Any occasion when a medication that’s meant to improve someone’s life cuts it short has to be viewed as an absolute tragedy.
But the sad death of nurse Susan McGowan after having just two weight-loss injections was, in many ways, a tragedy waiting to happen.
Let’s be clear: powerful drugs such as Mounjaro, Ozempic or Wegovy are fantastically effective for losing weight. But, like all medicines, they can have side-effects.
You have to be very careful when taking them and every patient who takes these drugs should be made aware of that.
And as they become more and more popular – and used by millions of people rather than the smaller numbers involved in clinical trials – it’s likely that we will see more of these extreme (although still relatively rare) adverse effects resulting in a heartbreaking outcome.
Susan McGowan, 58, (left) died with her niece Jade Campbell (right) by her side two weeks after taking a weight-loss drug
Take pancreatitis, for example, 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 any number of things – from gallstones (tiny deposits that can block the duct running from the pancreas to the intestines) to drinking too much alcohol. Plus, certain medicines such as Mounjaro (also known as tirzepatide) – but this isn’t a new finding.
In fact, we have known this could be a knock-on effect from fairly early on in the clinical trials that investigated Mounjaro as a possible treatment for adults with type 2 diabetes.
In trials, around 23 in every 1,000 patients prescribed Mounjaro developed acute, rapid-onset pancreatitis.
The nurse of three decades went to A&E at the hospital she worked at with severe stomach pains but her colleagues were sadly unable to save her
Other blockbuster weight-loss drugs can have the same effect.
Semaglutide (the injectable drug used to make Ozempic and Wegovy) triggers pancreatitis in about five out of every 1,000 of those taking it, and with liraglutide (which goes under the brand names Victoza and Saxenda) about eight in every 1,000 are affected. (All of their modes of action target the pancreas so it’s right in the firing line.)
The NHS prescribing information given to GPs and other medical professionals lists pancreatitis as one of the main adverse effects to be aware of.
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.’
Weight-loss jab Mounjaro was approved for use by NHS Scotland by the Scottish Medicines Consortium in June this year
And as has been widely reported, there can be other unpleasant but less serious side-effects from all these drugs.
For example, studies show around one in 100 people develop gastroparesis (or stomach paralysis), where stomach muscle contractions become too weak to pass food through to the intestines; this can cause nausea and vomiting. Around half those who develop gastroparesis also become constipated.
Some users also complain of foul-smelling ‘rotten egg’ burps – possibly because the drug increases the number of sulphur-producing bacteria in the gut. Another theory is that because it slows gastric-emptying, food lingers for longer than normal – causing more unpleasant aromas.
Then there’s so-called ‘Ozempic face’, where accelerated facial ageing – more wrinkles and saggier skin – develops after a few months on the drug.
Here, the rapid, significant weight loss is probably to blame, as facial fat smooths out wrinkles and cushions the skin.
And there are lingering concerns about the possible (albeit 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 patients serious harm are pretty low. And for those living with unmanaged obesity or type 2 diabetes the benefits will normally exceed the risks.
What’s more, doctors overseeing the treatment will (hopefully) routinely warn of any potential risks and, crucially, intervene if they do 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 that they see being used by high-profile names such as Oprah Winfrey, TV presenter Sharon Osbourne and pop star Boy George.
As a result, there is a booming market in unregulated online sales of the drugs (or, in some cases, dangerous fake versions) for use at home, with no professional guidance on safety. And this is where I think the biggest danger lies.
Should we also be worried about the long-term effects of these drugs, given that many people may end up on them for life?
I don’t think so. I’m pretty confident that, five years down the line, we will be talking about their long-term benefits rather than seeing a surge in previously unrecognised long-term adverse effects.
The overriding message to anyone on these medicines is not to get too worried about these isolated – albeit tragic – examples of severe reactions.
But remember these drugs work because they are powerful. We need to do more to restrict the online sale of them so that only the type of patients on whom they were trialled – people with type 2 diabetes with obesity – and who are under strict medical supervision, actually get them.
The risk otherwise is too great.
Wasim Hanif is professor of diabetes and endocrinology at University Hospital Birmingham
Interview by Pat Hagan
