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Drug Pricing, GLP-1s, and the Long Game in Cancer Care
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Released: August 28, 2026

John Marshall
John Marshall, MD
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Drug Pricing, GLP-1s, and the Long Game in Cancer Care

[00:00:06] John Marshall, MD: Summer traditionally is a kind of slow time for new papers and new stuff that's happening in the business world. So our federal government did its usual thing, and we actually got a press release very recently that said, "Never before have we seen such a fall in drug prices."

And of course, our current administration claimed that it was they who were totally responsible for all the good things that have happened in the world. Well, the reality, if one looks back, is that this story about drug pricing, brief history, was created by the second George Bush when we were trying to expand access to insurance covering drugs, oral medicines at your local pharmacy, particularly in the Medicare space.

And so there needed to be some deals cut, and one of the deals that was cut is that we agreed that we would not negotiate drug price. Of course, that started the current wave that has occurred where, when a drug gets FDA-approved, they basically can ask whatever they want, and insurance companies basically need to figure out how to pay that. So that's created this dramatic escalation in the price of drugs. Well, Biden, I don't know if you remember him, he basically was the first one that came out and said, "We've got to start changing this." And he published a list of, I think it was 10 drugs that we're going to now negotiate price on as a sort of trial balloon.

In the next year, another list came out, and since then there have been increasing numbers of drugs that have been on the list where we, as a US government, the government and CMS Medicare, have a right to negotiate the price of those drugs. And that's essentially what the current administration is claiming as the victory is that we're now starting to see that having an impact on our overall budget in healthcare through a reduction in some very expensive drugs' prices.

I coupled that story with the fact that I spent the weekend with someone who, for the first time ever, I'd actually spent a weekend with somebody who's on a GLP-1 drug. And this is a good friend of mine who initially started taking it because of being a bit heavy, maybe a bit of prediabetes.

But because he doesn't fit the classic scenario, he basically is buying the medicine himself, at a decent cost, as you might expect.

Living with him for the weekend and eating three meals a day with him taught me something about these medicines: that he eats completely differently: what he eats, how much he eats, his need to focus on getting enough protein because his appetite has been turned down a bit.

He certainly has lost some weight, and his blood counts look better. So, the impact he was looking for, he's had, he's having with this medicine. But then I started to dig a little deeper on this, and what came out these past couple of weeks is that there's been this dramatic rise in the number of people in the United States who are taking GLP-1 drugs.

So, in 2024, what AI told me was that 3% of us in the United States were on these drugs. They were first founded in, like, 2005, so they've made their way along. But just a few, couple years ago, 3%, and now it's 12% of the US population on these drugs. So, that's a dramatic increase in these medicines. Now, so far, the stats say that about half of everybody who takes them stops them at about one year.

And as I think you all already know, when you stop them, you kind of revert back to what you were doing before. So, it's, it's only while you're taking the medicine. It doesn't fix it, and then you're done. It's only while you're taking the medicine that you have the impact. No question, we've seen obesity rates fall as a result of this.

So far, again, this is new; we haven't been following people for very long, and that's sort of my main worry here: that we haven't seen a big change in diabetes outcomes at this point. So yes, people get skinnier, yes, their blood sugars get better, but are we going to see the downstream positive effect with less cardiac and other problems, vascular disease, et cetera, from that?

So, people are changing their eating habits, a lot of them. And you know I'm all obsessed with microbiome and needing to eat the variety that's out there and you know, sort of that Mediterranean-based diet, full of plants. Yes, some protein, but full of a variety of plants. Also, what comes with these is actually muscle wasting, so we may be changing microbiome not for the better.

We may be changing our muscle mass also not for the better. But again, they're so new we haven't really seen the long-term impact. Where does this play in cancer? There have been several reports; patients have been bringing me their phone reports, where they see reports of GLP-1 drugs decreasing carcinogenic risk.

Well, that hasn't really turned into a real clear decrease in incidence of the disease. The things that cause the risk, obesity and other things like that, have fallen, and so the assumption is that we're going to see a decrease in cancer as a downstream result. So I've got patients on active therapy who want to also be on a GLP-1 drug, and I can't really justify doing that based on where we are now.

There also is some suggestion that they might have other anti-inflammatory effects that would help suppress tumors. So there is an emerging lore (that's all it is at the present) that these drugs might in fact help with regard to cancer downstream as well. So, in a way, it's kind of almost too good to be true on some level, and I'm nervous: when all of these people are taking these drugs for this long of a period of time, what will in fact be the actual outcome?

And as you know, I reflect back on past times that I've had, and it sort of reminds me of the opioid crisis. I realize it's different, but do you remember when pain was not a vital sign, because it didn't use to be? It became a vital sign because the companies who made the opioids, as part of what we later called the opioid crisis, said, "We need to have pain as a vital sign."

And when I trained and when I was an early faculty member, there was no dose that was too high. You just kept going up on everybody. So I had lots of patients on very high milligrams of narcotics, and I had a palliative care program that was standing next to me that said, "Yep, that's the right thing to do," only to later find out that we had created this sort of national pain crisis that was built on not the best research, if you will.

And so now I have maybe one person at a time who's on such high doses of narcotics, again, with that same palliative care team next to me, but we seem to be doing okay without those super high doses. And so I realize it's different, but it makes me think of these waves of sort of... They're not fads…There's science and there's intervention and there's ability to intervene, right, on these folks, but without a really clear understanding of where it's going to end up in the long game. So I'm not saying don't take GLP-1s. They're very useful in the right patient population. You gotta keep taking them, as best I understand. But I do think we need to watch very carefully over time: what does this do to our microbiome as we begin to understand more about that? What does it do to muscle mass? What does it actually do to long-term cardiovascular risk and other things that diabetes and obesity lead to, including increased risk of cancer?

So, fingers crossed, it is a medicine and a medicine approach that we will figure out and optimize for the right patient at the right time, and as a result, we will see less cancer, fewer other problems, and they'll be worth their weight in gold.

John Marshall, Oncology Unscripted.

This transcript was generated by AI and lightly edited for clarity.