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    • Ozempic ads seem to be everywhere. Doctors and ethics experts are worried about that

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    With ads popping up on TV, social media, giant billboards and at professional sports games, Canadians may be feeling bombarded by marketing for Ozempic and sister drug Rybelsus.

    Some have taken to social media to document their most remarkable sightings, including Ozempic and Rybelsus ads wrapping entire streetcars and encircling the field at Toronto Blue Jays baseball games.

    Both medications are semaglutide drugs manufactured by Novo Nordisk  -- Ozempic is the injectable form and Rybelsus is the pill form. They're approved in Canada for treating Type 2 diabetes and often prescribed off-label to treat obesity.

    But some doctors and medical ethics experts say the marketing campaign is too aggressive. They worry that such intense saturation of advertising could lead to pressure on doctors to prescribe Ozempic to patients who don't actually need it, leading to shortages for those who do.

    They also worry that serious potential side-effects such as pancreatitis and gallbladder inflammation, although rare, could start to appear due to the sheer volume of people taking the drug.

    "What the (company is) trying to do is to put the ads in so many places that it's very difficult to avoid seeing them," said Dr. Joel Lexchin, a professor emeritus at York University who studies pharmaceutical policy.

    Health Canada allows pharmaceutical companies to run "reminder ads," Lexchin said. Advertisements can say the name of the drug but they can't say what conditions it treats. Instead, they urge people to ask their doctors about the drug.

    Kate Hanna, a spokeswoman for Novo Nordisk's Canadian arm, told The Canadian Press on Monday that the national marketing campaign is aimed at people with Type 2 diabetes.

    "Diabetes is not being effectively managed and this is not a niche market. Diabetes is a public health crisis," Hanna said.

    "There really is a need to educate Canadians on Type 2 diabetes risk and support those living with the condition to engage their health-care professional for optimal disease care."

    But the marketing influx comes on the heels of an explosion of unofficial Ozempic promotion for weight loss from social media influencers and celebrities. Canadian doctors and pharmacists have already confirmed an enormous increase in patients asking for the drug for that purpose.

    The ever-present reminder ads are likely to prompt more people wanting to lose weight to put pressure on their doctors to prescribe Ozempic, even though they don't have diabetes or meet the clinical criteria for obesity, Lexchin said.

    "It's not approved for treating somebody who wants to lose 10 or 15 pounds so that they can fit into a bathing suit or a tuxedo or what have you. But the ads that you're seeing don't tell you that," he said.

    "You've tried to lose weight, you figure if you can get from 180 to 160 (pounds) you'll be in much better shape," Lexchin said. "You see one of these ads and you go see your doctor. And that's what this kind of advertising is designed to do."

    Even diabetes and obesity specialists who praise Ozempic for its effectiveness in treating those conditions are worried about Novo Nordisk's marketing strategy.

    "I'm not impressed," said Dr. Ehud Ur, an endocrinologist at St. Paul's Hospital and Vancouver General Hospital.

    Ur noted that he has been involved with Novo Nordisk for "many different drugs" and that he's personally found the company's practices to be ethical.

    But "the push to get everybody and their dog on Ozempic" is problematic, he said.

    "We've never had a drug as good as Ozempic. But on the other hand we've never had so much interest and so much pressure on people to prescribe it," Ur said.

    Like with all prescribed medications, doctors need to do a risk versus benefit assessment, he said.

    According to the manufacturer's website, minor side-effects include nausea, vomiting, diarrhea, constipation and abdominal pain.

     More serious but rare risks include inflammation of the pancreas, gallbladder problems, kidney issues and low blood sugar. Animal studies found an association between Ozempic and thyroid tumours in rats, but it's not clear whether that's a real risk in humans.

    For someone with diabetes or obesity, the risks of not getting effective treatment often outweigh the rare potential risks associated with Ozempic, Ur said.

    But for someone who wants to lose 10 to 20 pounds for "cosmetic" reasons, the medical benefit may not be worth the risk.

    "Where you are placed in that continuum of risk is really an important calculation for a physician," Ur said.

    The problem with the mass Ozempic advertising campaign is that it cultivates an impression among people that it's a "wonder drug that's going to help them lose weight," he said.

    If they convince their doctor to prescribe it, those patients "are now going to expose themselves to the risk of a medical intervention without a huge amount of medical benefit."

    Huge demand for Ozempic could also create shortages for patients who rely on it for diabetes control, Ur said, noting he has patients who have already had trouble with the drug being on back order.

    When asked to respond to that concern, Hanna of Novo Nordisk said the company is "ramping up our production to meet the demands."

     She also said there are no current shortages in Canada.

    Another issue, Ur said, is that mathematically, the more people who take the drug, the more likely it is that someone will suffer one of the rare side-effects.

    "I think ultimately (Novo Nordisk) may be shooting themselves in the foot by this strategy," Ur said.

    Despite the criticisms, the company's Ozempic marketing campaign complies with Canadian law, Health Canada said in an email on Monday.

    "To date, (Health Canada) has assessed 30 complaints. The current advertisements of Ozempic that have been reviewed are deemed compliant with the current advertising provisions in Canada," the email said.

    Both Lexchin and Ur said Canada should not allow any direct-to-consumer advertising for prescription drugs, similar to regulations in the U.K. and Europe.

    Kerry Bowman, a bioethicist at the University of Toronto, said he finds the company's advertising blitz "disturbing."

    "They're taking advantage of Canadian law because they're staying within the parameters of it, but not the spirit of it because, you know, the saturation of these ads is incredible," Bowman said.

    "This is not about public health, this is not about well-being. This is about marketing and it is very, very much for profit. And so there's no question about that."

    This report by The Canadian Press was first published June 20, 2023.

    Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

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