Novo Nordisk (Ozempic)

The episode introduces Novo Nordisk as a company whose identity and revenue remain concentrated in metabolic health. It is not a broadly diversified pharmaceutical conglomerate: for roughly a century, insulin and diabetes have been its core. The hosts use this unusual focus to explain why the arrival of Ozempic and Wegovy matters. The drugs connect a long established diabetes business to a much larger public debate about obesity and weight loss.

The scale of need is central to the story. The hosts cite 38 million Americans and more than 500 million people worldwide with diabetes, and estimate that about one billion people globally have obesity. They present these figures as evidence of a very large potential market. At the same time, the emergence of GLP-1 drugs was not sudden: semaglutide trials for type 2 diabetes began in 2008, built on research from the early 1990s, and evidence that GLP-1 could reduce food intake had appeared in scientific literature in the mid-1990s. The episode asks how a decades-long research program became a public phenomenon only much later.

The historical narrative begins in Toronto in 1921, with a University of Toronto Medical School group that extracted insulin from the pancreas. Its members included physician Frederick Banting, medical student Charles Best, and chemist John Macleod. Credit for the discovery remained controversial: the hosts say later historical consensus gave much of the credit to Banting and Best, although the 1923 Nobel Prize went to Banting and Macleod. The episode notes that this question of recognition would return later in the company's story.

Before insulin, Type 1 diabetes was often a death sentence, and patients were placed on starvation diets that could prolong life but offered little quality of life. The Toronto researchers found a substance from dog pancreases that patients could use, producing dramatic recoveries. Yet insulin was not a cure: patients needed repeated injections as their bodies used it up. The early discovery was therefore both a medical breakthrough and the beginning of a demanding treatment routine for patients.

The initial production process was fragile and difficult to scale. The hosts describe an early procedure that was documented, lost, and later reconstructed; meanwhile, only a small number of usable vials were available in Toronto. The University of Toronto's culture also resisted the idea of making private fortunes from medical discoveries, even as demand grew and patients needed insulin for life. This created a practical tension between open medical research and the industrial capacity required to supply a chronic treatment.

The university addressed the supply problem by licensing Eli Lilly, an American drug company, an exclusive one year right to develop mass production. Lilly had to report manufacturing advances back to the university, while retaining its brand. The hosts describe the arrangement as a compromise: industry could invest in production, but technical learning was shared. They also note how scaling insulin required sourcing animal pancreases from slaughterhouses, turning what would otherwise be waste into a new supply chain. The first commercialization challenge was therefore not only scientific; it depended on logistics, incentives, and the willingness of industrial partners to reorganize production.

Eli Lilly's one year license paired industrial production with shared technical learning. Lilly had to report manufacturing advances to the University of Toronto, but it could retain its own brand, giving customers a recognizable signal of the product's source and quality after the exclusive period ended. The arrangement helped make insulin available beyond a small university supply while allowing Lilly to build a durable commercial identity around it.

The founders of Novo Nordisk entered the story through an unexpected connection: August Krogh, a 1920 Nobel laureate and animal physiologist, nominated Banting and Macleod for the 1923 prize. His wife Marie was diagnosed with diabetes in 1920. She was a physician and Denmark's first woman to earn a doctorate in medicine. Her illness connected the Kroghs with Hans Christian Hagedorn, a Copenhagen endocrinologist, and helped set in motion the effort to bring insulin to Scandinavia.

August and Marie traveled to the United States in 1922, where Harvard physician Elliott Joslin told them about the Toronto discovery. August then visited Toronto, met John Macleod, and observed insulin production. Denmark did not allow drug patents at the time, so a conventional national patent license would not have been enforceable. Instead, the Insulin Committee gave the Kroghs and Hagedorn its formal support and rights across Scandinavia. They returned to Copenhagen, sourced animal pancreases, and used the Toronto method to extract insulin.

The same supply problem faced the Scandinavian effort as the Toronto team: laboratory extraction could not meet population wide demand. The hosts cite an estimate that producing one pound of insulin required 8,000 pounds of pancreatic glands from 23,500 animals. Even by 1980, one million animals were reportedly needed each year to supply 30,000 patients. The story establishes a constraint that would shape the business for decades: before newer production methods arrived, insulin output depended on the amount of animal tissue that could be sourced and processed.

To scale production, the Kroghs and Hagedorn partnered with Løvens Kemiske Fabrik, or The Lion's Chemical Factory, owned by August Kongsted. By the summer of 1923, the group had enough insulin to complete successful trials with eight patients in Copenhagen. Hagedorn left medical practice to focus on the work full time. The product was sold under the name Insulin Leo, a brand that the hosts say remained associated with Nordisk insulin for decades.