If we were to choose a “drug of the year” for 2023, the undisputed winner would be semaglutide (Ozempic). Semaglutide (Ozempic) is a blockbuster drug that had a moment in the medical and cultural zeitgeist. This is not to say that there are no corresponding results. Let's take a moment to be in awe of a drug that can suppress one of our most basic and important instincts: eating.
Semaglutide is a type of GLP-1 agonist that is a new drug. The weight loss research published so far is impressive, with a study in the New England Journal of Medicine showing a 15% reduction in body weight compared to 2.4% with a placebo. Currently, its use is being tested with respect to other, possibly more destructive desires: alcohol, tobacco, and drug use. With 500,000 people dying every year from tobacco and more than 100,000 from drug overdoses, positive outcomes are desperately needed.
The struggle with temperance troubled Benjamin Franklin, Philadelphia's most famous founding father. In his autobiography, he states the following clear goals: Do not drink until you reach altitude. ” He goes on to analyze this issue from the perspective of rationality. “I knew what was right and what was wrong, but I didn't understand why I always did one and avoided the other.”
The cause of the rift between our knowledge of what is good for us and our overt self-sabotaging behavior is now known to have a clear neurobiological basis. Frank Leone and Sarah Evers-Casey, tobacco addiction experts at the University of Pennsylvania, clearly outline the problem in their new book. why do people smoke.
They divide the part of the brain that controls behavior into three parts, known as the triune brain. The first brain to develop is aptly named the “first brain” and controls basic instincts and behaviors that need to be automated, such as running away from an aggressive animal.
The third brain is our neocortex and is where our conscious thinking and abstractions emerge. Here we consider the importance of art, mathematics, language, and love. Here we analyze the past, consider the present, and try to transcend the future.
Although we think of the third brain as the place where we can control our actions, there is a lot of information coming from the subconscious second brain, the invisible hand that has infuriated everyone with compulsive behavior. It has a big impact.
It is this second brain that forces us to eat that dessert while our conscious third brain keeps telling us we don't need it. Even worse, we may not be enjoying that cake.
The second part of the brain that neuroscientists have focused on is the mesolimbic system. Here the addiction is reinforced, and the neurotransmitter dopamine not only gives us feelings of satisfaction and reward, but also creates neural pathways that make it harder to resist the behavior in the future.
GLP-1 agonists such as semaglutide slow stomach movements, leading to a feeling of fullness, but they also appear to act centrally in the brain, calming dopamine pathways in the mesolimbic system. Perhaps this is why some patients receiving semaglutide for weight loss report also quitting alcohol, often without effort. NIH researchers are currently studying its effects on alcohol abuse and smoking in detail.
“One of the happy coincidences of GLP-1 agonists is that addictive behavior is not a moral failing, but a very complex interaction of neurotransmitters and neural pathways that we do not fully understand. “This clearly shows that it is certainly not possible to completely control this through conscious thought,” Leone said. .
There are also risks. As conscious humans, we are constantly striving to explore, understand, create, and transcend. However, with drugs like semaglutide, the ability to suppress appetite can be extrapolated to an anhedonic state or manipulated into valuing rewards that are not in the human's best interest.
As with any technology, it's natural to think that how you use it will matter. Wondering if Ben Franklin was a user of semaglutide, since he said, “Wine is constant proof that God loves us and wants us to be happy.” Some people may think so. If so, I would like to think that it was probably only a small amount.
Michael J. Stephen, MD, is a pulmonologist at Penn Medicine and author of Breath Making, A Biography of the Lungs.
