Anti-vaxxers go to great lengths to create strawman arguments against vaccines, and the newest one is the potential of an Ozempic mandate for obese college students. You know the argument, if we’re going to mandate COVID-19 booster vaccines for college students, then we’re going to mandate Ozempic for obesity.
When I first saw it, I thought “who got drunk and came up with that analogy?” When I see things like this, it makes me wonder why I look at my Twitter feed because it gives me a headache.
Well, it apparently was started by Vinay Prasad, who, according to the immutable Orac, once “appeared to be a champion of evidence-based medicine and more rigor in clinical trials used to approve oncology drugs.” Then he became an ardent anti-vaxxer (Orac’s article covers Prasad’s descent into the dark side of the force).
The first thing I wanted to know was who Vinay Prasad is. And second, how on earth did he get from COVID-19 vaccines to Ozempic, a drug used for type 2 diabetes? This caused me to go down into the rabbit hole of anti-vaccine “logic,” or more likely, logical fallacies.
As usual, there is no science, lots of pseudosciences, and a dollop of conspiracy theories in the rabbit hole of anti-vaxxers. I always need a shower afterward.
First up, what is Ozempic?
You probably know the drug by its annoying earworm advert that plays over and over again on TV, “Oh Oh Oh Ozempic…” It’s based on an annoying early 1970s pop song, “Magic,” by Pilot.
So now you have the earworm, you can thank me personally in the comments.
But back to the drug in question. Ozempic is the brand name of the drug semaglutide, a GLP-1 receptor agonist, that mimics the action of the human incretin glucagon-like peptide-1 (GLP-1). Semaglutide increases insulin secretion which increases blood sugar disposal and storage, which leads to better glycemic control.
Semaglutide also reduces the production of glucagon, a hormone that is the antagonist of insulin, which increases the production of glucose in the body and signals the release of stored glucose into the blood.
The drug was developed strictly for type 2 diabetes mellitus (T2DM), a metabolic disorder that is characterized by high blood glucose with insulin resistance and relative insulin deficiency. In general, someone with T2DM produces low (or maybe even adequate) insulin levels, but various cells and organs become resistant to insulin, so cells don’t remove or store blood glucose.
Semaglutide and similar drugs (usually with some modification of the structure of the drug) like dulaglutide (Trulicity), exenatide (Byetta), and liraglutide (Victoza), have been very successful at improving blood sugar levels in patients.
All this probably sounds good, but what’s this got to do with obese college students?
Ozempic and obesity — the mandate
These GLP-1 agonists, like Ozempic, have another very unique indication — they can be used for weight loss. It reduces food intake by lowering appetite and slowing down digestion in the stomach, helping to reduce body fat. Novo Nordisk, the pharmaceutical company that markets semaglutide, sells the weight-loss version under the brand name Wegovy. It also markets an oral version under the brand name Rybelsus.
These medications can cause a significant and rather fast loss of weight, up to 20% of body weight. So, they have become the newest fad drug for weight loss, causing shortages of Ozempic (really Wegovy) across the USA. I’m fairly certain that Novo Nordisk spent several million dollars coming up with separate names.
Just in case you were wondering, these GLP-1 agonists are not without some risks, up to and including an increased risk of certain types of thyroid cancer. And the long-term effects of the drugs are not well known, since the drugs have been out only for a relatively short period.
So this is the way we get to the Ozempic college obesity mandate, at least in the mind of Vinay Prasad.
Ozempic mandate = vaccine mandate
Prasad begins connecting the dots with his anti-vaccine claim:
Consider this: colleges were among the most relentless in mandating boosters for young men and women. Most made no exemption for having had and recovered from covid. Even though it was clear that boosters were a net harm to young men, they mandated them anyway.
Covid19 vaccines do not protect others. With time, there is an ~100% chance everyone will get covid whether we force vaccines on college kids or any other subset of Americans.
Let’s stop right here before we get to the Ozempic mandate. The COVID-19 anti-vaxxers like to misuse the article that young men are susceptible to myocarditis after receiving the COVID-19 vaccine. Except it’s not true. It is a very rare adverse event, but there’s one more thing — the risk of myocarditis from the COVID-19 virus is much greater than the risk of myocarditis due to the vaccine.
Let me repeat myself. A young male will have a greater risk of myocarditis from the disease itself compared to the minor risk from the vaccine. Anti-vaxxers tend to ignore this comparison when attacking any vaccine, but they love doing this to the COVID-19 vaccines in particular.
Let’s get back to Oh Oh OH Ozempic. Prasad tries to compare vaccine mandates to an imaginary Ozempic mandate for obese students.
Therefore, when colleges mandate these shots, they are saying: we are allowed to mandate interventions if we believe it is in the best interest of our students. We don’t need benefits to third parties. We are allowed to embrace surrogate endpoints, and no one can question us.
By that logic, it is clear, colleges can mandate ozempic for overweight students.
Let’s count the ways that his “logic” makes no sense:
- The vaccine protects against the disease. Does it stop it 100% of the time? No, and I know this as I have had five COVID-19 vaccinations and still got the damn disease. Except…
- The vaccines protect against the most severe outcomes from COVID-19, including hospitalization and death. I was sick for a few days, but it was barely worse than a mild cold.
- The vaccines protect against transmitting the disease to others.
- The vaccines are extraordinarily safe.
Then his logic goes full-blown illogical, by making the following claims:
1 – Boosters do not provide benefit to others/ Ozempic does not provide benefit to others
2 – Boosters increase antibody titers/ Ozempic lowers weight
3 – We don’t know if boosters reduce severe disease at these ages/ we don’t know if Ozempic makes you live longer at these ages
4 – Expert groups recommend bivalent boosters (CDC) and experts recommend ozempic (AAP)
5 – Both are FDA approved/ authorized
Ergo, by established precedent, colleges can mandate Ozempic.
Well, let me tackle this nonsense one by one with real logic and real science.
- Boosters do provide benefits to others by preventing the disease from being transmitted. Ozempic does not provide benefits to others, but then again, it wasn’t developed to do so.
- Boosters do increase antibody titers. Ozempic does not lower weight in everyone. But this is like comparing apples to bowling balls.
- We do have large quantities of data that boosters reduce severe disease. We do not know of the long-term safety and effectiveness of Ozempic, though I suspect it would be good enough given that weight reduction has long-term benefits.
- Expert groups do recommend both. And right now, those expert groups are made up of real scientists, physicians, and epidemiologists, not some anti-vaxxer trying to connect weird dots.
- Yes, they’re both approved by the FDA. All drugs have to be, I’m not sure what Prasad’s point is.
Yes, there are very important benefits to weight loss, especially at the levels provided by Ozempic and similar drugs, but there is no way a college or university would mandate it for their obese students. Preventing a serious infection like COVID-19 with a shot and a booster is easy. Ozempic requires weekly injections, and the benefits may take years to notice.
One more thing. Ozempic is expensive, $300-1000 a month — does Prasad think that the college is going to pay that cost for four years? In the USA, it’s not covered by a lot of insurance, so it’s an “out-of-pocket” cost. The COVID-19 vaccine is free, in case you’re wondering.
Enough with this
Let’s get back to reality. There are not a lot of colleges this year that are mandating vaccines. Orac says, in his article about the imaginary Ozempic mandate:
Data from No College Mandates, a project opposing college vaccine requirements that documents institutions’ vaccine policies, show that fewer than 20 colleges and universities have mandated the new booster this fall.
Only 20 colleges. Maybe they will also mandate Ozempic. It’s kind of disappointing to read that, but I think many people (not me, of course) believe that the pandemic is over, and colleges have, more or less, stopped trying to police this.
So, we really aren’t having a massive amount of vaccine mandates for school (although most still require that incoming students are up-to-date on all of the other vaccines, so there’s that). And comparing it to an imaginary Ozempic mandate makes so little sense, I still am not sure if Prasad has any logical skills, given his incredible strawman.
One last thing, taking these GLP-1 agonists like Ozempic is not a guaranteed way to lose weight. It does not work 100% of the time, greater than 10% body weight loss was observed in only about 25% of patients in the clinical trials. Maybe it would be more over a longer period of time.
Let me leave you with this — OH OH OH OZEMPIC. Again, you can thank me in the comment section.
- Blundell J, Finlayson G, Axelsen M, Flint A, Gibbons C, Kvist T, Hjerpsted JB. Effects of once-weekly semaglutide on appetite, energy intake, control of eating, food preference and body weight in subjects with obesity. Diabetes Obes Metab. 2017 Sep;19(9):1242-1251. doi: 10.1111/dom.12932. Epub 2017 May 5. PMID: 28266779; PMCID: PMC5573908.
- Dhillon S. Semaglutide: First Global Approval. Drugs. 2018 Feb;78(2):275-284. doi: 10.1007/s40265-018-0871-0. PMID: 29363040.