — And that’s just one of many risks that I go through in the book. So, yeah, there’s a lot that I’m worried about. We know that if you give these drugs to rats and the rats get pregnant, they’re much more likely to have babies with birth deformities. So, I would say, if you’re—not just if you’re planning to get pregnant, but if you’re at risk of getting pregnant—don’t take these drugs.

Mayim Bialik

01:46:26 — At risk?

Johann Hari

There’s a whole array.

Mayim Bialik

I feel like you’re talking about being at risk. Just keep your legs closed, ladies.

Johann Hari

01:46:33 — What’s the line in Absolutely Fabulous? “My mother didn’t give birth; she had something removed.” But the—yeah, you know, if you’re—if there’s—yeah, it’s funny. It’s funny you should say that, because, as you can probably tell, I’m gay. And I only have had sex with two girls in my life when I was 15. And not very long ago, I bumped into one of them for the first time in all this time, and she had a baby in her arms, and literally my first thought was, “Oh, it’s my child!”.  Like, and then I was like, “Oh, no way, unless she had a very long pregnancy, this is unlikely.”

Mayim Bialik

01:47:04 — Well, I think that should be on your book jacket, that you are at very low risk of getting anyone pregnant.

Johann Hari

01:47:11 — Exactly. It’s exceptionally low, I think, is the benefit there, but yeah. So, in terms of what I want to get off my chest—obviously, I go through a lot of the risks in the book—but for me, the thing I most want to thump the table and say…

01:47:29 — Is at the moment, people like me have a choice that is really painful. It’s between a risky medical condition and a risky set of drugs, right? And I hope my book is a guide so people can think through those risks for themselves and make their own decisions in consultation with their doctor. But the main thing I want to say is that doesn’t have to be the choice. I went to Japan. Japan is the third richest country in the world, right?

01:47:56 — Japan has almost no obesity at all. 42.5% of Americans are obese. In Japan, it’s 4%. Their childhood obesity rate is almost literally zero. It is really weird to go to Japanese schools with 1,000 kids, walk around, and say to the teachers, “Where are your overweight children?” And they say, “We don’t have any overweight children,” right?

The reason they achieve this is because they protect their children from processed and ultra-processed foods and educate them to love and enjoy healthy, fresh foods that feed their bodies and make them well. We can do that too. Just like we profoundly changed the culture around smoking—very few 16-year-old Americans smoke now compared to when we were that age.

01:48:43 — Okay, we’ve got issues around vaping and that’s a real thing but vaping is, if you had a choice between vaping and smoking cigarettes, we’d choose vaping every time, right? So we don’t have to tolerate this. We can fix this. We can put this right. We absolutely need to do that. Now though, for someone like me, it’s too late. I’ve had a life on KFC, right? I can’t go back in time and undo that environment. Environment. I’ve made the difficult choice I’ve made. Other people will have to make a difficult choice.

01:49:18 — Even just knowing about the environmental factors has reduced my shame. I felt like such a failure for being fat. I was in fact an entirely typical product of the environment I grew up in, right? It was not my fault. So I would say know that this was done to you, not something you did to yourself, and know that it doesn’t have to keep happening to the next generation, and the next generation, and the next generation. And we can put this right if we want to. We’ve got a new tool to deal with this problem, which is exciting and disturbing.

01:49:48 — And I hope it wakes us up to go, how the fuck did we get to this point?

Mayim Bialik

01:49:55 — Well, I mean, I never in a million years did I think I’d get to speak to you.

Johann Hari

01:50:01 — And I insist—or I will literally hang myself—that we end this podcast with the last lines from Beaches, which are, “I remember the line you say, which is, ‘Well, sure, we’re friends, aren’t we?'” What’s the line that she says before that?

Mayim Bialik

01:50:15 — She says, ”Hold on, Valerie, can you pull this up?”

Johann Hari

01:50:18 — So for people who don’t know, for being gay, people are listening and they don’t know this. If you have not watched Beaches, you must just immediately stop and your life will never be the same again. You just literally need to, whatever you’re doing – I don’t care if your child is about to die and you need to go to the hospice, – abandon the child and watch Beaches, because it is the greatest film I’ve seen.

01:50:34 — But the… I mean, I do care if your child is dying, don’t get me wrong, but priority’s here. So there is a flashback at the end of Beaches. This is a slight spoiler, but where Hillary and C.C, who meet when they’re little children in Atlantic City, go into those things that no longer exist, photo booths that take photos of you. And this is the day they meet, and they say something like, we’re gonna say the line. And then at the very end of the film, after they’ve gone through many travails and many things have happened, which I will not ruin to you. Well, tell me the line.

01:51:06 — OK, OK, Valerie found it.

Mayim Bialik

01:51:07 — I’ll be you, you be you, and I’ll be Barbara Hershey. OK, I’ll be me. So your line is, be sure to keep in touch, C.C, OK?

Johann Hari

01:51:17 — That’s it. That’s it. OK, ready? Again, she says she’s meant to be like a little posh girl as well.

Mayim Bialik

01:51:22 — Well, your accent is working for me, yes.

Johann Hari

01:51:24 — OK, OK. Yeah. Be sure to keep in touch, Cece. You have to say OK. Oh, I’m sorry, be sure to keep in touch, C.C, okay? Well, sure. We’re friends, aren’t we? Could I just say this is the greatest moment of my life. This is, nothing better will ever, my life has now peaked, and nothing better will ever happen to me again.

01:51:50 — So, this is it.

Mayim Bialik

01:51:52 — Johann Hari, you are delightful. You are such, you’re such a gift with your writing and your journalism and your research, and it has just been so much fun and so helpful to talk this out with you. We’re so grateful to you.

Johann Hari

01:52:08 — Aw, hooray. And I meant to say on my publisher’s taser me, they give me this fucking thing to say, if you’d like to know where to get my books, you can go to j-o-h-a-n-n-h-a-r-i.Com. You can get them as audio books, eBooks or physical books. You can also see where to follow me on social media. And you can also get them, I meant to say you can get them from all good bookshops, but you can also get them from shitty bookshops. It doesn’t really, we have no quality test, right?