Digamma Consulting

MOTIVE AND PROFITS

Dr Kessler, Former head of FDA, says in his May 2025 New York Times article: “In era of addictive foods, we need GLP-1s”. This statement was actually the impetus for this whole article, as it triggered a fear that the unnatural aspects of the food industry was creating an equally unnatural aspect of the pharmaceutical industry. This would mean that through financial incentives, each industry fed each other revenue at the expense of the public health. Comments, in response to this article, from everyday Americans are all over the road from supportive to combative, innovative to paranoid, and informed to ignorant. After having reviewed several key comments which we have reproduced screenshots of in the appendix, we have organized them into six major categories:

 

1. RFK / Trump supporting comments. Many of them may surprise you because they don’t necessarily seem to be coming from classically conservative mindsets, but because they are critical of “establishment” types, such as former regulators of large corporations, they show explicit support for the MAHA / MAGA movement generally.

 

2. Anti-big business comments with emphasis on pharmaceutical and agriculture industries. In particular the emphasis that the link between the two is profitable to both and exponentially more detrimental to public health than either in isolation. Generally though, these are unified behind calls for proper regulations of big business, with a focus on food and drug industries as egregious examples of under-regulated industries in the US. Privatized healthcare and the myriad of issues it brings, largely through misaligned incentives between finance and public health, is a secondary but critical theme as well.

 

3. Anti-shame comments / complaint of low empathy for weight struggles. This dovetails with a greater progressive movement to address body image issues in society at large and is connected with clinical data showing eating disorders have been rising rapidly in recent years, more than doubling in less than two decades and rapidly approaching 10% of the US population.

 

4. Anti-addictions comments, which the team behind this article is very much sympathetic to. Food has been engineered in the US to be “the new cigarette” and yet lawsuits against the big business entities responsible for and profiting from this are not mirroring what happened with big tobacco years ago.

 

5. Anti-meat / vegan comments, also much sympathy from the authors, although some vegan activist show a tendency to a myopic worldview on these issues. Also just because many of these are coming from a genuinely good place, doesn’t make them scientifically informed in all cases.

 

6. Pro-GLP-1RA comments that say things like “the war against obesity via behavior modification is lost, and what ‘actually works’ needs to be championed.” Comments such as this show a demographic that is aware of, but has given up on, an ideal practice of medicine and regulation of the industry thereof. Very similar to category 2 above, but with more of an emphasis on clinical necessity and practical considerations, rather than an big business or industrial economic look.

 

Please feel free to review the comments in the appendix to see the examples we have provided to give some social context to this discussion. What is remarkable is the theme of complaint in these comments about corruption and essentially collusion between the large business interests of the food industry, sometimes called “Big Ag” or “Big Food”, and those of the pharmaceutical industry, known widely as “Big Pharma”.

 

What the narrative essentially describes is a Big Ag that has engineered the most profitable food products imaginable, and now Big Pharma can create a very lucrative market fixing the obesity that this creates. Many call for the FDA to “do something” about this collusion between Big Ag and Big Pharma, which in turn reveals a diverse array of parties to blame for the current public health crisis. Some blame business-as-usual FDA attitudes that are too friendly with big business to check their interests and properly and fairly regulate their industries as a result. This blame can be seen to be blamed on the outgoing Biden administration, particularly by those championing RFK or Trump, although this practice largely resembled previous administrations, and so was not really a uniquely Biden, or Democrat, issue. Other more apparently left leaning comments blame excessive capitalism and under regulation for these issues and seem to be calling for a social democrat style philosophy of more stringent regulation and taxation for causes designed to address the negative effects on public health.

 

Regardless of blame that is assigned by the public, the history of the FDA and how it arrived at its current state of regulation is very interesting. As many studied in high school US history class, “The Jungle” by Upton Sinclair, was an early investigative journalism exposé into abuses in the food industry. This revealed practices such as dust from red bricks being used to adulterate ground cinnamon, which was of great concern (and the relatable, almost contagious, human emotion “disgust”) to the public once they became aware. This created a climate in which the modern FDA started being created, approximately between 1900-1940 with a series of laws strengthening its powers until the passage of the landmark 1970 Controlled Substance Act and creation of enforcement division known as the DEA (Drug Enforcement Administration).

 

Although it is less commonly seen in populist online comments, those with some insight into how modern FDA regulation of pharmaceutical companies work have pointed out that approximately half of the FDA budget comes not from taxpayer funds from congress, but rather from “user fees”. In this context, the “user” is not the patient taking the drug, but the pharma company applying for approval of a new drug. On the surface it can seem like a clever way of making the pharma industry that profits from these drugs pay for a greater share of the industry regulation, letting society at large to be taxed less for the cost of this highly specialized regulation. But over time this makes the federal agency beholden to the finances of the pharma companies and indirectly dependent on their cashflow and profitability to fund their own regulatory activities. For example, shutting down one of the biggest pharma giants would result in the loss of the “user fees” from that very large company, which may represent a significant fraction of the FDA’s budget. Subtle financial incentives such as this, over time, can motivate the regulators to keep cash flowing through the existing parties, which can limit the extent of regulatory limits imposed and enforcement actions taken by the FDA.

 

A few examples of the FDA’s ability to steer food and drug norms in the United States may merit mentioning for context of how this agency’s power and influence are exerted. American cheese is the most obvious example, made through a process involving chemicals such as sodium citrate. This process allows for a more consistent looking cheese with better “meltability” (less separation during cooking) and most profitable of all, a longer shelf life. This was patented by James L. Kraft in 1916 in the US and made available as Kraft Singles in 1950. What this has created since is a whole industry of “cheese products” which are legally distinct from natural cheese. Whereas natural cheese is a regulated food product, “cheese products” are unregulated and can contain less than 51% natural cheese in their ingredients. This has created a unregulated pocket within the greater dairy industry for ultra-processed and highly profitable products which have become increasingly normalized in the American diet.

 

Another example is the rise of anti-depressant class known as SSRI (selective serotonin uptake inhibitor). Because there are so many SSRIs now we will focus on the first, brand name Prozac (fluoxetine). This was developed in the 70’s by one of the big pharma companies we are examining for GLP-1 drugs, Eli Lilly. While development of the drug took until the mid 80’s, in 1987 the drug went on the US market and grew to $350 million in sales in the first year and peaked at $2.6 billion years later, which represents a very rapid rise of a new product and a new medical market for treatment of depression. When the patent on this drug expired in 2001 and let other companies compete with generic versions of the drug, sales dropped an astonishing 70%. What this blockbuster drug did was create not only a wave of generic drugs of this molecule, but similar and competing molecules that would come with a patent.

 

The irony of the anti-depressant narrative is that after the first SSRIs, no patent would ever be as profitable as that first one again, despite the market for SSRIs growing because it is now sub-divided into market shares between the big pharma companies. But the financial incentives of each company still drove the changes to medical and clinical practice in the US, with six major SSRIs currently very popular including the original Prozac: Citalopram (Celexa), escitalopram (Lexapro), fluvoxamine (Luvox), paroxetine (Paxil), and sertraline (Zoloft). This has created a “drugs first” pattern in the treatment of depression among US psychiatrists where these drugs which were originally used for treatment resistant depression due to unpleasant side effects are quickly becoming a line of first response for all patients, often with a period of cycling between these drugs to find the “right fit” for a patient based on side effects and symptom management. Compare this to EU standard medical practice which is to use behavioral interventions first (exercise, diet, lifestyle), followed by natural remedies (lemon oil, St. John’s wort, etc), and only third “harsher” synthetic pharmaceuticals. In the US the triage seems to work backwards with pharmaceutical products being given first and “alternative medicine” only being pursued by patients who continue to experience issues with depression symptoms or side effects. Although this is not beneficial for patient health, it is very lucrative for the pharmaceutical companies and distributes a fair amount of cash to prescribing psychiatrists, pharmacies, and many other ancillary services that are paid in conjunction with the drug maker. Aside from contributing to the high cost of drug prices and inaccessibility of healthcare, this pattern also leaves millions of Americans struggling with SSRI withdrawal years after their battle with depression has ended.

 

The important thing in this case study is the regulatory aspects and how we can learn about them in our thinking on the GLP-1 drugs. Is it the FDA’s jurisdiction to create prescribing guidelines for doctors, or is that more the role of the AMA (American Medical Association) or APA (American Psychological Association)? Well its a complex area because the FDA’s jurisdiction includes what the drug is and is not approved to treat, but things such as “first line of response vs. treatment resistant cases only” are not squarely in the FDA’s purview and start to stray into AMA / APA territory. But the pattern of profitable drugs driving the treatment options available to patients is clearly seen here, and that process, of what drugs are approved and for what disorders, is more squarely in the jurisdiction of the FDA.

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