615. Is Ozempic as Magical as It Sounds?

In a wide-ranging conversation with Ezekiel Emanuel, the policymaking physician and medical gadfly, we discuss the massive effects of GLP-1 drugs like Ozempic, Wegovy, and Mounjaro. We also talk about the state of cancer care, mysteries in the gut microbiome, flaws in the U.S. healthcare system — and what a second Trump term means for healthcare policy. SOURCES:Ezekiel Emanuel, vice provost for Global Initiatives, co-director of the Health Transformation Institute, and professor at the University of Pennsylvania Perelman School of Medicine. RESOURCES:"Obesity Drugs Would Be Covered by Medicare and Medicaid Under Biden Proposal," by Margot Sanger-Katz (The New York Times, 2024)."International Coverage of GLP-1 Receptor Agonists: A Review and Ethical Analysis of Discordant Approaches," by Johan L. Dellgren, and Govind Persad, and Ezekiel J. Emanuel (The Lancet, 2024).The Coming Wave: Technology, Power, and the Twenty-first Century's Greatest Dilemma, by Mustafa Suleyman (2023)."The Significance of Blockbusters in the Pharmaceutical Industry," by Alexander Schuhmacher, Markus Hinder, Nikolaj Boger, Dominik Hartl, and Oliver Gassmann (Nature Reviews Drug Discovery, 2022).Reinventing American Health Care: How the Affordable Care Act Will Improve Our Terribly Complex, Blatantly Unjust, Outrageously Expensive, Grossly Inefficient, Error Prone System, by Ezekiel J. Emanuel (2014)."Why I Hope to Die at 75," by Ezekiel J. Emanuel (The Atlantic, 2014)."Direct-to-Consumer Advertising of Pharmaceuticals," by Ziad F. Gellad and Kenneth W. Lyles (The American Journal of Medicine, 2014).Brothers Emanuel: A Memoir of an American Family, by Ezekiel J. Emanuel (2013)."Bounds in Competing Risks Models and the War on Cancer," by Bo E. Honoré and Adriana Lleras-Muney (Econometrica, 2006). EXTRAS:"How to Fix Medical Research," by People I (Mostly) Admire (2024)."The Suddenly Diplomatic Rahm Emanuel," by Freakonomics Radio (2023)."Ari Emanuel Is Never Indifferent," by Freakonomics Radio (2023)."Who Pays for Multimillion-Dollar Miracle Cures?" by Freakonomics, M.D. (2023)."Who Gets the Ventilator?" by Freakonomics Radio (2020).

Last week, we heard a former U.S. ambassador describe Russia’s escalating conflict with the U.S. Today, we revisit a 2019 episode about an overlooked front in the Cold War — a “farms race” that, decades later, still influences what Americans eat. SOURCES:Anne Effland, former Senior Economist for the Office of Chief Economist in the U.S.D.A.Shane Hamilton, historian at the University of York.Peter Timmer, economist and former professor at Harvard University.Audra Wolfe, writer, editor, and historian. RESOURCES:Freedom’s Laboratory: The Cold War Struggle for the Soul of Science, by Audra Wolfe (2018).Supermarket USA: Food and Power in The Cold War Farms Race, by Shane Hamilton (2018).“Association of Higher Consumption of Foods Derived From Subsidized Commodities With Adverse Cardiometabolic Risk Among US Adults,” by Karen R. Siegel, Kai McKeever Bullard, K. M. Narayan, et al. (JAMA Internal Medicine, 2016).The Rise and Fall of American Growth: The U.S. Standard of Living Since the Civil War, by Robert J. Gordon (2016).“How the Mechanical Tomato Harvester Prompted the Food Movement,” by Ildi Carlisle-Cummins (UC Davis Department of Plant Sciences Newsletter, 2015). EXTRAS:"Is the U.S. Sleeping on Threats from Russia and China?" by Freakonomics Radio (2024).

John J. Sullivan, a former State Department official and U.S. ambassador, says yes: “Our politicians aren’t leading — Republicans or Democrats.” He gives a firsthand account of a fateful Biden-Putin encounter, talks about his new book Midnight in Moscow, and predicts what a second Trump term means for Russia, Ukraine, China — and the U.S. SOURCES:John Sullivan, former U.S. Deputy Secretary of State and former U.S. Ambassador to Russia.  RESOURCES:Midnight in Moscow: A Memoir from the Front Lines of Russia's War Against the West, by John Sullivan (2024)."The ‘Deathonomics’ Powering Russia’s War Machine," by Georgi Kantchev and Matthew Luxmoore (The Wall Street Journal, 2024).War, by Bob Woodward (2024)."On the Record: The U.S. Administration’s Actions on Russia," by Alina Polyakova and Filippos Letsas (Brookings, 2019)."Why Economic Sanctions Still Do Not Work," by Robert A. Pape (International Security, 1998). EXTRAS:"The Suddenly Diplomatic Rahm Emanuel," by Freakonomics Radio (2023).

Macy’s wants to recapture its glorious past. The author of the Wimpy Kid books wants to rebuild his dilapidated hometown. We just want to listen in. (Part two of a two-part series.) SOURCES:Mark Cohen, former professor and director of retail studies at Columbia Business School.Will Coss, vice president and executive producer of Macy’s Studios.Jeff Kinney, author, cartoonist, and owner of An Unlikely Story Bookstore and Café.Tony Spring, chairman and C.E.O. of Macy’s Inc. RESOURCES:"Macy’s Discovers Employee Hid Millions in Delivery Expenses," by Jordyn Holman and Danielle Kaye (The New York Times, 2024)."NBC Ready to Pay Triple to Gobble Up Thanksgiving Parade Broadcast Rights," by Joe Flint (The Wall Street Journal, 2024)."How Macy’s Set Out to Conquer the Department Store Business — and Lost," by Daphne Howland (Retail Dive, 2022).An Unlikely Story Bookstore and Café. EXTRA:"Can the Macy's Parade Save Macy's?" series by Freakonomics Radio (2024).

The 166-year-old chain, which is fighting extinction, calls the parade its “gift to the nation.” With 30 million TV viewers, it’s also a big moneymaker. At least we think it is — Macy’s is famously tight-lipped about parade economics. We try to loosen them up. (Part one of a two-part series.)Please take our audience survey at freakonomics.com/survey. SOURCES:John Cheney, carpenter at Macy’s Studios.Will Coss, vice president and executive producer of Macy’s Studios.Jeff Kinney, author, cartoonist, and owner of An Unlikely Story Bookstore and Café.Kevin Lynch, vice president of global helium at Messer.Jen Neal, executive vice president of live events and specials for NBCUniversal EntertainmentTony Spring, chairman and C.E.O. of Macy's Inc.Jessica Tisch, commissioner of the New York City Department of Sanitation; incoming commissioner of the New York City Police Department.Dawn Tolson, executive director of Citywide Event Coordination and Management and the Street Activity Permit Office for the City of New York. RESOURCES:Macy's: The Store. The Star. The Story., by Robert M. Grippo (2009).History of Macy's of New York, 1853-1919: Chapters in the Evolution of the Department Store, by Ralph M. Hower (1943).Macy's Thanksgiving Day Parade. EXTRA:The Economics of Everyday Things. 

It’s true that robots (and other smart technologies) will kill many jobs. It may also be true that newer collaborative robots (“cobots”) will totally reinvigorate how work gets done. That, at least, is what the economists are telling us. Should we believe them? SOURCES:David Autor, professor of economics at the Massachusetts Institute of Technology.James Rosenman, C.E.O. of Andrus on Hudson senior care community.Karen Eggleston, economist at Stanford University.Yong Suk Lee, professor of technology, economy, and global affairs at the University of Notre Dame. RESOURCES:"Robots and Labor in Nursing Homes," by Yong Suk Lee, Toshiaki Iizuka, and Karen Eggleston (NBER Working Paper, 2024)."Global Robotics Race: Korea, Singapore and Germany in the Lead," by International Federation of Robotics (2024)."Unmet Need for Equipment to Help With Bathing and Toileting Among Older US Adults," by Kenneth Lam, Ying Shi, John Boscardin, and Kenneth E. Covinsky (JAMA Internal Medicine, 2021)."Robots and Labor in the Service Sector: Evidence from Nursing Homes," by Karen Eggleston, Yong Suk Lee, and Toshiaki Iizuka (NBER Working Papers, 2021).The Work of the Future: Building Better Jobs in an Age of Intelligent Machines, by David Autor, David Mindell, Elisabeth Reynolds, and the MIT Task Force on the Work of the Future (2020)."Robots and Jobs: Evidence from US Labor Markets," by Daron Acemoglu and Pascual Restrepo (University of Chicago Press, 2020)."The Slowdown in Productivity Growth and Policies That Can Restore It," by Emily Moss, Ryan Nunn, and Jay Shambaugh (The Hamilton Project, 2020)."The China Shock: Learning from Labor Market Adjustment to Large Changes in Trade," by David H. Autor, David Dorn, and Gordon H. Hanson (NBER Working Papers, 2016)."Deregulation at Heart of Japan's New Robotics Revolution," by Sophie Knight and Kaori Kaneko (Reuters, 2014). EXTRAS:"What Do People Do All Day?" by Freakonomics Radio (2024)."Did China Eat America’s Jobs?" by Freakonomics Radio (2017).

After a dramatic election, Donald Trump has returned from exile. We hear what to expect at home and abroad — and what to do if you didn’t vote for Trump. SOURCE:Fareed Zakaria, journalist and author. RESOURCES:"The Most Dangerous Moment Since the Cold War," by Fareed Zakaria (The Washington Post, 2024)."America’s Failed Approach to Iran Can’t Really Be Called a Strategy," by Fareed Zakaria (The Washington Post, 2024).Age of Revolutions: Progress and Backlash from 1600 to the Present, by Fareed Zakaria (2024). EXTRAS:"Are We Living Through the Most Revolutionary Period in History?" by Freakonomics Radio (2024)."Are Private Equity Firms Plundering the U.S. Economy?" by Freakonomics Radio (2023).

Some people want the new cannabis economy to look like the craft-beer movement. Others are hoping to build the Amazon of pot. And one expert would prefer a government-run monopoly. We listen in as they fight it out. (Part four of a four-part series.) SOURCES:Jon Caulkins, professor of operations research and public policy at Carnegie Mellon University.Adam Goers, senior vice president of The Cannabist Company and chairperson of the Coalition for Cannabis Scheduling Reform.Yasmin Hurd, director of the Addiction Institute at Mount Sinai.Jared Polis, governor of Colorado.Ryan Stoa, associate professor of law at Louisiana State University. RESOURCES:"Prevalence of and Trends in Current Cannabis Use Among U.S. Youth and Adults, 2013–2022," by Delvon T. Mattingly, Maggie K. Richardson, and Joy L. Hart (Drug and Alcohol Dependence Reports, 2024)."Colorado’s Weed Market Is Coming Down Hard and It’s Making Other States Nervous," by Mona Zhang (Politico, 2024)."Reducing Alcohol Consumption, the Nordic Way: Alcohol Monopolies, Marketing Bans and Higher Taxation," by the World Health Organization (2023)."Economic Benefits and Social Costs of Legalizing Recreational Marijuana," by Jason P. Brown, Elior Cohen, and Alison Felix (Federal Reserve Bank of Kansas City Research Working Paper, 2023)."Competition in the Markets for Beer, Wine, and Spirits," by the United States Department of the Treasury (2022)."Alcohol Monopolies," by Robin Room (Scottish Health Action on Alcohol Problems, 2021)."Craft Beer Is the Strangest, Happiest Economic Story in America," by Derek Thompson (The Atlantic, 2018)."Marijuana Discontinuation, Anxiety Symptoms, and Relapse to Marijuana," by Marcel O. Bonn-Miller and Rudolf H. Moos (Addictive Behaviors, 2009). EXTRAS:"Is America Switching from Booze to Weed?" series by Freakonomics Radio (2024)."Why Do Your Eyeglasses Cost $1,000?" by Freakonomics Radio (2024)."Should You Trust Private Equity to Take Care of Your Dog?" by Freakonomics Radio (2023)."Is Dialysis a Test Case of Medicare for All?" by Freakonomics Radio (2021).

Chris Weld worked for years in emergency rooms, then ditched that career and bought an old farm in Massachusetts. He set up a distillery and started making prize-winning spirits. When cannabis was legalized, he jumped into that too — and the first few years were lucrative. But now? It turns out that growing, processing, and selling weed is more complicated than it looks. He gave us the grand tour.  (Part three of a four-part series.) SOURCES:Chris Bennett, operations manager at Berkshire Mountain Distillers.Luca Boldrini, head of cultivation at The Pass.Yasmin Hurd, director of the Addiction Institute at Mount Sinai.Chris Weld, founder and owner of Berkshire Mountain Distillers. RESOURCES:"As America’s Marijuana Use Grows, So Do the Harms," by Megan Twohey, Danielle Ivory, and Carson Kessler (The New York Times, 2024)."Evaluation of Dispensaries’ Cannabis Flowers for Accuracy of Labeling of Cannabinoids Content," by Mona M. Geweda, Chandrani G. Majumdar, Mahmoud A. ElSohly, et al. (Journal of Cannabis Research, 2024)."The Complicated, Risky — but Potentially Lucrative — Business of Selling Cannabis," by James R. Hagerty (The Wall Street Journal, 2023)."Marijuana Content Labels Can’t Be Trusted," by Shira Schoenberg (CommonWealth Beacon, 2022)."Growing Cannabis Indoors Produces a Lot of Greenhouse Gases — Just How Much Depends on Where It’s Grown," by Jason Quinn and Hailey Summers (The Conversation, 2021)."Blood and Urinary Metal Levels Among Exclusive Marijuana Users in NHANES (2005-2018)," by Katlyn E. McGraw, Anne E, Nigra, Tiffany R. Sanchez, et al. (Environmental Health Perspectives, 2018)."The Carbon Footprint of Indoor Cannabis Production," by Evan Mills (Energy Policy, 2012). EXTRAS:"Cannabis Is Booming, So Why Isn’t Anyone Getting Rich?" by Freakonomics Radio (2024)."Is America Switching From Booze to Weed?" by Freakonomics Radio (2024).

With abortion on the Nov. 5 ballot, we look back at Steve Levitt’s controversial research about an unintended consequence of Roe v. Wade. SOURCES:John Donohue, professor of law at Stanford Law School.Steve Levitt, professor emeritus of economics at the University of Chicago and host of People I (Mostly) Admire.Jessica Wolpaw Reyes, professor of economics at Amherst College. RESOURCES:“The Impact of Legalized Abortion on Crime Over the Last Two Decades,” by John J. Donohue and Steven D. Levitt (The National Bureau of Economic Research, 2019).“The Demise of the Death Penalty in Connecticut,” by John J. Donohue (Stanford Law School Legal Aggregate, 2016).“Environmental Policy as Social Policy? The Impact of Childhood Lead Exposure on Crime,” by Jessica Wolpaw Reyes (The B.E. Journal of Economic Analysis & Policy, 2007).“The Impact of Legalized Abortion on Crime,” by John J. Donohue and Steven D. Levitt (The Quarterly Journal of Economics, 2001).“State Abortion Rates: The Impact of Policies, Providers, Politics, Demographics, and Economic Environment,” by Rebecca M. Blank, Christine C. George, and Rebecca A. London (The National Bureau of Economic Research, 1994). EXTRAS:"John Donohue: 'I’m Frequently Called a Treasonous Enemy of the Constitution,'" by People I (Mostly) Admire (2021).