good points, and both ones I considered for my initial post. I didn't because I thought I was bumping up against the TL;DR threshold.


I'm sure I hit that threshold all the time, but people are free to stop reading if they want, so I've never let other people's boredom stop me.


...the fen-phen drug that Wyeth produced, that looked like it would be a homerun until 5 years after its introduction, when cardiac valve problems completely dissolved the franchise
========
However, I disagree that from the provider trenches it ever truly looked like a home run. Yes, it was prescribed by a few providers (for a lot of patients). My recollection was that locally it was principally written for by a TV doc and a midlevel who later went into property development. 'nuff said there.

But for the large majority of primary care docs, the drugs looked scary from the outset...


This was my experience also: a lot of mistrust by GPs, and that turned out to be prudent. Still, apparently there were 77 million people who got the drugs before sales were stopped in 1997 (although only 6 million Americans).

I doubt these problems will apply to the GLP/GIP/glucagon agonists - there's a chance, but the probability is small. But what if you can get a $75 shot of semaglutide every week, instead of paying $1000 for Mounjaro? How many insurers are going to go along with that? I think that is the big risk, along with the flood of competing me-too drugs that are coming from all the companies jealous of LLY/NVO's success. I wouldn't be surprised to see Ozempic/Wegovy/Mounjaro/Zepbound continue to do well, but I don't think they will be able to keep increasing their revenues at the current pace when there is a fight for market share at the high end and cheap generics at the low end.

dtb