This interview was originally published on the Jay Campbell website.
The wacky world of pharmaceutical-induced weight loss is about to get a lot crazier, as witnessed in the 83rd Scientific Sessions conference hosted by the American Diabetes Association (ADA).
A LOT of brand new intel on weight loss drugs was revealed to the world over this past week.
Specifically, everyone lost their minds when the Phase 2 clinical trial results of Retatrutide were revealed.
Obese adults who took the highest weekly dose (12 mg weekly) lost 24% of their body weight over 48 weeks… and 25% of those subjects lost over 30% of their body weight.
Absolutely unprecedented. I literally mean it when I say we have never seen these kinds of results in modern medical history.
But will drugs like Retatrutide truly be the cure we’ve finally been looking for to solve the obesity epidemic? Or will the world continue to get fatter and fatter despite these breakthroughs?
I sat down and interviewed Jason Horowitz, a former high-ranking healthcare executive with more than 2 decades of experience in navigating America’s “sick care” system.
On top of living a past life as an investment banker in corporate finance, he also helped build up an ambulatory network’s footprint from $1 billion to $8 billion over 8 years.
Nothing is more valuable than the perspective of somebody who has excelled while being deep in the belly of the beast.
Let’s see how far down the rabbit hole we can go!
When Did Weight Loss “Drugs” Start to Exist?
So where does this all start? When did we first conceive of the idea to use a drug for the purpose of inducing weight loss?
I believe it goes back to the 1930s and 1940s. If I recall correctly, that’s when we first introduced amphetamines to the world in the context of weight loss. However, and this is a reflection of the times, they were primarily marketed to housewives so they could stay fit and keep up an attractive appearance in the family household.
I know there were lots of things being done before then with thyroid hormones and dinitrophenol, which had the secondary effect of thermogenesis and therefore keeping weight down.
However, from a medical standpoint, that was when the first real prescription wave hit the USA.
For the next 30-40 years from that point on, the predominant train of thought was just to increase metabolism. You got people wired up on stimulants long enough to not think about food and eat less.
Granted, they were effective, but you had the usual laundry list of side effects that you would expect to happen when you jack up your metabolism: Thyroid issues, hypertension, strokes, liver disease, etc.
In the 1970s and 1980s, you had something called the Ayds Reducing Plan Candy (literally pronounced as “AIDS”). It was a chewable toffee gum you would use to suppress your appetite, and I believe the main active ingredient was either benzocaine or phenylpropanolamine.
The 1990s, as you probably know better than anybody else, was when FenPhen – the combination of phentermine and fenfluramine – was released to the world. Of course, we all know how that disaster ended.
I want to stop you at the FenPhen story. Is there anything people don’t know about this disaster that people will be shocked to find out, in terms of how bad things got?
As you know good and well, Jay, lots of people just like to skim headlines without even diving deep into the details.
The scandal obviously caused a huge amount of damage to the population who was unfortunate enough to use FenPhen consistently. And Phentermine obviously took the bad rap even though it was Fenfluramine that was responsible for all the harmful side effects.
So as a result, the industry pivoted tremendously and now what you’re seeing is appetite-suppressing drugs made especially for severely obese people with at least one other comorbidity (usually type 2 diabetes).
In the past, you got weight loss drugs either through your primary care physician or your psychiatrist.
Today, the big surge in weight loss prescriptions is being driven by endocrinologists as an alternative to gastric bypasses, liposuctions, and other weight loss surgeries.
But it’s interesting to note how there’s NOW a more positive outlook being taken on weight loss drugs, whereas before the idea of a GLP-1 receptor agonist people would be staunchly against the idea of using drugs to help with weight loss. Your options were largely limited outside of a pharmaceutical context – diet, nutrition, Metformin for managing blood sugar, and maybe surgery if you really needed it.
Well, as a healthcare executive, you look at the industry and see what puts dollars in your pocket.
More chronic pain and more long-term illnesses = more pills to keep people alive, and whether you heal them or not is irrelevant. What matters is having the recurring revenue stream.
If you have a sick patient with comorbidities, but they aren’t getting any worse, you have a very profitable patient.
Where is the value incentive for a healthcare provider or system if we give that same patient an effective weight loss modality? You miss out on the high blood pressure medications, the glucose monitoring system, the anti-inflammatory drugs… not a good situation if you’re getting paid by the acuity and not by the patient as a whole.
Even simple things like the debate about whether the body mass index (BMI) is really the right standard for determining health versus something like the waist-to-height ratio don’t truly matter.
Nothing has supplanted the 60-70 years of entrained thought patterns through which the healthcare industry operates, focusing on taking money instead of keeping patients healthy.
Hold on a second. that’s the case, then it sounds like there is a strong disincentive for a weight loss drug that actually keeps the weight and all associated disease states away. UNLESS You had to spend the rest of your life taking the drug.
Absolutely. From an industry perspective, it’s much easier and way more profitable to ONLY prescribe weight loss drugs to people that are exhibiting diabetic tendencies or on their way to doing so.
There is zero financial incentive to treat a person who is already health and trying to stay at a decent bodyweight. For someone like me in a past life, the risk-reward profile wouldn’t justify it.
They will, however, be more than happy to spend the money for a diabetic patient with a BMI of 40. Because they don’t just make money off the one weight loss drug. They also have the other three drugs the patient will most likely be using concomitantly. The more drugs, the better.
As Dr. Rudolph Eberwein informed me, Semaglutide was the first GLP-1 receptor agonist where the weight loss side effect was significant enough to justify using it for that sole reason. It was interesting to see how this peptide was decades in the making before now having its worldwide reputation as THE drug for fat people.
It’s not all too different from the story of how Viagra had the “accidental” side effect of inducing erections in patients. You look for drugs that do one thing and then they have this secondary beneficial effect that ends up being even better than what you were originally looking for.
The same thing happened to Semaglutide and Tirzepaitde. We didn’t expect it to have dramatic effects on weight loss and appetite suppression, nor did we even think it could be efficacious in non-diabetic fat people.
Once Hollywood got a hold of these drugs, everyone wanted a piece of it. I think that’s where the unexpected rise of Semaglutide and the other GLP-1 receptor agonist drugs started to take place.
And now you have this concerted effort from mainstream publications over-exaggerating and paying attention only to the detrimental effects of Semaglutide. The same will happen for Tirzepatide if it isn’t happening already.
The “War” Against GLP-1 Receptor Agonists
It’s funny that you mention Hollywood people, because paradoxically they’re the ones who always have access to these things first. They are first in line and try them before anybody else knows about them, and we have to figure out from them. These ‘fear porn’ articles scare YOU from using Tirzepatide and Semaglutide, but they don’t sway rich people and celebrities from trying these agents.
Exactly right, so you continue to have this bifurcation and the “us vs them” split in society.
And it looks like this: You have celebrities and certain individuals getting these tip-of-the-spear type of drugs and protocols because they are willing to do whatever it takes, and the very sickly who use them as a way to continue to be part of the system because they are under the will of the white lab coat people.
Everyone else just gets lucked out, asleep at the wheel, or gets misinformed by the mainstream media.
We love to talk about the “haves” and “have-nots” in the context of wealth accumulation and distribution.
But here’s a very different game happening in the world of health. It’s the “knows” and the “know-nots”.
And here’s the really interesting thing about the rich people… it’s not so much that they have $10 million to spend, but it’s more about the network and connections they have BECAUSE of the social status that $10 million provides.
You best believe these people are saving 10x on the price of peptides by getting them from compounding pharmacies. Because they certainly aren’t paying brand name prices by going direct to companies like Novo Nordisk and Eli Lilly.
Can you explain to me why there are people out there who are actively dissuading people from using Golden Age modalities like Semaglutide and Tirzepatide? A lot of them are anti Big Pharma folks who mean well and rant about the importance of willpower, discipline, and self-control. There is indeed some truth to this, but if that was all we needed then we wouldn’t be in our current situation with ever-rising obesity rates. At some point you have to sit down and wonder if all those virtues are only part of the solution.
I can say with full confidence that a lot of it is a concerted effort to keep people unhealthy.
Yes, you have a segment of the population that ascribes to keeping everything as natural as possible, not giving in to synthetics being pumped into the population with no rhyme or reason. But I think that segment is small in size.
In my opinion, we’re past the point of Internet trolling because what they’re doing is putting out disinformation intentionally. What their rhetoric will end up doing is making us a sicker and more controllable population you can now take advantage of and get more money out of.
If our public health systems were in it to keep people healthy, we would not be reimbursing and providing services the way we are doing today.
Everyone talks the talk. They talk about value-based care and individual care, but their actions speak louder than their words. They’re stratifying by socioeconomic areas where they don’t necessarily drive results because you’re not putting clinicians and services in those areas.
Even when you look at those areas, they’re completely bombarded by all the unhealthy things we would expect. Lots of fast food places and alcohol stores but zero gyms and no centers for nutritional education.
You couldn’t have said it any better. One of the biggest falsehoods continually perpetuated is the idea that Semaglutide MUST be taken forever. If you look at myself, my crew of fully optimized people, and even Dr. Eberwein’s massive list of thousands of patients, we literally have real-world evidence that you are not bound to these medications for life.
Indeed. And it’s the same thing with therapeutic testosterone and other forms of hormonal optimization. We use these tools to become an enhanced version of ourselves. We don’t necessarily NEED them, but there’s absolutely nothing wrong with wanting a better quality of life.
With drugs like Semaglutide, you can stop using them. There are ways to stop using them. There are legitimate reasons to stop using them. And you may not want to stop using them. But the option is always available when needed.
No kidding! Even if you debunk the ridiculous assertion of lifelong use, the goalposts move to the incidence of thyroid cancers associated with GLP-1 receptor agonist use. What’s your take on that claim?
I had a look at some of the data and the risk is blown way out of proportion.
Yes, you do have to state the risk for the sake of full transparency and informed consent, but I personally don’t buy that it’s nearly as likely or common as the anti Big Pharma likes to claim it is.
Hell, people were being prescribed Zantac and Prilosec for gastroesophageal reflux disease (GERD) for forever, with some doctors going as far as to give it to children.
Look at the side effects that wound up from it, even the hilarious bit about containing a carcinogen for all these years the drugs were being given out.
I have to take every bit of these studies and their hyped-up components with a grain of salt, both the good and the bad.
As Dr. Eberwein already told you, it’s extremely unlikely we will see a timeline over the next 15-20 years where we find out the GLP-1 receptor agonists are causally linked to thyroid cancers.
With how aggressively we’ve been targeting this molecular pathway, we would have seen something by now and stopped long ago.
The data would be irrefutable and staring us right in the face.
What will be interesting, however, and what I worry about most, is the introduction of Semaglutide as Ozempic happens to coincide pretty much at the exact same time when “other things” were introduced to the population circa 2021.
It will be very difficult to weed out and isolate the effects of Semaglutide without also considering if those “other things” have anything to do with thyroid cancer.
Retatrutide: What Does The “Triple G” Agent Have In Store For Humanity?
That transitions towards my newfound interest in Eli Lilly’s newest agent Retatrutide, which I have briefly written about before.
I don’t have to tell you about the very recent release of the Phase 2 clinical trial results for its use in obesity.
People on Twitter were going wild over the data, sharing every bit of intel the second something new was mentioned.
I had a chance to see those results and they were absolutely stunning.
The real question is what we have just stumbled upon.
With these kinds of results, you could theoretically get an unhealthy population very healthy with Retatrutide, the right high-protein diet, and the right exercise program in 2 years or less.
I foresee this going one of two ways: Either it’s an exclusive drug everyone starts using before you have a tremendous windfall, or it goes the way of the guy who created the engine that runs on water who we “mysteriously” never heard of again.
Granted, the Phase 3 trials for Retatrutide are not expected to conclude until near the end of 2025.
But one thing that was really telling was how Eli Lilly, the pharmaceutical company that manufactured Retatrutide, chose to use dulaglutide (Trulicity) as the competition drug during the Phase 2 trials ran specifically for people with Type 2 Diabetes.
But this same company also manufactures Tirzepatide.
Why would they purposefully choose an inferior agent to make the comparison?
I don’t remember exactly who said this, but companies like Eli Lilly and Pfizer do not make mistakes when designing clinical trials at the level they do.
They make choices.
In this case, you have to consider the cost-benefit analysis.
Tirzepatide, although already approved for diabetics, is poised for approval to treat obesity by the end of 2023 and will unquestionably be a best-selling drug for Eli Lilly.
So say that Phase 2 trial in patients with Type 2 Diabetes put Tirzepatide and Retatrutide in a head-on competition.
One of two things could happen.
First, Retartrutide outperforms Tirzepatide and all the built-up traction for the latter is cannibalized.
You still have to deal with the possibility of failure for Retatrutide.
Second, Retatrutide ends up failing when compared to Tirzepatide.
All of the hype generated for what could be a potentially very good new drug gets squashed in Phase 2 clinical trials.
From an investor’s standpoint, you want to at least reach Phase 3 trials before you axe the drug.
I would say it was a very smart and safe choice on their end.
I’m sure they knew Retatrutide would outperform Trulicity, but nowhere near to the degree of what we just saw.
Let’s talk about pricing.
We already know that Semaglutide and Tirzepatide are sitting at around $1,200/month without copay or insurance coverage.
Where do you see the price point for Retatrutide once it becomes available to the public?
There’s no way it doesn’t get charged at premium prices.
If it makes it through Phase 3 clinical trials with equally successfully results, it will be very difficult to keep patients on this drug forever.
From the perspective of the health insurance company, you have to factor in the cost of acquisition to the patient and then losing the patient.
The numbers won’t add up to something profitable, not to mention the treatment of other comorbidities the patient has due to the excess weight they’re carrying around.
I wouldn’t be surprised if the initial price tag comes out to something like $1,200-1,500 per month.
I didn’t even get to the issue of compounding pharmacies, which the three-letter agencies are starting to crack down on.
There’s no way in hell they will allow the compounding of Retatrutide on a large scale, at least not for long as it will eat right into Eli Lilly’s profit margins.
Definitely. If they’re going to have supremacy in the weight loss market for 1-3 years, they’re going to milk the cow for every last drop it can give them.
It’s sad we even need to have this conversation and it speaks to the larger problem of America’s healthcare infrastructure.
You have actual products available to cure the chronic diseases society has placed upon itself, and yet the financial impact to the company is what takes first priority.
The Newest “100 Million Person” Market For Big Pharma to Target
I really wish I could remember who exactly said this, but I remember a big-wig pharmaceutical executive saying something along the lines of obesity being the final “100 million person” market in the USA for Big Pharma to treat.
With something like Retatrutide in our hands, the obese population will shrink, metaphorically and literally.
Sounds about right.
The global population, Americans especially, did a phenomenal job of making themselves fat and unhealthy.
It will spell big trouble for a lot of people if everyone suddenly loses their cravings for sugary foods.
You don’t see this same thing with something like low testosterone levels.
Yes, there are a growing number of men who suffer from hypogonadism, but it’s nowhere near the size of the obesity market and it may be past our lifetimes where that sector grows anywhere near close to what the obese demographic is right now.
How would Retatrutide then succeed in the long run, given what you just said?
One way I envision Retatrutide’s longevity is through the use of disinformation campaigns.
You disincentivize everyone else to take it except for the highly diseased population.
Because everyone else won’t take it out of fear and ignorance, you have a potential roadmap where Retatrutide lives forever.
It will be very interesting to see what thresholds the patient needs to achieve before a prescription is allowed.
All of this goes back to the gatekeeping issue that allows the profits to accumulate for Big Pharma while keeping the population unhealthy.
I have this one theory of mine where people and doctors continue to mis-use Retatrutide and lead to the “loss of lean mass” that arises from poor protein intake and lack of resistance training.
Thus leading to the creation of a population that is no longer fat but heavily under-muscled.
I think we’re setting the stage for the next market and therefore the next drug for folks to be dependent on, especially with the fear-mongering you just talked about.
Yes, as you said, there’s high protein intake and lifting weights, but we both know that doesn’t make money for anybody.
That’s why all the really smart people tend to get into these positions where they can foresee the next 2-3 steps.
We made you sick, and we’ll make you better but not better enough.
You’ll never be completely optimized because you’ll always be dependent on the next big thing being released by Big Pharma.
But just imagine what would happen if someone like you used Retatrutide alongside a drug like Bimagrumab to not only preserve lean muscle tissue but even build more muscle than what your body would naturally allow.
That kind of thought experiment would be interesting for the fit bros and the anti-aging crowd to try out, especially as we climb past the age of 45 and start to see some degree of muscle loss.
I could even foresee people in their 70s retaining 70-80% of their muscle mass.
The Future Of The Weight Loss Industry
In my opinion, Retratutide is setting the bar so high to the point where it will be near impossible for other competitors to come up with something superior.
But what does this mean for the future of weight loss, and weight loss drugs especially? What now?
I still think it’s going to be dependent on the availability of Retatrutide to certain populations.
If you take the weight loss industry as a whole, including programs like Weight Watchers, nutritional supplements, surgeries, and diabetic management through endocrinologists, we are only looking at prescribed weight loss drugs given specifically to the “inflamed dumpster fires” as you like to call them.
The industry in and of itself won’t change that much, except for the way the sick population will be treated.
From a delivery system perspective, instead of weight loss centers focused on nutrition and surgery, you’ll have them focused on endocrinology (and hopefully some sort of physical therapy/exercise).
But even with all the information available to us FOR FREE in 2023, and with all the data points converging towards one final answer, very few people will have a holistic hybrid approach where multiple modalities are combined for maximum efficacy.
Everyone loves the easy button.
Depending on who you talk to, that easy button changes.
When I was building businesses around weight loss, if you talked to gastric bypass surgeons, their tool is surgery.
They only looked at surgery and nothing else.
If you talked to a psychiatrist, they only cared about behavioral health issues.
Zero credence will be given to the pharmaceutical agents.
If you talked to an endocrinologist who loves hormones and prescriptions, take a guess at what their #1 focus is going to be.
And a functional medicine doc will hopefully look at a combination of all of the above.
When all you have is a hammer, the only thing you can see is a nail.
People say this will completely destroy the surgical industry, but I don’t think so.
You’ll just see folks trusting the doctors and the anecdotal stories of their friends and family.
Until someone in power takes the lead, you will have these fractional areas of service hyper-focused on only one modality at the expense of all others.
So if I understand you correctly, there may be some truth to the idea of Retatrutide being a weight loss industry disruptor.
But you’re stating it won’t be an industry killer?
Well, as I just showed you with the examples I give, people tend to put on blinders to the rest of the healthcare industry and the rest of the world by extension.
Even in your large circle of people, it’s easy to forget the perspectives and experiences of everyone else.
Sure, you and I will see Ozempic being advertised on every other ESPN commercial, but what about the person in Nebraska whose primary care physician is overweight and completely clueless.
I could see major changes happening on the East and West coasts of the USA, and any location where people are on social media and paying attention to this kind of stuff.
But definitely not a majority of the world population.
But I can’t foresee Retatrutide and other effective weight loss drugs being that huge of a disruptor.
You’re right on that point.
I definitely didn’t stop to think about how Retatrutide will be perceived and used in other countries outside of the USA.
Look at the global healthcare economy as a whole, and how countries on the other side of the world practice and perceive medicine.
Retatrutide may never see the day of light in those places.
It may come down to who you know and the connections you have.
Because if you have stringent prescription requirements such as having a BMI of 35 or above, you’re not getting the drug no matter where you are.
Another fact to consider is how different the demographics are on a country-to-country basis.
The population of North America has a reputation for being unhealthy and obese, and we REALLY need something like Retatrutide to turn things around.
But if you’re sitting in an EU country like Greece, Italy, or Spain, you don’t have a majority of the population being overweight and diabetic.
Granted, things are getting worse, but they aren’t near the “OH SHIT” moment we’re having where it’s time to panic.
They may get to where we are eventually but time is on their side (for now).
We have an extremely large market for diseased people in the USA and we spend trillions of dollars on healthcare, so it makes sense why something like Retatrutide is such a huge deal to us.
In our little circle of health optimization, we tend to jump to far more conclusions and give America more credit than it deserves.
It’s important to remember that if we as a nation were doing things the right way, you would not see the rampant increase in fat out-of-shape people ranging from the very young to the very old.
How to Safeguard Yourself Against “Sick Care” Medicine
To conclude this interview on a paradoxically pessimistic yet optimistic note, the only way is to figure out everything for yourself.
Learn about drugs like Retatrutide and what they actually do to your body, connect with people like myself, find doctors who understand what it means to combine every modality available.
You either take the life raft of Golden Age intel or you drown, and the way I see things going, not everyone is going to make it out alive.
It’s unfortunate that you have to take accountability for your own health, especially when we give so much credence to the accreditation processing and the white coats.
They’re just like everyone else.
They are taking orders from somebody else.
Who is paying for medical school?
Who pays for these published studies?
Who keeps the small practitioners alive because reimbursements from insurance companies or Medicare/Medicaid are paying cents on the dollar for the care being given?
It’s the pharmaceutical companies.
The people who are inherently incentivized to make sure you don’t have a healthy patient.
What does that lead to?
Unfortunately, the only option out of this mess is a self-directed path.
On a more positive note, I do think there is a rising tide and that has to do with what happened in 2020 and 2021.
People started seeing through the veil, and suddenly it wasn’t about the health and safety of the population. It was about following the mantra of the authoritative voices out there.
That has awoken a lot of people, and hopefully they take the lessons they’ve learned and apply them to other areas.
If you have the FDA coming out and saying that doctors should stop prescribing Ozempic to people who “don’t need it”, it means people are doing their research and concluding it could help them even if they aren’t diabetic.
As I said in my article about the suppression of therapeutic peptides, sometimes the FDA has to act as the parental mommy/daddy figure and take dangerous things away from us.
But I wouldn’t be surprised if enough people abuse and misuse Semaglutide, Tirzepatide, Retatrutide and other effective weight loss drugs to the point where they have to step in under the auspice of “This is why grown-ups can’t have nice things, so now nobody gets to touch them”.
Do you foresee something like this happening?
It comes to your own inherent look on life.
Do you let people be stupid, or do you need someone to take away the car keys?
I come from a liberty-oriented background.
You have the right to be an idiot, and people do it all the time.
As long as you’re informed and you understand the risks associated with whatever you put in your body, and people give you both sides of the case, you can make your own decision.
I’m not a big fan of taking the toys away because one person decided to be irresponsible.
Right now, nobody else is targeting any modality for the time being.
We seem fixated on GLP-1, GIP, and glucagon.
Are we at the point where we are going to be obsessed with these molecular targets for the next few years before we find yet another mechanism through which weight loss can be induced?
Yeah, I think so.
It all goes in cycles.
Everyone jumps on the ONE BIG THING to try and perfect it, and then they move on.
You saw it with the way we treated cancer for 20-30 years and the different drugs associated with that, and then the moved on to the gene therapies, and now the mRNA platform.
The same will happen with weight loss as well.
We were in the bubble of amphetamines for quite some time.
Once we discovered GLP-1 and saw what it was capable of, we got to escape from the traditional modality of “stemming” someone so hard to the point of hypertension.
Hopefully we’re on the cusp of something safer.
Jason, thank you for your time as always.
I look forward to talking again soon, and I can’t wait for the world to see the incredible fat loss transformation you achieved with the protocol outlined in the upcoming 30 Days 2 Shredz book!