We’re firmly in the “buyer beware” era of obesity drugs. And unfortunately, it seems like we’re going to be stuck here for a while — even after product shortages resolve.

There’s recently been a flurry of worrying warnings about the safety and efficacy of knock-off obesity medications. Despite how these drugs are often marketed, they are not generic versions of Novo Nordisk’s Wegovy or Eli Lilly & Co.’s Zepbound. And they might be dangerous, as a new study — and increased calls to Poison Control — make clear.

Consumers today are bombarded with messages about Wegovy and Zepbound (also known as semaglutide and tirzepatide, or by the names of their diabetes-drug counterparts, Ozempic and Mounjaro). Beyond the intense media coverage and TikTok weight-loss testimonials, there are online ads, billboards, signs in storefronts and “med spas.” More recently, the drug manufacturers have produced their own glossy commercials.

“I dropped off my kids at camp this morning and saw a sign on the street that said, ‘Get your semgalutide here’ by some doctor prescribing it out of a clinic,” Tim Mackey, a professor at UC San Diego’s Global Health Program, where he studies counterfeit drugs. “That’s kind of what the market looks like right now — a mix of different access points and risk factors for consumers.”

Some of what’s on offer is legit product, of course. But it’s increasingly difficult for consumers to know what’s real and what’s too good to be true.

Mackey and his collaborators recently published work that hints at the reach and dangers of those counterfeit drugs. The group analyzed nearly 1,100 websites mentioning semaglutide in July 2023, and found that 134 of those directed people to illegal online pharmacies, where people could buy products without a prescription.

The researchers ordered samples from six rogue sites with the intention of analyzing their quality. But three orders never arrived, and the vendors asked for more money to help the product clear customs — a common scam.

Of the products that did arrive, one appeared to be contaminated with bacteria and all three had a much higher amount of semaglutide than indicated on the label.

Because the researchers were only interested in businesses selling the drug without a prescription, they didn’t investigate the practices of 148 telemedicine sites they identified that required one. But it’s fair to say that buyers should beware of those, too.

The big issue here is the uncertain quality of their compounded semaglutide or tirzepatide. Compounded versions are not generics, but reside in a regulatory grey zone that allows pharmacies to sell alternate versions of brand-name products amid a drug shortage. It’s unclear where pharmacies are getting their active ingredient, and, as Bloomberg recently reported, whether they are preparing it under the kind of sterile conditions needed to keep out contaminants.

Still other sellers are offering the product in unproven formulations, like lozenges or oral drops, or mixed with ingredients that purport to improve weight loss or minimize side effects, but could affect the drug’s efficacy.

A few different things are going on at once. Soaring demand has outpaced supply. Spotty insurance coverage has pushed some customers to look for cheaper alternatives. And consumers may be confused between the genuine product provided by pharmacies, the compounded product (mostly) legally sold by some clinics, and the counterfeit stuff.

The result has not been good for consumers. The World Health Organization in June warned the public about falsified vials of semaglutide that contained undeclared ingredients, including insulin. And in July, the Food and Drug Administration warned consumers about dosing errors occurring with compounded drugs, some of which caused people to end up in the hospital. Rather than the single-use pens sold by Novo Nordisk, compounders typically offer a vial of semaglutide and inexperienced patients injected far too much of the drug. Calls to Poison Control centers related to overdoses or side effects of this class of drugs have soared from less than 1,000 in all of 2019 to nearly 700 in June 2024 alone.

The problem may abate once Novo Nordisk and Lilly have sufficient manufacturing capacity to meet demand for Wegovy and Zepbound. (The arrival of competing drugs could help, too.) In theory, the end of the drug shortage would spell the end of the compounding free-for-all — though some might find ways to get around the regulations to continue offering some version of the products. A good sign came last week when the FDA indicated that tirzepatide was now considered available, a situation that Lilly CEO David Ricks had told Bloomberg was imminent.

Unfortunately, even if the compounding issue clears up, the problem with counterfeits is likely to persist. Mackey doubts a steady supply of legitimate product — or even significantly improved insurance coverage — can fix that problem, which has evolved into a game of regulatory Whac-a-Mole with new sites popping up as fast as others are shut down. That’s not dissimilar to the years-long game regulators have been playing with counterfeit producers of other products that have captured the cultural zeitgeist, like Viagra.

What a mess.

For now, the best strategy — though a frustrating one — is simply to keep reminding consumers that fake drugs are no bargain.

Lisa Jarvis is a Bloomberg Opinion columnist covering biotech, health care and the pharmaceutical industry. Previously, she was executive editor of Chemical & Engineering News.

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At a production facility in Minnesota, a man worked meticulously to attach a “Saint Paul Fire” decal to the city’s newest firetruck.

Another worker was customizing shelves inside the truck, ensuring there was a place to secure all the firefighters’ equipment.

The firetruck was switched on, but unlike the noisy rumble of most large vehicles, it was humming quietly. This is Minnesota’s first electric firetruck, which will soon be at work in St. Paul.

At the Wyoming, Minn., facility — the North American headquarters of Rosenbauer — the final touches are being put on the truck. It was on display for the first time in St. Paul on Tuesday, outside Mayor Melvin Carter’s budget address in downtown.

It was a warm summer day, but how will an electric fire engine perform on a wintry Minnesota day, when there’s no time to spare in an emergency?

“There’s a lot of validity to those thoughts,” said Todd McBride, Rosenbauer RTX program manager. People may remember seeing news stories about drivers of electric vehicles stranded because their cars wouldn’t start in the cold weather.

But an electric firetruck doesn’t have the same problems because it’s almost always starting from a heated fire station, McBride said. The Rosenbauer RTX electric firetrucks also have a small diesel backup generator, which automatically kicks in if the batteries’ charge is too low.

$1.8M price tag

The firetruck, which the city ordered last year, cost about $1.8 million. A traditional gas or diesel fire engine goes for $800,000 to $1 million, said Assistant St. Paul Fire Chief of Operations Jeramiah Melquist.

The city estimates $25,000 a year in fuel savings and additional savings for maintenance. The RTX comes with a five-year warranty for most of its maintenance. Rosenbauer estimates an RTX will last 12 to 15 years with its initial batteries, which wouldn’t stop working but would lose efficiency, similar to how a cellphone battery doesn’t hold a charge as well as it becomes older.

Environmental factors weren’t the leading design factor for Rosenbauer — the RTX is intended to maneuver better, especially on tight city streets, and to be safer for firefighters getting in and out of it each day, McBride said.

There are two batteries powering the truck. Everyone asks how long they’ll run the truck between charges, though McBride said it’s not a simple answer because it depends on what the truck is doing, such as pumping water from its tank or pumping from a hydrant.

“The difference with a firetruck is it’s not driving from St. Paul to Duluth,” though it could, McBride said. “If you think about what a firetruck does, it typically is sitting in a station ready to go. It’s usually plugged in with the battery being 100%.”

St. Paul firefighters, who are also paramedics and EMTs, handle all emergency medical calls in the city and that’s the majority of what they respond to. For example, they could leave the station with the RTX’s batteries fully charged, drive a mile or two to a call, provide initial emergency care and leave with an ambulance after about 20 minutes to return to the station. That would use 10 percent to 15 percent of the batteries’ power — and it would take 15 to 20 minutes to charge to 100 percent, McBride said.

There’s a 33-gallon fuel tank and, if the batteries get down to 20 percent, the diesel automatically starts up to recharge them, getting back to 80 percent in as little as 30 minutes, McBride said. For large fires that keep firefighters on scene all night, in the winter, it’s expected that the truck would use some diesel for those situations.

In Vancouver, which started its testing phase on its new RTX on May 1 and has responded to about 1,100 calls, the engine has used its batteries 98 percent of the time, which is typical, McBride said. They’ve gone through about 20 gallons of diesel for the truck.

Russ Stark, St. Paul’s chief resilience officer, posted a photo of the new truck on X (formerly Twitter) on Tuesday, which was met by skeptical replies about the costs and whether it would work in the cold. He noted the purchase was led by the fire department.

Mike Smith, president of the International Association of Fire Fighters Local 21, said there were questions among some St. Paul firefighters along the lines of, “What if it doesn’t start?” but he said all his concerns were addressed when he and others talked to Rosenbauer officials and saw the truck up close.

‘Fire engine of the future’

Todd McBride, RTX sales and marketing manager for Rosenbauer America, demonstrates the remote control for the top-mounted water cannon on the company’s RTX fire engine in their manufacturing facility in Wyoming, Minn. An array of cameras, instead of mirrors, will help the drivers with their field of vision. (John Autey / Pioneer Press)

Rosenbauer, which has been building firetrucks since 1866, set out in 2012 to develop “the fire engine of the future,” McBride said. They teamed up with universities to interview fire chiefs, firefighters, fleet mechanics and city administrators around the world to determine “what do they battle on a daily basis?” One of the consistent answers was that firetrucks were getting too big and needed to be more compact and maneuverable for getting around.

The challenge was: How do you make a firetruck narrower when you need room for a powerful engine?

An engineer raised his hand and asked, “What if we did electric?”

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“They kind of laughed at him,” McBride said. “But they had a rule that if somebody put something on the table, they’d talk through it. What happens if we get rid of the transmission, the exhaust system? All of a sudden they started checking a lot of their boxes” to get the truck more ergonomic for firefighters.

Rosenbauer originally marketed its electric trucks to fire departments in Europe, and have sold about 60 on that continent. They’ve also sold their electric trucks to departments in Tokyo, Japan (the largest fire department in the world), Australia and Chile.

The company now has six electric vehicles in service in North America: two in California and four in Canada.

“There are going to be a lot of people in cold climates that are going to look to St. Paul, because there’s this perception that electric vehicles don’t operate well in cold weather,” McBride said, adding that they’ve “done extensive cold weather testing” in cold chambers and Norway.

What makes the truck different

The RTX truck doesn’t have side mirrors — cameras around the truck’s exterior are displayed on screens inside the cab to show the side views, along with what’s below the front and rear bumpers.

The truck is 92.5 inches wide, while most firetrucks are about 100 inches wide, plus side mirrors that add 12 to 14 inches to each side.

It’s lower to the ground and there are stairs inside the truck. For a typical firetruck, a firefighter would have to take a big step up or hoist themselves up to get inside, all while wearing about 75 to 80 pounds of equipment. The lower height to enter the RTX is important to prevent falls when firefighters are rushing out to respond to an emergency, and is also less jarring on their bodies through the years, McBride said.

Adjustable suspension allows the operator to raise the truck higher, creating more ground clearance to get through flooding, for example. It could make it through about 32 inches of floodwater.

It’s all-wheel drive, which isn’t the case for St. Paul’s other fire vehicles, and will be “huge for St. Paul in the wintertime,” McBride said.

Traditional firetrucks have a big, loud engine in the middle of the cab. Without that in the new electric firetruck, firefighters can more easily discuss their plan of attack as they approach a fire or another emergency.

The cab of the Rosenbauer RTX fire engine that is scheduled to go into service in St. Paul by late September. (John Autey / Pioneer Press)

If firefighters are coming back from a tragic situation — say they rescued kids from a burning house, but a child didn’t survive — they may not want to talk or look at each other, which is easier to do with the seating and noise in a traditional firetruck. With the more open layout of the new firetruck, “it’s designed to help promote communication,” which is important because mental health and PTSD are concerns for first responders, McBride said.

There’s also a cleaning station on the side of the truck, which allows firefighters to rinse off some contaminants before going back to their station and doing a more complete cleaning. Because of chemicals that firefighters are exposed to, research suggests they are at higher risk of some types of cancers, and cancer is a leading cause of death among firefighters, according to the National Institute for Occupational Safety and Health.

From Austria to Wyoming, Minn.

St. Paul’s truck was built at Rosenbauer’s global headquarters in Austria, traveled by ship to New York and arrived by truck to Wyoming, Minn., in late July.

There, Rosenbauer works with fire departments to customize the trucks, including such details as the layout of storage for firefighting equipment.

Last week at the Wyoming facility, Daniel Marosok, RTX assembly technician, lined a shelf inside a compartment on the St. Paul firetruck’s side with a waterproof vinyl mat. He worked from measurements he’d written down in advance. “I have to give myself a little sketch so I remember which way I need it oriented,” said Marosok, who worked as a finish carpenter before going to work at Rosenbauer about a year and a half ago.

On the truck’s other side, behind a roll-up door, Marosok had already installed heavy-duty clips on the back wall to hang bolt cutters. He put in a series of brackets on the floor to keep buckets and orange traffic cones from sliding around while the truck is in motion.

Putting together all the behind-the-scene parts is like playing the game Tetris, Marosok said. “I consider myself to be a good problem solver.”

Roseville and Superior, Wis., also each recently ordered a Rosenbauer electric firetruck, which will likely be delivered next year.

REV Fire Group and Pierce Manufacturing, which is based in Appleton, Wis., also make electric firetrucks.

After St. Paul’s truck was on display downtown Tuesday, McBride brought it back to the Wyoming facility, where there will be testing and more finishing touches. The fire department hopes to have it on display again at the Governor’s Fire Prevention Day at the Minnesota State Fair on Aug. 23.

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Then, St. Paul fire equipment operators will be trained in operating the new vehicle in September and the department aims to have it ready to go by the start of October.

It will initially serve as an additional engine at Station 1 at West Seventh Street and Randolph Avenue. When construction on the new Station 7 is completed at Ross Avenue between Earl and East Seventh streets, that will be the fire engine’s permanent home.

The fire department tried to get a federal grant for the truck, but wasn’t able to; it was funded through the city and the fire department over two years, Assistant Chief Melquist said. If everything goes well with the new truck and they keep seeing the potential for savings, the department will look into grants in the future for another electric firetruck.

Today is Thursday, Aug. 15, the 228th day of 2024. There are 138 days left in the year.

Today in history:

On Aug. 15, 1969, the Woodstock Music and Art Fair opened in upstate New York; more than 460,000 people attended the three-day festival, which would become a watershed event in American music and culture.

Also on this date:

In 1057, Macbeth, King of Scots, was killed in battle by Malcolm, the eldest son of King Duncan, whom Macbeth had slain.

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In 1914, the Panama Canal officially opened as the SS Ancon crossed the just-completed waterway between the Pacific and Atlantic oceans.

In 1935, humorist Will Rogers and aviator Wiley Post were killed when their airplane crashed near Point Barrow in the Alaska Territory.

In 1947, India gained independence after nearly 200 years of British rule.

In 1961, as workers began constructing a Berlin Wall made of concrete, East German soldier Conrad Schumann leapt to freedom over a tangle of barbed wire.

In 1989, F.W. de Klerk was sworn in as acting president of South Africa, one day after P.W. Botha resigned as the result of a power struggle within the National Party.

In 1998, 29 people were killed by a car bomb that tore apart the center of Omagh (OH’-mah), Northern Ireland; a splinter group calling itself the Real IRA claimed responsibility.

In 2003, bouncing back from the largest blackout in U.S. history, cities from the Midwest to Manhattan restored power to tens of millions of people.

In 2017, President Donald Trump, who’d faced harsh criticism for initially blaming deadly violence in Charlottesville, Virginia on “many sides,” told reporters that there were “very fine people on both sides” of the confrontation and that groups protesting against the white supremacists were “also very violent.” (In between those statements, at the urging of aides, Trump had offered a more direct condemnation of white supremacists.)

In 2021, the Taliban regained control of the Afghan capital of Kabul after the withdrawal of U.S. forces from the country.

Today’s Birthdays:

Actor Jim Dale is 89.
Retired Supreme Court Justice Stephen Breyer is 86.
U.S. Rep. Maxine Waters, D-Calif., is 86.
Author-journalist Linda Ellerbee is 80.
Songwriter Jimmy Webb is 78.
Actor Phyllis Smith is 75.
Britain’s Princess Anne is 74.
Actor Tess Harper is 74.
Actor Zeljko Ivanek (ZEHL’-koh eh-VAHN’-ehk) is 67.
Celebrity chef Tom Colicchio is 62.
Film director Alejandro Gonzalez Inarritu (ihn-YAH’-ee-tu) is 61.
Philanthropist Melinda French Gates is 60.
Actor Debra Messing is 56.
Actor Anthony Anderson is 54.
Actor Ben Affleck is 52.
Olympic gold medal beach volleyball player Kerri Walsh Jennings is 46.
Rock singer Joe Jonas (The Jonas Brothers) is 35.
Actor Jennifer Lawrence is 34.