Ozempic Probably Won’t Be the Last Advance From Novo Nordisk
Ozempic Probably Won’t Be the Last Advance From Novo Nordisk
The Danish pharmaceutical company has produced a weight loss drug and is pursuing further advances. This functional scientific institution is a rare example of for-profit investment in basic science.
The Danish pharmaceutical company Novo Nordisk is a major global manufacturer of medications for diabetes and obesity, and is the developer of semaglutide, which—under the brand names Ozempic and Wegovy—has been approved in the United States as a weight loss drug since 2021. The drug’s perceived effectiveness has made it a global sensation. In January 2024, Novo Nordisk reached a market capitalization of almost $480 billion, with projected annual revenues of $30 billion.1 This has made it not just the most valuable company in Europe, overtaking Dutch semiconductor company ASML, but the second-most valuable pharmaceutical company worldwide behind U.S. corporation and fellow insulin manufacturer Eli Lilly, which now offers a similar weight loss drug. Novo Nordisk is a case study in how traditions of knowledge in basic science can be housed in private companies and successfully produce new knowledge that results in widespread improvements to human life.
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Ozempic, a medication for diabetes, is now Novo Nordisk’s most lucrative drug, bringing in $5.5 billion in 2022, while Wegovy, the version for obesity and weight management, brought in $570 million.2 Demand is rapidly rising in both cases, as well as for Eli Lilly’s similar products. In the first three months of 2023, Wegovy brought in $3.1 billion in revenue, while $9.4 billion of Ozempic was sold.3 Both products are weekly semaglutide injections self-administered with disposable injection pens. Wegovy’s popularity has been helped by reported widespread use among business and world leaders. Elon Musk, for one, has admitted to taking Wegovy.4 Pfizer, AstraZeneca, and other pharmaceutical companies are also seeking to enter the market.
Weight management could eventually eclipse diabetes as the company’s main source of revenue, though both obesity and diabetes are trending upwards worldwide. One global study projects that a majority of the world population will already be overweight by 2035, of whom 24% will be clinically obese.5 In the United States, more than half of adults are projected to be obese by then; the obesity rate is already around 42% according to the Centers for Disease Control and Prevention.6 According to the Milken Institute, the annual economic cost of obesity exceeds $1.4 trillion, or about 6% of U.S. GDP.7 More importantly, no country has ever reported a significant, sustained decrease in obesity or diabetes.8 Like low fertility rates, obesity and diabetes belong to a class of problems that suggest human biological incompatibility with current industrial civilization.9 Semaglutide and other compounds like it promise a scalable solution.
The high hopes for reducing or even curing obesity have already inflated the company’s finances and are further a rare example of American consumers subsidizing an innovative European company, rather than the other way around. Novo Nordisk has proved to be a functional scientific institution and the scientists who produced semaglutide, though aging, all remain involved in the company. Further improvements on semaglutide to reduce side effects, increase weight loss, produce longer-lasting effects, or address other ailments related to obesity are likely in the medium term, regulatory approval timelines notwithstanding. But even should Novo Nordisk eventually make obesity and diabetes a thing of the past, the gains in health and economic productivity will be widely dispersed. The financial gains at the company, however, are already being used to fund further basic science research.
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A Nordic Company That Sells Medicine to Diabetic Americans
Headquartered just outside Copenhagen, Denmark and with 60,000 employees worldwide, Novo Nordisk is not a small company, but nor is it a conglomerate with wide-ranging revenue streams. It has built its business narrowly on manufacturing diabetes and obesity therapeutics, especially insulin. In 2022, 79% of the company’s revenue came from diabetes therapeutics, while 9% came from obesity therapeutics and 12% from therapeutics for rare diseases.10 Novo Nordisk, Eli Lilly, and France’s Sanofi together comprise 99% of the global insulin market by value and 96% by volume.11 From 2020 to 2023, Novo Nordisk maintained about 44% of the global insulin market and grew slightly from 29% to 33% of the diabetes therapeutics market.12 Of these three companies, Novo Nordisk is the most financially reliant on diabetes and obesity therapeutics, but also the most profitable.13
Obesity medication, meaning semaglutide, is the high-growth segment for the company and has nearly doubled in revenue from 2021 to 2022.14 Molecularly, semaglutide is very similar to the hormone “glucagon-like peptide-1” (GLP-1), as is Eli Lilly’s tirzepatide. These drugs, called GLP-1 agonists, imitate the hormone in the human body and activate the same cell receptors, stimulating the body to produce more insulin when blood sugar levels rise and slowing the movement of food from the stomach to the small intestine, creating a feeling of satiety.15 Novo Nordisk also offers an oral version called Rybelsus for diabetes. As of November 2023, Novo Nordisk had an estimated 53% of the GLP-1 market in the U.S. and 69% of the market outside the U.S.16
Rare disease treatment is a comparatively small aspect of Novo Nordisk’s business. “Rare disease” is a broad medical term for ailments that affect less than 1 in 2000 people, with over 7000 such identified rare diseases existing and an estimated 350 million people suffering from them globally. They generally have no cure. Novo Nordisk focuses primarily on rare blood disorders and rare endocrine disorders i.e. hormonal disorders. Notably, the company is also a major manufacturer of human growth hormone (HGH). Novo Nordisk marketed its first human growth hormone in 1973.17 In 2017, Norditropin, the main human growth hormone developed by the company, had 37% of the global growth hormone market, more than any other drug.18
The company has production facilities in Denmark, the U.S., Brazil, France, China, Russia, Algeria, and Japan. The first part of making the drugs is manufacturing “active pharmaceutical ingredients.” Production of these is limited to sites in Denmark and the U.S. The next stage is filling or tableting the drugs. Tableting is also limited to Denmark and the U.S., but filling, packaging, and final assembly are also done in Brazil, France, and China. Although it is a global company, Denmark remains the largest and most important concentration of the company’s employees and facilities. In 2022, the company reported 55,000 employees, with 23,000 in Denmark, 7000 in North America, and 6000 in China, Hong Kong, and Taiwan.19
The company has also had to rely on contract manufacturers to scale up the production of Wegovy in response to rapidly rising demand. Its initial partner, Catalent, has suffered production setbacks in filling the Wegovy injection pens at its facility in Brussels, Belgium.20 Novo Nordisk is in talks to use U.S. firm Thermo Fisher as another contractor.21 In 2023, it purchased production sites in Ireland.22 Production of active pharmaceutical ingredients is being increased internally, with the company spending $5 billion to increase production in Denmark.23 Capital expenditure driven by manufacturing is increasing markedly, with $3.7 billion total spent in 2023, more than all capital expenditure between 2020 and 2022.24
Although its research and production are tied to Denmark, its sales are tied to the U.S. The North American market is so central to Novo Nordisk that, in its financial reports, it splits between North American operations and “international operations,” encompassing everything besides North America.25 This is a general feature of the pharmaceutical industry, where the U.S. is by far the largest market worldwide despite a relatively much smaller population. In 2021, North America accounted for 49% of global pharmaceutical sales, more than double the share of Europe.26 More importantly, 64% of sales for new medicines between 2016 and 2021 were in the U.S.27 For Novo Nordisk, the U.S. alone was 48% of net sales revenue in 2022 and North America as a whole was slightly over half of all revenue.28 It was also by far the fastest-growing market year-on-year, growing by +35% compared to just +17% for the rest of the world.
Americans spend more per capita on drugs than any other country.29 Drug prices are far higher in the U.S. For example, the average price of insulin in 2018 was $99, almost five times that of the next-highest, Chile.30 Despite being 31% of OECD insulin demand in terms of units, the U.S. represents 81% of sales.31 The U.S. market is relatively unique because it does not regulate drug prices. While in most of the world, governments directly negotiate with producers to cap drug prices, in the U.S., pharmaceutical companies are relatively free to broker prices with private insurers, or Medicare and Medicaid, the federal health insurance programs for the elderly and poor. Compared to the rest of the developed world, the U.S. population is relatively unhealthy—nearly 40% is medically obese—but also more affluent and more culturally open to taking substances. All these factors make the U.S. the top market for drugs.
The pharmaceutical industry is research and capital-intensive. Companies see immediate reductions in revenue when drug patents expire and “generic” drugmakers begin manufacturing them. The U.S. patent for semaglutide lasts from 2019 to 2033.32 In addition to patent protection, “market exclusivity” is granted by major medical agencies like the U.S. Food and Drug Administration (FDA) when a new drug is approved. This puts into place a period during which no other applications can be accepted for the same active ingredient.
There are different categories of exclusivity. For example, “orphan drug” exclusivity protects new drugs designed to counter rare diseases for up to seven years.33 This protocol, introduced in the Orphan Drug Act of 1983, incentivizes pharmaceutical companies to invest heavily in niche, rare diseases, essentially offering them a temporary monopoly. These protections allow Novo Nordisk to retain its research-intensive rare diseases division. With research timelines stretching decades, companies argue they have limited time to cash in on their investments and often selectively modify the same drug to try and maintain patent protection.34
Though it is publicly-traded and 72%-owned by various institutional investors—including BlackRock and the Norwegian sovereign wealth fund—Novo Nordisk is controlled by the Novo Nordisk Foundation, which, through a holding company, owns 28% of the company but 77% of votes in it, taking advantage of a dual-class share structure.35 The holding company, Novo Holdings, also has minority ownership but a controlling stake in Novozymes, a biotechnology firm focused on producing industrial enzymes that was spun out of Novo Nordisk in 2000.36 This foundation-ownership structure is not uncommon for major European industrial conglomerates.
Novo Holdings manages the endowment of the foundations and the profits of its two major companies, reinvesting them into philanthropic causes and business and research ventures. In 2022, its investment portfolio was €108 billion, split between targeted research or venture funding in the life sciences and more traditional capital investments such as public and private equity, fixed income, and tangible assets.37 It has an early-stage venture fund called Novo Seeds with 40 companies and close to $400 million in assets under management.38 In 2022, the foundation also awarded $1.1 billion in grants, double what it awarded in 2018.39 These grants are largely aimed at scientific work, including $200 million to build Denmark’s first quantum computer.
The Tradition of Knowledge Behind Semaglutide
Novo Nordisk’s first scientific breakthrough in GLP-1 agonists was a hormone called liraglutide, which was invented by Lotte Bjerre Knudsen, a career scientist at Novo Nordisk who first joined the company in 1989.40 She led the team that developed liraglutide in 1997, which, after more than a decade of safety trials, was approved for treating diabetes by the European Union in 2009 and the FDA in 2010. Another liraglutide product was approved in the U.S. as a weight loss drug in 2014.41 Semaglutide was the more effective and only once-weekly successor to liraglutide, which required daily injections. Novo Nordisk started clinical trials for semaglutide as early as 2008.42 A 2015 paper on semaglutide’s discovery credited a large number of researchers at the company, including Knudsen, but was led by Jesper Lau and Thomas Kruse.43 Later, a 2019 paper by the company named Knudsen as an inventor of liraglutide and Lau as an inventor of semaglutide.44
In 1994, as a junior researcher without even a doctorate, Knudsen was one of only a few researchers focusing on then-nascent GLP-1 development. Early on, results were disappointing because the drugs would only last for a few minutes before being broken down by the body. Knudsen was however given a mandate by Mads Krogsgaard Thomsen, then the new head of research for diabetes drugs, to “figure out what to do with GLP-1” to make a viable product, otherwise the research would be shut down.45 Thomsen—also a scientist by training—and Knudsen both described Novo Nordisk’s management back then as skeptical of the research, both because of disappointing initial results and because they were not inclined to see potential in GLP-1 for treating obesity, but rather only for diabetes.46
Research into GLP-1 dates back to the early 1980s. The active insulin-stimulating forms of it were discovered independently in the late 1980s by a team led by Harvard Medical School’s Joel Habener, and by the University of Copenhagen’s Jens Juul Holst.47 Importantly, according to Knudsen, Holst was her “guru” for many years in the 1990s, inspiring her to focus on developing GLP-1 at Novo Nordisk despite a wider lack of interest.48 A professor at the University of Copenhagen to this day, Holst himself has been an on-and-off consultant to the company since 1991. Though he has described having close scientific contact with the company over the years, he has downplayed his financial relationship to it.49 The company has, however, funded the Novo Nordisk Foundation Center for Basic Metabolic Research at the University of Copenhagen, where Holst leads a team, and in 2023 granted him funds and an award for his scientific achievements.50
Notably, Novo Nordisk was not the first company to bring GLP-1 drugs to market. In 2005, the FDA approved exenatide, which was developed and sold under the brand name Byetta by Eli Lilly. This hormone had its origins in research by John Eng, a physician in New York, who discovered it in the venom of the Gila monster, a lizard native to the American southwest.51 Like liraglutide, this drug was just not as effective as semaglutide eventually turned out to be, and had to be taken more often. Later, Eli Lilly developed tirzepatide, which some studies have shown to be significantly more effective at producing weight loss than semaglutide.52 Tirzepatide was approved for diabetes in the U.S. and Europe in 2022 under the brand name Mounjaro and, in November 2023, was approved by the FDA for use as a weight loss drug under the brand name Zepbound.
Semaglutide was, in short, the product of thirty years of scientific trial and error. This science was carried out and funded in large part by Novo Nordisk, following the lead of its scientists and GLP-1 champions like Lotte Bjerre Knudsen and Mads Krogsgaard Thomsen. Importantly, despite skepticism, initially disappointing results, and years of delays, the management of Novo Nordisk ultimately deferred to their scientists. Thomsen was promoted to Chief Scientific Officer in 2000, before any GLP-1 product had been released, and remained in that role until 2021, when he was appointed CEO of the Novo Nordisk Foundation, which ultimately owns the company. Knudsen and Lau remain scientists at the company in leading research roles.
In addition, the scientists employed at Novo Nordisk, like Knudsen, were only a part of a wider scientific circle genuinely attempting to solve the problem of creating a cure for obesity with GLP-1 development. Academic researchers like Jens Juul Holst, the German Michael Nauck, and the Canadian Daniel Drucker—another early pioneer in GLP-1 research, mentee of Joel Habener, and scientist who studied the venom of Gila monsters—were also evidently long-term interlocutors of Novo Nordisk’s scientists and would receive funding from Novo Nordisk for their own GLP-1 research.53 Semaglutide is thus a product of successful long-term collaboration between academic science and the pharmaceutical industry, which overlap in Novo Nordisk’s research divisions.
Novo Nordisk has close relationships with Denmark’s top universities, especially the University of Copenhagen. Four centers for stem cell, metabolism, protein, and in vivo pharmacology have been funded by Novo Nordisk at the university. Novo Nordisk and the university are the corporate and academic foundation for what is referred to as “Medicon Valley,” a cluster of pharmaceutical companies and research institutions stretching from eastern Denmark to southern Sweden. Novo Nordisk produces over half the cluster’s revenue.54 Mads Krogsgaard Thomsen was given an adjunct professorship at the University of Copenhagen the same year he was promoted to be Novo Nordisk’s Chief Scientific Officer, and later chaired the university’s board. Lotte Bjerre Knudsen attended the Technical University of Denmark, just outside Copenhagen, and is today also an adjunct professor, at Aarhus University. Many Danish university graduates in the life sciences go on to work for Novo Nordisk.
The development of semaglutide is in fact the most recent success for a company that has housed and nurtured a tradition of knowledge in endocrinology—the scientific study of hormones—for just over a hundred years. Novo Nordisk was effectively founded in 1923 by the Nobel Prize-winning Danish physiologist August Krogh and his wife Marie, also a physician and a research collaborator to her husband. Krogh was a professor at the University of Copenhagen and had been invited to the U.S. by researchers at Yale University to lecture on his medical research in 1922.55 During their tour of the U.S., Krogh and his wife—a diabetic—learned that insulin had been recently isolated and extracted for the first time by Canadian researchers Frederick Banting and John Macleod.56
In November 1922, the Kroghs visited Macleod in Toronto and returned to Denmark with a license to use his insulin production process in Scandinavia, on the condition that rather than making “nasty profits,” the profits would be reinvested into further research.57 Back in Denmark, they founded the Nordisk Insulinlaboratorium, literally Nordic Insulin Laboratory, with funding from the pharmacist August Kongsted, and set up the foundation that owned the company the same year.58 While this would become Nordisk, Novo was the result of the brothers hired to build insulin production machines splitting off to found their own insulin company in 1925. The two pharmaceutical companies both operated in Copenhagen until they merged in 1989 to form the modern incarnation of Novo Nordisk.
Following its founding, August Krogh left the company after a few years to focus on other research. Novo Nordisk was thus never run by a family dynasty. But Krogh’s intention for the organization to give deference to scientific priorities over financial ones seems to have been maintained through foundation-ownership and close ties to Danish academia. Since traditional science normally does not make financial sense for a company to pursue, this is a notable achievement of institutional design. Today, the board of the Novo Nordisk Foundation has nine members, including three employee-elected representatives. All nine are Danish. Of the six appointed members, four are scientists by career or training, three are scientific professors, and two are professors at the University of Copenhagen, including chairman Lars Rebien Sørensen.59 The previous chairman, Sten Scheibye, was also a scientist by training.
This is a stark contrast to the board of Novo Nordisk itself, where only a minority of board members are Danish—all but one as employee representatives—and which is stacked with financial and management professionals, including chairman Helge Lund, a Norwegian businessman who simultaneously serves as chairman of British Petroleum and previously ran Norway’s state oil company.60 Similarly, the CEO of Novo Nordisk, Lars Fruergaard Jørgensen, is not a scientist either. The board of Novo Holdings, the foundation’s holding company, is in-between: chaired by Lars Rebien Sørensen and majority-Danish, but led by Kasim Kutay, a British investment banker.
But, ultimately, it is the foundation that controls the companies, not the other way around, and scientific leaders like Mads Krogsgaard Thomsen can evidently rise directly from Chief Scientific Officer to become CEO of the foundation. Thomsen is perhaps a parallel to Dutch semiconductor company ASML’s Martin van den Brink, also a scientist by training who oversaw decades of successful, innovative product development and was rewarded with more organizationally-powerful positions. It seems that rather than directing science towards commercial goals themselves, the financial and management professionals at Novo Nordisk focus on commercializing the work of the scientists.
The Future of Novo Nordisk
Mads Krogsgaard Thomsen’s successor as Chief Scientific Officer is the German Marcus Schindler, who was brought in at the beginning of 2018. He joined from British-Swedish AstraZeneca, where he had been in charge of research for medicine for cardiovascular and metabolic diseases. Schindler is focused on finding acquisitions and external partnerships. In 2018, partnership projects comprised 15% of Novo Nordisk’s research pipeline. But Schindler has increased this to a third and hopes to make it 50%.61 These partnerships are necessary to access techniques that Novo Nordisk does not have internally, either to develop new drugs or to improve existing ones.
The company is ratcheting up acquisitions of smaller biotechnology companies too. Since 2018, it has spent billions of dollars on acquisitions, the most prominent being U.S.-based Dicerna in 2021. Dicerna has specialized in ribonucleic acid interference. This technology suppresses specific genes before they can produce proteins contributing to disease progression. It can be applied to diabetes and obesity treatments but also to non-alcoholic steatohepatitis, a severe fatty liver disease. Notably, Novo Nordisk partnered with Dicerna for years before acquiring it. A steady stream of further acquisitions should be anticipated if the company continues to increase partnerships. The company has said it is focusing on early-stage acquisitions to bolster its technological capabilities rather than replace its own research operations, which remain “intact.”62
Novo Nordisk’s next major obesity and diabetes product is the CagriSema drug, which is currently undergoing Phase 3 trials.63 CagriSema combines semaglutide with cagrilintide. Thomas Kruse, a leader in the development of semaglutide, led development of cagrilintide.64 The hope is that CagriSema will increase average bodyweight loss to 25%, up from 17% for Wegovy and 22.5% for Eli Lilly’s Zepbound.65 More speculatively, Novo Nordisk is also exploring medicines that could prevent obesity.66
The company’s growing revenues are being used to increase grants and capital spending on factories and research. In the first nine months of 2023, research spending was 40% higher than in the first nine months of 2022, and more than the whole year for 2021.67 The company’s research pipeline is unsurprisingly heavily skewed towards therapeutics for diabetes and obesity. But from 2020 to 2022, the proportion of research other than on diabetes and obesity increased from 12% to 16%.68 Rare diseases being targeted include sickle cell anemia and hemophilia. The windfall in revenue will still see most research focused on GLP-1 development and obesity drugs, but more resources will be set aside for rare diseases and chronic disease treatments.
The most immediate and significant potential new opportunity for Novo Nordisk are atherosclerotic cardiovascular diseases (ASCVD).69 This is a broad category that encompasses heart failure, strokes, and high cholesterol, and it is the leading cause of death in the developed world.70 Such diseases heavily overlap with obesity and diabetes too. Novo Nordisk’s management has stated it wants to release a drug targeting ASCVD and heart failure between 2024 and 2028.71 It is likely to be a form of semaglutide or another GLP-1 agonist, which, besides current uses, can also reduce heart failure symptoms.72 Semaglutide’s properties could also potentially allow it to be used to slow the progression of Alzheimer's disease or reduce alcoholism and other addictions.73 Studies on this are being undertaken by the University of Copenhagen, with the help of Jens Juul Holst and money from the Novo Nordisk Foundation.74
Novo Nordisk has had a measurable impact on the mid-sized Danish economy. From 2007 to 2022, pharmaceutical goods grew from 7% of Danish exports to 17%, from $3.8 billion to $15 billion.75 From 2010 to 2019, the life sciences sector grew from 2% to 3.5% of all income and corporate taxes, with Novo Nordisk becoming the single largest taxpayer.76 Novo Nordisk’s exports have strengthened the Danish currency, forcing the central bank to slow interest rate rises.77 Without growth in the pharmaceutical sector, which is dominated by Novo Nordisk, the Danish economy would be in a recession.78 The market capitalization of the company is now larger than Denmark’s entire GDP. Like in other countries with industrial export-oriented economies, Novo Nordisk has a close relationship with the Danish government.79
However, European Union regulators are indicating they will crack down on Novo Nordisk. CEO Lars Fruergaard Jørgensen has criticized the EU for proposed reforms to create a common pharmaceutical market, which were first unveiled in April 2023.80 They propose price negotiations on drugs with the whole EU bloc rather than individual countries. The rationale is that poorer countries cannot strike as good deals for new drugs as richer ones. The proposed reforms would also shorten patent protection for pharmaceutical companies from ten to eight years and data protection for medicines from eight to six years.81 Jørgensen has threatened to move production and research to the U.S. as a consequence.82 The Danish government has backed Novo Nordisk.83
The full potential of GLP-1 agonists—let alone of endocrinological interventions for human health and longevity—are unlikely to be exhausted already. Scientific understanding of this area has improved incrementally since the 1990s and produced liraglutide, semaglutide, and other compounds like Eli Lilly’s tirzepatide, which might be even more effective. Semaglutide is simply the first variant to have crossed the threshold of effectiveness where its effectiveness has become popularly recognized. While Thomsen, Knudsen, Lau, Kruse, and other key scientists are in their 50s and 60s now, they remain at the company and probably have a decade or so of useful work left in them. They are also likely passing down their knowledge to junior members of their teams who, like Knudsen, are liable to remain unrecognized until a major breakthrough.
The Novo Nordisk Foundation has, on paper, become the largest charitable foundation in the world by a significant margin, surpassing even the Gates Foundation.84 The man who oversaw GLP-1 development for twenty years, Mads Krogsgaard Thomsen, is now its CEO. Thomsen recognizes the foundation’s growing philanthropic potential and has said he wants to fund more research into early-stage cardiovascular and metabolic diseases, which he has called “grossly underfunded” compared to infectious diseases.85 This fits the company’s new research and acquisition strategy as well. Another executive at the foundation has compared diabetes to cancer and argued that, rather than management, a “cure” is needed.86 Rather than resting on its laurels, Novo Nordisk seems to be raising its ambitions further. While scientific breakthroughs are neither easy nor predictable, the company’s medium-term future, both scientific and financial, looks bright.
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“Revenue for Novo Nordisk (NVO),” Companies Market Cap, 2023, https://companiesmarketcap.com/novo-nordisk/revenue/
“Annual report 2022,” Novo Nordisk, 2023, https://www.novonordisk.com/content/dam/nncorp/global/en/investors/irmaterial/annual_report/2023/novo-nordisk-annual-report-2022.pdf
Tristan Manalac, “Novo Logs Over 700% Wegovy Sales Growth in Q3, Raises 2023 Outlook,” Biospace, November 2, 2023, https://www.biospace.com/article/novo-logs-over-700-percent-wegovy-sales-growth-in-q3-raises-2023-outlook-/
Anna Medaris, Gabby Landsverk, “Elon Musk says he used a popular weight-loss drug to get 'fit, ripped, and healthy',” Business insider, September 26, 2023, https://www.insider.com/elon-musk-weight-loss-drug-wegovy-semaglutide-fit-ripped-healthy-2022-10
“Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: a systematic analysis for the Global Burden of Disease Study 2021,” The Lancet, July 15, 2023, https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)01301-6/fulltext
Samo Burja, “The End of Industrial Society,” Palladium Magazine, March 24, 2021, https://www.palladiummag.com/2021/03/24/the-end-of-industrial-society/
“Annual report 2022,” Novo Nordisk, 2023, https://www.novonordisk.com/content/dam/nncorp/global/en/investors/irmaterial/annual_report/2023/novo-nordisk-annual-report-2022.pdf
David Beran, “A perspective on global access to insulin: a descriptive study of the market, trade flows and prices,” National library of medicine, April 7, 2019,
“Investor presentation – First 9 months of 2023,” Novo Nordisk, 2023, https://investor.novonordisk.com/q3-2023-presentation/?page=9
David Beran, “The insulin market reaches 100,” National library of medicine, March 11, 2022, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8915140/
“Annual report 2022,” Novo Nordisk, 2023, https://www.novonordisk.com/content/dam/nncorp/global/en/investors/irmaterial/annual_report/2023/novo-nordisk-annual-report-2022.pdf
Regina Castro, “GLP-1 agonists: Diabetes drugs and weight loss,” Mayo Clinic, June 29, 2022, https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/expert-answers/byetta/faq-20057955
“Investor presentation – First 9 months of 2023,” Novo Nordisk, 2023, https://investor.novonordisk.com/q3-2023-presentation/?page=9
“Human growth hormone market,” Market Research Future, February, 2021, https://www.marketresearchfuture.com/reports/human-growth-hormone-market-6494
“Annual report 2022,” Novo Nordisk, 2023, https://www.novonordisk.com/content/dam/nncorp/global/en/investors/irmaterial/annual_report/2023/novo-nordisk-annual-report-2022.pdf
Fraiser Kansteiner, “Lapses at Catalent plant filling Novo's Wegovy forced 2 prior shutdowns: report,” Fierce Pharma, July 27, 2023, https://www.fiercepharma.com/pharma/catalent-suffered-sterility-quality-lapses-belgian-plant-filling-novos-wegovy-report
Dan Stanton, “Wegovy: Thermo Fisher allegedly second CDMO for Novo Nordisk,” BioProcess International, August 24, 2023, https://bioprocessintl.com/bioprocess-insider/facilities-capacity/wegovy-thermo-fisher-allegedly-second-cdmo-for-novo-nordisk/
“Novo Nordisk buys production facilities in Ireland,” MedWatch, December 15, 2023, https://medwatch.com/News/Pharma___Biotech/article16689234.ece
“Novo Nordisk plans multi-billion Denmark manufacturing expansion,” European Pharmaceutical Review, November 10, 2023, https://www.europeanpharmaceuticalreview.com/news/188581/novo-nordisk-plans-multi-billion-denmark-manufacturing-expansion/
“Investor presentation – First 9 months of 2023,” Novo Nordisk, 2023, https://www.novonordisk.com/content/dam/nncorp/global/en/investors/pdfs/financial-results/2023/Q3-2023-investor-presentation.pdf
Ibid.
The Pharmaceutical Industry in Figures,” The European federation of pharmaceutical industries and associations, 2022,
https://www.efpia.eu/media/637143/the-pharmaceutical-industry-in-figures-2022.pdf
“The Global Use of Medicines 2022,” IQVIA Institute, January, 2022, https://www.iqvia.com/-/media/iqvia/pdfs/library/publications/the-global-use-of-medicines-2022.pdf
“Annual report 2022,” Novo Nordisk, 2023, https://www.novonordisk.com/content/dam/nncorp/global/en/investors/irmaterial/annual_report/2023/novo-nordisk-annual-report-2022.pdf
Matej Mikulic, “Pharmaceutical spending per capita in selected countries in 2022,” Statista, August 22, 2023, https://www.statista.com/statistics/266141/pharmaceutical-spending-per-capita-in-selected-countries/
Doug Irving, “The Astronomical Price of Insulin Hurts American Families,” RAND Organization, January 6, 2021, https://www.rand.org/pubs/articles/2021/the-astronomical-price-of-insulin-hurts-american-families.html
Andrew W. Mulcahy, Daniel Schwam, Nathaniel Edenfield, “Comparing Insulin Prices in the United States to Other Countries,” RAND Organization, Oct 6, 2020,
Kevin Dunleavy, “At Viatris' request, US agency will review Novo Nordisk patent on semaglutide,” Fierce Pharma, October 5, 2023, https://www.fiercepharma.com/pharma/novo-nordisk-patent-semaglutide-invalid-viatris-request-uspto-will-review
“Types of Marketing Exclusivity in Drug Development,” Allucent, 2023, https://www.allucent.com/resources/blog/types-marketing-exclusivity-drug-development
Robin Feldman, “May Your Drug Price Be Evergreen,”Oxford Journal of Law and the Biosciences, October 31, 2017, https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3061567
Steen Thomsen, “Foundation Ownership at Novo Nordisk,” Copenhagen Business School, May 4, 2016, https://www.enterprisefoundations.dk/wp-content/uploads/2020/08/Novo-Nordisk-09.pdf
“Final year report 2022,” Novo Holdings, 2023, https://a.storyblok.com/f/228216/x/c2fad90a2b/novo-holdings-annual-report-2022.pdf
“Seed investments,” Novo Holdings, 2023, https://novoholdings.dk/investments/seed-investments
“Final year report 2022,” Novo Holdings, 2023, https://a.storyblok.com/f/228216/x/c2fad90a2b/novo-holdings-annual-report-2022.pdf; 'Molly Gamble, “Weight-loss drug wealth' shows up in charitable giving,” Becker’s Hospital Review, October 17, 2023, https://www.beckershospitalreview.com/pharmacy/weight-loss-drug-wealth-shows-up-in-charitable-giving.html
Martin U. Muller and Alexander Preker, “Interview with Weight Loss Drugs Inventor Lotte Bjerre Knudsen,” Der Spiegel, January 4, 2024, https://www.spiegel.de/international/business/interview-with-weight-loss-drugs-inventor-lotte-bjerre-knudsen-a-f2815950-ff24-4e87-b7e9-b6d6c1982d57
“FDA approves weight management drug for patients aged 12 and older,” U.S. food & drug administration, June 15, 2021, https://www.fda.gov/drugs/news-events-human-drugs/fda-approves-weight-management-drug-patients-aged-12-and-older
Jesper Lau et al., “Discovery of the Once-Weekly Glucagon-Like Peptide-1 (GLP-1) Analogue Semaglutide,” J. Med. Chem. 2015, 58, 18, 7370–7380, Publication Date: August 26, 2015, https://doi.org/10.1021/acs.jmedchem.5b00726. URL: https://pubs.acs.org/doi/10.1021/acs.jmedchem.5b00726
Lotte Bjerre Knudsen and Jesper Lau, “The Discovery and Development of Liraglutide and Semaglutide,” Front. Endocrinol., 12 April 2019. Sec. Molecular and Structural Endocrinology. Volume 10 - 2019 | https://doi.org/10.3389/fendo.2019.00155. URL: https://www.frontiersin.org/articles/10.3389/fendo.2019.00155/full
Lotte Bjere Knudsen, “Inventing Liraglutide, a Glucagon-Like Peptide‑1 Analogue, for the Treatment of Diabetes and Obesity,” ACS Pharmacology and translational science, 2019,
Ibid.
Lotte Bjere Knudsen, “Inventing Liraglutide, a Glucagon-Like Peptide‑1 Analogue, for the Treatment of Diabetes and Obesity,” ACS Pharmacology and translational science, 2019,
Matt Reynolds, “What the Scientists Who Pioneered Weight-Loss Drugs Want You to Know,” WIRED, June 12, 2023, https://www.wired.co.uk/article/obesity-drugs-researcher-interview-ozempic-wegovy
“Researcher receives prize for huge contribution to modern treatment of diabetes and obesity,” Novo Nordisk Foundation, May 16, 2023, https://novonordiskfonden.dk/en/news/researcher-receives-prize-for-huge-contribution-to-modern-treatment-of-diabetes-and-obesity/
Patricia Rodriguez et al., “Comparative Effectiveness of Semaglutide and Tirzepatide for Weight Loss in Adults with Overweight and Obesity in the US: A Real-World Evidence Study,” medRxiv, November 22, 2023, https://www.medrxiv.org/content/10.1101/2023.11.21.23298775v1
For example, see the two Novo Nordisk-funded outside semaglutide studies in the Abstracts of the 48th EASD Annual Meeting of the European Association for the Study of Diabetes here: https://link.springer.com/article/10.1007/s00125-012-2688-9
“State of Medicon Valley 2022,” Medicon Valley alliance, November 2022, https://mva.org/wp-content/uploads/2022/11/State-of-Medicon-Valley-2022_MASTER-Final.pdf
“The Nobel Prize in Physiology or Medicine 1920,” The Nobel Prize, 2023, https://www.nobelprize.org/prizes/medicine/1920/summary/v
Jan Lindsten, “August Krogh and the Nobel Prize to Banting and Macleod,” The Nobel Prize, April 2, 2001, https://www.nobelprize.org/prizes/themes/august-krogh-and-the-nobel-prize-to-banting-and-macleod/
“How anti-obesity drugs built the world’s largest charitable foundation,” Financial Times, December 26, 2023, https://www.ft.com/content/69324884-a626-4787-a4ce-aece410d1dcc
Hannah Blake, “A history of... Novo Nordisk,” Pharmaphorum, February 27, 2013, https://pharmaphorum.com/views-and-analysis/a_history_of-_novo_nordisk
Christopher Due Karlsson, “Novo Nordisk's acquisition journey is driven by price pressure and a hunger for innovation,” MedWatch, March 28, 2022,
https://medwatch.com/News/Pharma___Biotech/article13833672.ece
Maggie Fick and Jacob Gronholt-Pedersen, “Novo seeks obesity, diabetes 'bolt-on' deals,” Reuters, November 10, 2023, https://www.reuters.com/business/healthcare-pharmaceuticals/drugmaker-novo-nordisk-seeks-obesity-diabetes-bolt-on-deals-2023-11-10/
“R&D pipeline,” Novo Nordisk, 2023,
https://www.novonordisk.com/science-and-technology/r-d-pipeline.html
Thomas Kruse, “Development of Cagrilintide, a Long-Acting Amylin Analogue,” Journal of medicinal chemistry, July 21, 2021,
Christian Bundgaard, “Novo Nordisk goes head-to-head with Eli Lilly obesity drug Zepbound,” MedWatch, November 16, 2023, https://medwatch.com/News/Pharma___Biotech/article16610231.ecehttps://medwatch.com/News/Pharma___Biotech/article16610231.ece
Hannah Kuchler , Richard Milne, “Novo Nordisk seeks to use obesity drug findings to prevent weight gain,” The Financial Times, December 5, 2023,
https://www.ft.com/content/63092b84-1ec6-42cf-85ba-f4578f31d3ab
“Investor presentation – First 9 months of 2023,” Novo Nordisk, 2023, https://www.novonordisk.com/content/dam/nncorp/global/en/investors/pdfs/financial-results/2023/Q3-2023-investor-presentation.pdf
“Annual report 2022,” Novo Nordisk, 2023, https://www.novonordisk.com/content/dam/nncorp/global/en/investors/irmaterial/annual_report/2023/novo-nordisk-annual-report-2022.pdf
Martin Holst Lange, Camilla Sylvest, “Cardiovascular Disease - Capital markers day presentation,” Novo Nordisk, March 3, 2022, https://www.novonordisk.com/content/dam/nncorp/global/en/investors/pdfs/capital-markets-day-2022/P7-other-serious-chronic-disease.pdf
Ibid.
Ibid.
Katie Kindelan, “Semaglutide used for weight loss also helps reduce heart failure symptoms, study finds,” ABC News, August 28, 2023, https://abcnews.go.com/GMA/Wellness/semaglutide-weight-loss-helps-reduce-heart-failure-symptoms/story?id=102616437
Natalie Grover, “Focus: After weight loss, Alzheimer's may be next frontier for drugs like Ozempic,” Reuters, May 8, 2023, https://www.reuters.com/business/healthcare-pharmaceuticals/after-weight-loss-alzheimers-may-be-next-frontier-drugs-like-ozempic-2023-05-08/
Naomi Kresge, Madison Muller, “Can Wegovy Fight Alcoholism? For Big Pharma, This Isn’t a Priority,” Bloomberg, December 6, 2023, https://www.bloomberg.com/news/articles/2023-12-06/can-ozempic-wegovy-treat-alcoholism-for-big-pharma-it-s-not-a-priority?sref=ZqW0mZJf
“Value of imports and exports (DKK 1,000) by main SITC groups, country and imports and exports,” Denmark Statistics, 2023,
“State of Medicon Valley 2021,” Medicon Valley Alliance, November 2021, https://mva.org/wp-content/uploads/2021/11/State_of_Medicon_Valley_2021.pdf
Sanne Wass, “Novo’s Rise Forces Denmark to Keep Rates Lower, Danske Says,” Bloomberg, August 16, 2023, https://www.bloomberg.com/news/articles/2023-08-16/novo-s-rise-forces-denmark-to-keep-rates-lower-danske-says?sref=ZqW0mZJf
Richard Milne, “Obesity drugmaker’s expansion raises dominance worries for Denmark,” The Financial Times, September 28, 2023,
https://www.ft.com/content/c4e8a5e2-6be4-47dd-a995-ffe4eb0b05b7
Andreas Lonstrup, “Billion-dollar profit boosts Novo Nordisk Foundation's political power,” MedWatch, November 27, 2023,
https://medwatch.com/News/Pharma___Biotech/article16637760.ece
“Reform of the EU pharmaceutical legislation,” European Commission, April 26, 2023, https://health.ec.europa.eu/medicinal-products/pharmaceutical-strategy-europe/reform-eu-pharmaceutical-legislation_en
Andy Bounds, Hannah Kuchler, Donato Paolo Mancini, “EU aims to create ‘single market for medicines’ with overhaul of pharma rules,” The Financial Times, April 26, 2023, https://www.ft.com/content/ace93ce5-7baa-41c5-9f6b-2a01e64914e4
“Novo Nordisk CEO sounds alarm on EU reform for cheaper medicines,” MedWatch, June 11, 2023, https://medwatch.com/News/Pharma___Biotech/article16576320.ece
Peter Thomsen, “Minister: Several countries are against key proposal in controversial EU reform,” MedWatch, September 27, 2023,
“How anti-obesity drugs built the world’s largest charitable foundation,” Financial Times, December 26, 2023, https://www.ft.com/content/69324884-a626-4787-a4ce-aece410d1dcc
Ibid.
Ibid.