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Wegovy works. But here’s what happens if you can’t afford to keep taking the drug

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Wegovy works. But here’s what happens if you can’t afford to keep taking the drug

Wegovy has been referred to as “a significant breakthrough” given how effectively it really works to scale back physique weight. However the injection drug is extraordinarily costly and when individuals cannot afford to remain on it, they expertise rebound weight acquire that is onerous to cease.

Katherine Streeter for NPR


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Katherine Streeter for NPR


Wegovy has been referred to as “a significant breakthrough” given how effectively it really works to scale back physique weight. However the injection drug is extraordinarily costly and when individuals cannot afford to remain on it, they expertise rebound weight acquire that is onerous to cease.

Katherine Streeter for NPR

From TikTok influencers speaking it as much as celebrities worrying about “ozempic face,” medication like Wegovy and Ozempic are being touted as weight reduction miracles in a rustic obsessive about slimness.

However, the medication aren’t meant for beauty weight reduction. Ozempic is permitted for diabetes, and Wegovy is for individuals with weight problems who even have weight-related circumstances equivalent to hypertension or excessive ldl cholesterol that put them prone to coronary heart illness. That is hundreds of thousands of Individuals.

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And proof reveals the brand new class of medication are far simpler than prior weight problems medicines. A landmark scientific trial revealed in The New England Journal of Drugs in 2021 discovered that the drug led to a 15% discount in physique weight, on common.

There’s been such a rise in demand that an FDA database lists the treatment’s energetic ingredient, semaglutide, as “at present in scarcity.” Its producer, Novo Nordisk, says maintaining provides secure is a precedence. The corporate additionally markets Ozempic to deal with diabetes, which is a decrease dose of semaglutide.

However at a value of about $1,400 a month — out of pocket when insurance coverage does not cowl it — many individuals cannot afford to remain on the treatment for the long run. And when individuals cease taking it, there’s typically rebound weight acquire that is onerous to manage. Actually, a examine discovered that most individuals acquire again many of the weight inside a yr of stopping the medication.

That is what is occurring to Yolanda Hamilton from South Holland, Ailing. Hamilton’s physician prescribed Wegovy as a result of she had an elevated BMI, hypertension and elevated blood sugar. She misplaced 60 kilos and began feeling a lot better.

“It gave me extra power,” she says, permitting her to train and do home chores. Her cravings for sugar subsided, and she or he felt happy from smaller meals. “I used to be very stunned by how good I felt,” Hamilton says. The drug is run by a as soon as per week injection at residence, which Hamilton says is simple to do.

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Her Aetna insurance coverage plan lined the price of the treatment, however when she modified jobs final fall, her new insurance coverage plan by way of Blue Cross and Blue Protect of Illinois denied protection. She now works in a hospital ER registering sufferers, which requires her to sit down many of the day. And, after a number of months of not taking the drug, she has gained again 20 kilos.

“I am very annoyed in regards to the weight coming again on in so little time,” Hamilton says.

Blue Cross and Blue Protect of Illinois informed NPR that advantages provided by employer plans can fluctuate. “Weight-loss medication like Wegovy could also be lined, relying on the member’s profit plan,” a spokesperson for the corporate stated. Many different insurance coverage carriers additionally decide protection primarily based on what employers are keen to cowl.

Limitations to a life-changing drug

The rebound weight acquire just isn’t a shock given how the treatment works. Wegovy’s energetic ingredient — semaglutide — is a GLP-1, or glucagon-like peptide-1, which mimics the GLP-1 satiety hormone in our our bodies. Once we eat, GLP-1 is launched from our intestines and sends indicators to our mind facilities that management urge for food.

“This hormone is telling your mind, I am full, I needn’t eat anymore,” explains Dr. Robert Kushner of Northwestern College, who treats Yolanda Hamilton. Kushner additionally serves on a Novo Nordisk medical advisory board, for which he receives an honoraria.

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“What the pharmaceutical firms have performed is taken this hormone that’s naturally occurring and restructured it right into a drug,” he explains. So, it is not a shock that when individuals cease taking the medication, they begin to really feel hungrier, he says.

“I crave sweets,” Hamilton says. And her urge for food has elevated. She not feels happy with small meals. “I am dropping my power” as the load comes again, she says.

Kushner’s workplace helps Hamilton attraction the insurance coverage denial, however as she waits, she’s frightened that stopping the treatment may even affect her blood stress and blood sugar. “She is prone to having these circumstances worsen with regain of weight,” Kushner says.

“If I acquire extra weight, I shall be on extra medicines,” says Hamilton. Given her lengthy wrestle with weight reduction, she’d lastly discovered one thing that was working.

“We’re seeing plenty of sufferers have this rebound weight acquire, and it will probably actually be devastating,” says Dr. Karla Robinson, a household doctor primarily based in Charlotte, N.C., and a medical editor at GoodRx, an organization that helps individuals discover the bottom costs for generic and model medication. There isn’t any generic model of semaglutide.

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“Sadly, being a brand new treatment, it is a kind of that’s topic to the pricing of the producer,” Robinson says.

A consultant from Novo Nordisk notes that the corporate provides a $500 coupon for Wegovy to scale back the price for sufferers paying money.

However, this chart from GoodRX reveals the bottom worth amongst all retailers is $1,304 monthly for individuals paying out of pocket, which is out of attain for most individuals — even with a coupon.

“I do really feel like Wegovy is revolutionary,” Hamilton says. However she says she undoubtedly cannot afford to pay for it.

“A few of the individuals who want it probably the most are unable to entry it,” Robinson says, declaring that individuals with low incomes expertise weight problems at disproportionately larger charges.

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“We’re speaking about an enormous well being fairness challenge,” she says. Black and Hispanic adults have larger charges of weight problems, in accordance with the CDC.

Since Wegovy was permitted by the FDA in 2021, some insurance coverage have begun to cowl the treatment for individuals who meet the scientific prescribing pointers. In line with the FDA, individuals are eligible if they’ve a BMI of 27 or larger and in addition have a minimum of one “weight-related ailment” equivalent to hypertension, diabetes, or excessive ldl cholesterol. Or they’ve a BMI of 30 or larger, no matter weight-related illnesses.

However insurance coverage protection could be very spotty. Medicare doesn’t cowl Wegovy or different weight reduction medication, and lots of insurers observe Medicare’s lead. More and more, there’s stress to alter this. As STAT reported final week, the Moffitt Most cancers Middle in Florida is lobbying for laws that may permit Medicare to pay for weight problems medication, citing the hyperlink between weight problems and most cancers threat. The NAACP can also be registered to foyer on this challenge.

As well as, the American Academy of Pediatrics has new steering recommending that pediatricians provide weight reduction medication to adolescents 12 and older with weight problems as an adjunct to habits change and life-style interventions.

Lengthy-term unknowns

However the truth that individuals might have to remain on Wegovy indefinitely with the intention to preserve the load loss has raised issues about long-term use. The commonest unwanted effects of the drug are GI signs. “Nausea, diarrhea, constipation, vomiting in some individuals, or heartburn,” Kushner says.

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He says beginning with a low dose and growing it over time may also help individuals tolerate the drug higher. There’s ongoing analysis to guage the drug’s impact on the cardiovascular system, which is constructive to this point.

However the drug does carry a black field warning as a result of in rodent research it induced thyroid tumors. So, Kushner says medical doctors have to display screen sufferers to search out out if they’ve a household historical past of a selected sort of thyroid carcinoma, or one other uncommon situation referred to as a number of endocrine neoplasia syndrome kind 2 (MEN 2). “This could be a person affected person dialog,” Kushner says. Usually, if you do not have a historical past of those circumstances, “this treatment is considered secure,” he says.

If this sounds unsettling, it is a reminder of how excessive the stakes are to fight weight problems. The theoretical threat of thyroid tumors could also be unnerving. However medical doctors level to the dangers of leaving weight problems untreated: Coronary heart illness is the main reason behind dying within the U.S., and weight problems and weight-related circumstances are prime threat components.

In fact, train and weight-reduction plan modification are nonetheless the primary methods to strive. However on condition that about 70% of Individuals are chubby or overweight, almost half of adults within the U.S. have hypertension and greater than 1 in 3 have pre-diabetes, medical doctors’ teams cite an pressing have to layer on extra interventions that may be useful.

“We, as a society, are spending $173 billion in obesity-related well being care prices,” says Dr. Marcus Schabacker, CEO of ECRI, an unbiased, nonprofit group that has reviewed the proof of latest weight reduction medication.

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He argues that the medication could be a part of destigmatizing weight problems by treating it like another illness that you simply deal with with drugs. “We might not ask somebody who has hypertension to only do workout routines and alter your weight-reduction plan after which you may be effective. No, we give them beta blockers. It is not totally different right here. Train and weight-reduction plan are key parts of tackling weight problems, however so are medicines which have confirmed to be efficient,” he says.

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Countries wooing corporate digital nomads hope to make them stay

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Countries wooing corporate digital nomads hope to make them stay

“Digital nomad” visas are increasingly being used by countries to attract remote corporate workers, according to tax experts, as governments seek to outbid each other in a global war for talent.

More countries have introduced a form of digital nomad visa — allowing a person to live in a country and work remotely — since the pandemic increased demand from employees to “work from anywhere”.

The notion of a “digital nomad” has tended to suggest footloose freelancers backpacking across countries or working on beaches from their laptops.

But self-employed digital nomads make up a relatively small slice of the total community. While their numbers have grown by more than 50 per cent since the pandemic, according to figures from MBO Partners, they were not the main group governments are trying to attract, global mobility experts told the FT.

“The ‘nomad’ visa is ironically not done for nomads,” said Gonçalo Hall, CEO of NomadX, a remote work consultancy, who advises governments on how to launch digital nomad communities.

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“Most governments are seeing [nomad visas] as a way to attract remote workers with the clear intention of getting them to stay and become permanent residents in their countries.”

Gonçalo Hall, the Portuguese founder of a digital nomad village in Madeira © Goncalo Hall
Images from Goncalo Hall’s Instagram promoting work as a digital nomad © Goncalo Hall/Instagram

The total number of US digital nomads hit 17.3mn in 2023, according to MBO Partners, of which just 6.6mn were self-employed. The survey only tracks Americans, thought to be the largest group of digital nomads by nationality. Remote salaried workers are not taking jobs from locals and their consumer activity contributes to their host economy.

Countries were jumping on the “buzzword” of digital nomads, but really the visas “should be called remote worker visas”, Hall said.

Italy last month became the most recent country to introduce a digital nomad visa, joining several European countries, including Portugal, Estonia, Greece, Malta and Spain, that are trying to attract a growing global remote workforce.

Pallas Mudist at Enterprise Estonia, a government agency, said: “Estonia’s digital nomad visa is specifically designed to attract not just entrepreneurs and freelancers but also salaried remote workers.”

The visas are only open to non-Europeans, with about 600 issued since the scheme launched in August 2020. But overall the government estimates that 51,000 digital nomads visited Estonia in 2023, including Europeans who do not need a visa.

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Similar programmes have also been introduced in Barbados, Brazil, Cape Verde, Costa Rica, Mauritius and the UAE among others. While there are no official figures on the number of countries that have introduced the visas, tax experts point to sources compiled by digital nomads such as nomadgirl.co, which says there are now 58 countries offering them.

You are seeing a snapshot of an interactive graphic. This is most likely due to being offline or JavaScript being disabled in your browser.

Daida Hadzic, a global mobility tax expert at KPMG, said that ageing societies was one reason governments were seeking to attract remote corporate employees using digital nomad visas. If such employees settle permanently in the country, they will contribute their skills and labour over the longer term too.

“The driving force behind digital nomad visas is that these countries are in competition with each other over labour,” she said.

Giorgia Maffini, tax expert at PwC UK, said countries offering digital nomad visas tended to be “a bit less competitive” at attracting foreign workers, citing Costa Rica, Croatia and Indonesia as examples.

Steve King, researcher at US-based workforce consultancy MBO Partners, said countries with digital nomad visa programmes often preferred salaried employees.

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“Many countries see digital nomads with traditional jobs as tourists on steroids who will spend money locally, but won’t take local jobs or be a burden on local social services,” he said.

You are seeing a snapshot of an interactive graphic. This is most likely due to being offline or JavaScript being disabled in your browser.

Marta Aguilar, who lives in Spain, said she spent almost half the year travelling the world while working for Coverflex, a flexible compensation company based in Portugal.

The company has no offices and employees work fully remotely, with a €1,000 a year remote working budget.

“I don’t like winter. So, I haven’t had winter for two years. I just skipped it,” said Aguilar.

However, the international tax system is often difficult to navigate for remote workers as the rules were not designed for a more mobile workforce.

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For companies, a key risk when employees work remotely is that the country they are in can be deemed a de facto business branch, or “permanent establishment” of the employer for tax purposes. That imposes tax reporting requirements on the business and means some of the business’s profits are potentially liable for tax in the country in which the employee is working.

Remote workers can also expose themselves to income and social security taxes on earnings generated while working abroad and potentially end up liable for tax in multiple places, also exposing the employer to liability.

Several intergovernmental bodies, including the EU, OECD and UN, are examining ways to make it easier for businesses and countries. In February, the European Economic and Social Committee recommended the taxation of remote employees take place in the country of the employer’s residence, with some tax revenue shared with the employee’s resident country.

Column chart of Number of US digital nomads (mn) showing Digital nomads have increased since the pandemic but growth has slowed

Experts also warn that some countries risk losing tax revenues as workers relocate — particularly if they move to lower-taxed jurisdictions.

“The problem with, say, the UK is we are so dependent on labour, and our weather is not great. [The trend for more remote working] may well lead to a lot of people going to, say, Greece, and undermining our tax base,” said Grant Wardell-Johnson, global tax policy leader at KPMG International.

These risks are thought to be small, for now. Rough estimates by the IMF in 2022 found that increased remote working reallocates about $40bn of the income tax that workers pay globally. This represents roughly 1.25 per cent of the global income tax base. The potential revenue either lost or gained across countries was found to be between 0.1 and 0.2 per cent of GDP.

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Small emerging market economies “with below-average tax rates and good remote work capability” typically gain the most from the trend, the research found — underlying the potential for tax winners and losers. 

Dino Jangra, a partner at Crowe, said: “In most countries, payroll wage tax is the biggest take. If you start to see a lot of people leaving your country, that becomes a problem.”

However, growth in remote working has slowed of late. According to MBO, the numbers of US digital nomads rose by just 2 per cent last year.

“I don’t think the digital nomad concept has so far quite turned out how people thought it would. There’s definitely been a wave of ‘get your bums back to the office’ happening all around the world,” said Jangra.

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Boeing's troubled Starliner spacecraft launch is delayed again

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Boeing's troubled Starliner spacecraft launch is delayed again

Boeing’s Starliner capsule atop an Atlas V rocket is seen at Space Launch Complex 41 at the Cape Canaveral Space Force Station on May 7, a day after its mission to the International Space Station was scrubbed because of an issue with a pressure regulation valve.

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Boeing’s Starliner capsule atop an Atlas V rocket is seen at Space Launch Complex 41 at the Cape Canaveral Space Force Station on May 7, a day after its mission to the International Space Station was scrubbed because of an issue with a pressure regulation valve.

John Raoux/AP

The first crewed launch of Boeing’s troubled Starliner spacecraft has been delayed again, to May 25, this time because of a helium leak in the service module.

NASA had set the liftoff for May 21 after scrubbing a May 6 launch but the helium leak was discovered on Wednesday. While the agency said the leak in the craft’s thruster system was stable and wouldn’t pose a risk during the flight, “Boeing teams are working to develop operational procedures to ensure the system retains sufficient performance capability and appropriate redundancy during the flight.”

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While that work is going on, NASA said its Commercial Crew Program (CCP) and the International Space Station Program will review data and procedures before making a final determination whether to proceed with a countdown.

The delay is the latest for the Starliner’s first crewed mission, which will carry NASA astronauts Barry “Butch” Wilmore and Sunita “Suni” Williams to the International Space Station. The astronauts are to spend about a week aboard the space station before making a parachute and airbag-assisted landing in the southwestern U.S.

If that mission is successful, NASA will begin the final process to certify Starliner for crewed rotation missions to the space station.

The delay comes roughly a decade after NASA awarded Boeing a more than $4 billion contract as part of the agency’s Commercial Crew Program, which pays private companies to ferry astronauts to and from the space station after the space shuttle was retired in 2011.

SpaceX, which was also awarded a $2 billion contract under the CCP initiative, has flown eight crewed missions for NASA and another four private, crewed spaceflights since 2020.

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A history of delays and design problems

But the Starliner program has been plagued with delays and design problems for several years.

It failed to reach the space station during its first mission in 2019 after its onboard clock, which was set incorrectly, caused a computer to fire the capsule’s engines too early. The spacecraft successfully docked with the space station during its second test flight in 2022, despite the failure of some thrusters during the launch.

Boeing then scrapped the planned launch of the Starliner’s first crewed flight last year, after company officials realized that adhesive tape used on the craft to wrap hundreds of yards of wiring was flammable, and lines connecting the capsule to its three parachutes appeared to be weaker than expected. The launch was delayed indefinitely.

The May 6 launch was scrubbed because of a faulty oxygen relief valve, NASA said.

Wilmore and Williams remain quarantined in Houston and will fly back to NASA’s Kennedy Space Center in Florida closer to the new launch date, NASA said. The Starliner, which sits atop a United Launch Alliance Atlas V rocket, remains in the Vertical Integration Facility at Space Launch Complex 41 on Cape Canaveral Space Force Station in Florida.

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Boeing has faced intense scrutiny this year on the commercial aviation side of its business after a rear door plug blew out of an Alaska Airlines flight shortly after takeoff in January.

Whistleblowers have since come forward to detail alleged quality control lapses at the storied company, and the Federal Aviation Administration said it was auditing Boeing’s production. The Justice Department also announced it would open a criminal investigation into the Alaska Airlines incident.

NPR’s Joe Hernandez and Geoff Brumfiel contributed reporting.

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Gantz threatens to quit Israeli government if no new war plan by June 8

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Gantz threatens to quit Israeli government if no new war plan by June 8

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Benny Gantz has threatened to leave Israel’s emergency government if Prime Minister Benjamin Netanyahu did not commit to a new plan for the war with Hamas in Gaza and its aftermath.

In a televised statement on Saturday evening, Gantz, an opposition figure and former general who joined Netanyahu’s coalition in the aftermath of Hamas’s October 7 attack on Israel, said that his centrist National Unity party would leave the government if his demands were not met by June 8.

Gantz’s ultimatum brings to a head months of tensions within Netanyahu’s government over the handling of the war, and comes just days after defence minister Yoav Gallant slammed Netanyahu for the lack of a postwar plan for Gaza, the enclave Hamas has ruled since 2007.

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