Drug Development Failure: how GLP-1 development was abandoned in 1990

Original Article ↗ Hacker News Discussion ↗

GLP-1 History, Missed Opportunity, and Hindsight Bias

  • Pfizer/MetaBio abandoned GLP-1 in 1990 despite efficacy and patents; Novo Nordisk restarted work shortly after and eventually created blockbuster drugs.
  • Commenters debate whether this was an obvious mistake vs a reasonable decision given then‑limited obesity prevalence, long timelines, and competing pipelines.
  • Several note “resulting”/hindsight bias: pharma has many parallel bets (e.g., obesity drugs, Alzheimer’s pathways, CETP inhibitors) and most fail despite smart, persistent teams.
  • Another angle: MetaBio’s startup structure was flawed (wholly owned from day 1, founders not fully committed), which left them powerless when the parent shifted priorities.

Injections, Patient Acceptance, and Delivery Tech

  • Disagreement over how much injection aversion mattered in 1990: some recall large syringes and clinic visits; others point out disposable syringes and short needles existed and subcutaneous injections are manageable.
  • Needle phobia and pain sensitivity are described as real barriers for some patients, influencing route-of-administration decisions.

Obesity, Diet, and Corporate vs Personal Responsibility

  • US obesity rose from ~17% (1990) to ~40% today; some estimate many deaths could have been avoided had GLP-1 therapy been available earlier.
  • Debate over primary drivers:
    • One side stresses cheap sugar/HFCS, 1970s farm policy, and “low‑fat, high‑sugar” reformulations.
    • Others cite data showing sugar intake has fallen since 2000 while obesity still rose, arguing hyper‑palatable foods (fat + sodium/sugar) and processed food engineering are bigger culprits.
    • Some emphasize parental/individual responsibility; others stress corporate manipulation and structural food environment.

Pricing, Patents, and Compounded Semaglutide

  • Strong criticism of US pricing (~$1k/month list, with limited insurance coverage for weight loss vs diabetes indications).
  • Compounded semaglutide is much cheaper while the drug is on the FDA shortage list; commenters explain that status temporarily permits compounding without licenses, but this will end.
  • Some compounders reportedly crush oral Rybelsus tablets as API; others worry about opaque sourcing and “shady” operators.
  • International price gaps (e.g., UK much cheaper) are noted, often blamed on US policy and lobbying.

Regulation, FDA Conservatism, and Access to Risky Drugs

  • Tension between protecting patients from harmful drugs vs the “hidden graveyard” of people who die because beneficial drugs are delayed or never developed.
  • Proposals: multi‑tier approval (experimental classes, noncommercial/terminal‑only), “accredited ingestor” status, or easier use of drugs approved in other rich countries.
  • Counterarguments stress fraud risk, desperation of terminal patients, manufacturing limits, and that even early‑stage drugs often fail on safety/efficacy.
  • Historical examples (e.g., thalidomide abroad vs delayed beta‑blocker approval in the US) are used on both sides to argue the FDA is too lax or too strict.