Any time a medication intended to improve someone’s life is discontinued should be seen as an absolute tragedy.
But the sad death of nurse Susan McGowan after receiving just two weight-loss injections was, in many ways, a tragedy waiting to happen.
Let’s be clear: powerful drugs like Mounjaro, Ozempic or Wegovy are incredibly effective for weight loss. But, like all medications, they can have side effects.
You have to be very careful when taking them and every patient who takes these medications should be aware of this.
And as they become increasingly popular (and used by millions of people rather than the smaller numbers involved in clinical trials), we are likely to see more of these extreme (although still relatively rare) adverse effects that will result in a heartbreaking result.
Susan McGowan, 58 (left) died with her niece Jade Campbell (right) at her side two weeks after taking weight loss medication.
Take pancreatitis, which is listed as one of the causes of Susan McGowan’s death.
It is a dangerous inflammation of the pancreas, the pear-shaped organ at the back of the abdomen that produces enzymes (to help us digest food) and insulin, to control our blood sugar levels.
It can be caused by a number of things, from gallstones (small deposits that can block the duct from the pancreas to the intestines) to drinking too much alcohol. Additionally, certain medications such as Mounjaro (also known as tirzepatide), but this is not a new finding.
In fact, we knew this could be a knock-on effect quite early in the clinical trials investigating Mounjaro as a potential treatment for adults with type 2 diabetes.
In trials, about 23 out of every 1,000 patients prescribed Mounjaro developed rapid-onset acute pancreatitis.
The nurse for three decades went to the emergency room at the hospital where she worked with severe stomach pains, but unfortunately her colleagues could not save her.
Other popular weight loss medications can have the same effect.
Semaglutide (the injectable drug used to make Ozempic and Wegovy) triggers pancreatitis in about five in 1,000 of those who take it, and liraglutide (marketed under the brand names Victoza and Saxenda) about eight in 1,000 are affected. (All of its modes of action target the pancreas, so it’s right in the line of fire.)
NHS prescribing information provided to GPs and other medical professionals lists pancreatitis as one of the main adverse effects to look out for.
It clearly states: “Patients should be informed of the symptoms of acute pancreatitis (nausea, fever, yellowing of the skin, and tender or swollen abdomen) and tirzepatide should be discontinued.”
The Mounjaro weight loss vaccine was approved for use in NHS Scotland by the Scottish Medicines Consortium in June this year.
And as has been widely reported, all of these medications can have other unpleasant but less serious side effects.
For example, studies show that about one in 100 people develop gastroparesis (or paralysis of the stomach), where the contractions of the stomach muscles become too weak to pass food to the intestines; this can cause nausea and vomiting. About half of people who develop gastroparesis also suffer from constipation.
Some users also complain of smelly “rotten egg” burps, possibly because the drug increases the number of sulfur-producing bacteria in the intestine. Another theory is that because it slows gastric emptying, food remains longer than normal, causing more unpleasant aromas.
Then there is the so-called “Ozempic face”, where accelerated facial aging (more wrinkles and sagging skin) develops after a few months of taking the drug.
In this case, rapid and significant weight loss is probably to blame, as facial fat softens wrinkles and cushions the skin.
And concerns remain about the possible (although extremely low) risk of thyroid cancer from taking Ozempic, although the European Medicines Agency ruled last year that there was no evidence of such a link.
I believe that used under proper medical supervision, the risks of causing serious harm to patients are quite low. And for those living with uncontrolled obesity or type 2 diabetes, the benefits will usually outweigh the risks.
What’s more, doctors overseeing treatment will (hopefully) routinely warn of any potential risks and, more importantly, intervene if they occur, usually by stopping treatment immediately.
But we live in a celebrity-driven culture, where people want instant access to the same miracle weight loss drugs they see used by high-profile names like Oprah Winfrey, TV host Sharon Osbourne and pop star Boy George.
As a result, there is a booming market for unregulated online sales of medications (or, in some cases, dangerous fake versions) for home use, without professional guidance on safety. And this is where I think the greatest danger lies.
Should we also be concerned about the long-term effects of these medications, given that many people may end up taking them for life?
I don’t think so. I’m pretty sure that, within five years, we’ll be talking about its long-term benefits rather than seeing an increase in previously unrecognized long-term adverse effects.
The overriding message for anyone taking these medications is not to worry too much about these isolated, yet tragic, examples of serious reactions.
But remember that these medications work because they are powerful. We need to do more to restrict their sale online so that only the type of patients they were tested on (people with type 2 diabetes with obesity) and who are under strict medical supervision actually get them.
Otherwise, the risk is too great.
Wasim Hanif is a professor of diabetes and endocrinology at the University Hospital Birmingham.
Interview by Pat Hagan
