Mounjaro and Ozempic have been hailed as miracle drugs

Let’s take a break from politics this week and talk about something that will at some stage affect most, if not all of us, but which is rarely discussed in opinion columns.

All of us know that many (I refrain from saying most) Indians start to put on weight after we are 35 or 40.

 

Though weight is not the only factor involved, it can contribute significantly to increases in blood pressure and to heart disease. We know also that diabetes remains a huge issue for middle aged people; in no other country have I seen so many successful and high powered men discussing their sugar levels over glasses of Scotch at parties.

 

   Indian doctors are seized of these problems and anyone over 40 has heard the same advice from their doctors: you should give up smoking, start exercising, eat only healthy food and less of it, etc.

 

   It’s good advice but it is offered so routinely that doctors must know the speech by heart and patients, inured to the advice, take the speech in from one ear and let it float out from the other.

 

   But here’s what we don’t realise. Patients have accepted that they have a problem but don’t necessarily want to do what doctors suggest. Instead they are increasingly opting for a new generation of drugs.

 

   The second largest selling branded medication in India is already Mounjaro, the rival to the better known Ozempic; both of which have been hailed as miracle drugs. Even though it has just been introduced to the country Mounjaro is flying off the shelves.

 

   According to The Economist so great is the Indian appetite for these new drugs that the market is expected to grow from $179m in 2025 to $1.5bn by 2030.

 

   After years of listening to doctors lecturing them about the dangers of obesity and the threats of diabetes and heart disease, Indians are finally doing something about it.

 

   And no, it is not what the doctors have been recommending for decades.

 

   Indians have a complicated relationship with new drugs. When Finasteride was introduced in the US as a proven arrester of male pattern baldness it was expected to do well in India because of baldies like myself. In fact, while it has done okay thanks to reasonably priced generic versions (sales are growing at around six per cent a year) it has not become the panacea for follically challenged Indians that it was expected to be: I suspect most people don’t even know what it is.

 

   Viagra, on the other hand, is the success that nobody dares talk about. The market is around $ 90 million a year and is expected to grow at 10 per cent a year because of cheaper Indian made versions of the drug that was originally launched by Pfizer. But of course nobody admits to taking it and it’s rarely discussed though one measure of its popularity may be that we see less advertising for ‘sexperts’ and other quacks.

 

"The instant success of the drugs in the Indian market tells us how quickly India is changing. And for once, the changes are for the better."

   Mounjaro is different. It outsold all versions of Viagra within months of being launched. Along with Ozempic it is hailed as a wonder drug around the world and there is only a tiny bit of embarrassment involved in admitting that you take it because it’s medical benefits are so well acknowledged: apart from the significant weight loss effects it brings sugars down and will help in battling heart disease, kidney problems, Alzheimer’s and will probably help people live longer.

 

   The science behind the new drugs can be tedious to explain but what you need to know is that they act on the body’s pleasure centre centres and give you a feeling of satiety relatively quickly. So you can still eat delicious food but because you feel fuller sooner you eat less. Initially it was believed that the other beneficial medical effects were related to the weight loss aspect but it is now emerging that the drugs may have unrelated benefits that are still being researched.

 

   So why have the new drugs taken off so quickly in India? Part of the reason is prescriptions from doctors. But that is not enough to explain their success given that most doctors are slow to prescribe new medicines.

 

   Part of it is price. Mounjaro can cost one third of what it costs in the US if you buy it in India. Manufacturers are targeting Asian markets because of what they regard as nuisance law suits and class actions in the US.

 

   But mostly, the success of the new drugs tells us something about the changing psyche of the Indian middle class. Though this is not medically advisable and probably illegal many consumers are self prescribing and buying them on their own. There can be side effects (nausea for instance) but people are willing to hang on till these recede (about a couple of weeks).

 

   I would like to be able to say that this is only because we are becoming more health conscious and while this is certainly true, there is no denying that weight loss may be the most powerful driver of sales. The Indian middle class is getting fed up of being paunchy and plump.

 

   And this is just the beginning. Two important developments will take place in the next couple of years.

 

   In early 2026 the patent for Ozempic will expire in India. That means that any Indian company can make its own version and sell it at a much lower price. At present though Ozempic is cheaper in India than in the West it is still expensive. But once the Indian manufacturers start selling it, the cost will not be a major impediment to its adoption.

 

   The second development is the introduction of a pill that has the same effect. At present the drugs have to be injected into the body to bypass the stomach where the gut may destroy their potency. But scientists seem sure that a pill that stands up to the gut is possible. It may not be available next year. But it is almost certain to be introduced the year after that.

 

   What does that do to India? If a relatively inexpensive tablet that controls diabetes and has a host of other beneficial effects is available all over India then its popularity will extend beyond the weight-conscious upper middle class and it could alter India’s public health landscape.

 

   A few months ago when The Weight Loss Revolution a book authored by Dr Ambrish Mithal, India’s leading endocrinologist with the well known writer and commentator Shivam Vij was released I anchored the launch discussion. The hall was packed out with might be described as the great and the good of Delhi (along with some of the bold and beautiful). All of them were fascinated by the weight loss aspect of the drugs.

 

   But when Dr Mithal told them that in the long run weight loss may not be the major consequence of the new drugs and that the other beneficial effects on society might outweigh the reductions in weight they looked sceptical.

 

   Dr Mithal was right of course. The instant success of the drugs in the Indian market tells us how quickly India is changing. And for once, the changes are for the better.