- Hi there, I'm Frank Graff.

What's the science behind those popular weight loss drugs?

A medical device used to help scuba divers in trouble goes mainstream and operating on the brain without an incision.

Science and your health, next on "Sci NC."

- [Announcer] Quality public television is made possible through the financial contributions of viewers like you who invite you to join them in supporting PBS NC.

[gentle inquisitive music] [gentle inquisitive music continues] - Hi again, and welcome to "Sci NC."

Market data shows the total U.S. weight loss industry reached $90 million in 2023.

That is a historic peak, and it's expected to grow another 4% in 2024.

Most of that growth is due to the soaring sales of the popular GLP-1 weight loss drugs.

As producer David Hurst explained, that marks a major shift in medical programs.

- The prevalence of diabetes in the United States is startling.

We are in the midst of a surging epidemic of type 2 diabetes.

- Diabetes is such a devastating disease for the individual and it inflicts a lot of collateral damage on society.

- The number of Americans living with diabetes continues to climb dramatically.

- More than 10% of Americans have diabetes and nearly 40% have pre-diabetes.

These numbers are increasing in part due to the obesity epidemic.

- Obesity was like a steamroller across the country over the last 50 years.

- But what is it about a new classification of drugs that is leading doctors to say this: - This really puts diabetes and obesity on the ropes.

- [David] Angie Crone has always found ways to stay active, but nearly 20 years ago, she was diagnosed with diabetes due to side effects from cancer treatment.

- I've always been very, very energetic, but in those last five years I was beginning to drag.

It was taking its toll on me.

- [David] Doctors tried just about every medication on the market, but her blood sugar levels continue to spike.

- We'd been working on it for a long time, and he finally recommended Ozempic.

- [David] Ozempic is part of a classification of drugs called GLP-1 receptor agonist or GLP-1s.

These medications promote the production of insulin, a hormone that lowers blood sugar levels.

- Since then, for the past three and a half years has been like it was when I was in my 20s and 30s.

It's just amazing.

- [Dr. Buse] Yes, it takes a long time.

- [David] Ozempic has only been on the market for a few years, but Dr. John Buse has studied GLP-1s since 1998.

- As the technology has advanced and the formulations evolved, these drugs have become the best blood-sugar-lowering drugs and the best weight-loss drugs in the world.

- Ozempic.

- Right.

Exactly.

[laughs] - [David] Dr. Buse says, not only are GLP-1s effective in treating diabetes, but they also have another benefit: weight loss.

- And what these drugs enable people to do is to have more satiety or that feeling of fullness after a small meal and adhere to a lifestyle plan.

- [David] Dr. Buse himself lost nearly 60 pounds over the span of nine months after taking Wegovy.

Wegovy is a medication that has the same active ingredient as Ozempic, but the difference is that Wegovy is approved by the FDA to treat obesity.

- It's changed my relationship with food.

You know, I'd always sort of struggled with loving to eat and knowing that I was overeating and heavy and now I love to eat and I'm basically eating under control without really thinking about it.

- [David] Dr. Buse is one of many who has seen positive results with GLP-1s.

In fact, these drugs have taken the nation by storm trending on TikTok and dubbed "the hottest drug in Hollywood."

- You on Ozempic?

- Yeah.

- [Andy] God, what housewife isn't on Ozempic?

- Not one.

- Bet you're not.

Yeah.

- Demand for these drugs has skyrocketed exponentially as the word has gotten out of how effective they are.

- [David] The high demand for these drugs has led to shortages.

Couple that with the steep cost and spotty insurance coverage and accessing these medications has been difficult for many.

- It is incredibly onerous to prescribe these medications, even for patients with diabetes where it's quote, unquote, "a little bit easier."

For weight management it's incredibly difficult.

There's so much paperwork and prior authorizations and I would say hurdles to patients to getting these medications.

- [David] North Carolina is playing a big role in helping address the shortages of these medications.

Novo Nordisk, the company that makes Ozempic and Wegovy, has manufacturing plants in Durham and Clayton.

Recently, the company announced plans to invest $4.1 billion and hire 1,000 more workers in Clayton.

It's one of the largest single life science investments in North Carolina history.

Eli Lilly, the maker of diabetes and weight loss drugs Mounjaro and Zepbound, have also expanded their manufacturing footprint in North Carolina.

In just the past few years, they've built facilities in Concord in the Research Triangle Park.

Dr. Janice Hwang has had to get creative in order to help patients get access.

She calls this drug a game changer, but says it's not a magic bullet.

She encourages patients to couple this medication with a healthy lifestyle.

- If these medications can help jumpstart healthier lifestyles, then the patients get more motivated and then they're moving, they're exercising and it becomes a positive feedback loop.

So that's the very, very gratifying piece of it.

- [David] For Angie Crone, she's glad to be back to her healthy lifestyle and hopes others will be able to benefit from this medication in the future.

- My sister had diabetes and if she could have gotten on this drug before she passed away, I think it would've changed her life.

- [David] The benefits of these drugs may even extend beyond diabetes and obesity.

GLP-1s are being studied to tackle some of the most difficult-to-treat brain disorders, including Alzheimer's disease.

Results are years away, but early tests show some promise.

- [Frank] Want more "Sci NC?"

You can find these stories and more on our YouTube channel.

Like and subscribe.

Now to some old science used in a new way.

Dive deep into the ocean, and if you surface too quickly, you will suffer from decompression sickness.

It's better known as the bends.

Producer Evan Howell shows us how hyperbaric medicine, which was first used to treat divers, is going mainstream.

[water splashing mutedly] - [Evan] Whether it be jumping or diving in a lake or pool, or going down to retrieve a toy off the bottom, or even pretending you were a creature of the deep, [dramatic music] well, that just means going underwater is part of your personal experience.

But you know if you go too deep, your ears start to hurt from the water pressure and you start to run out of air.

So you swim back to the surface as fast as you can.

- [Researcher] 30 seconds.

- [Evan] It's all about pressure and oxygen.

And that's what they study here at the Duke Department of Hyperbaric Medicine, where researchers look at how oxygen moves through the body, the blood flow, and how the environment impacts how tissues react.

And what's also here is a Duke hyperbaric chamber.

It's the only civilian one of its kind in the country certified by the U.S. Navy and where they study how pressure can be used to treat patients.

It's led by Dr. Richard Moon.

- We treat patients with hyperbaric oxygen, we treat emergencies and also people with chronic problems, certain types of chronic wounds.

- [Evan] These giant tubes can be sealed where staff can regulate pressure to simulate either an increase or decrease of it depending on the need.

A patient sits inside the chamber, which is basically identical to a hospital examination room.

But how does pressure actually affect you?

You might even think scuba divers have it made because they take oxygen down with them, but even divers need to be careful.

That water pressure you felt in the pool affects a diver's entire body.

The deeper the dive, the higher that pressure is that their bodies feel under the massive weight of the water.

And if they come up too fast, they can get what's called decompression sickness.

That's when nitrogen builds in the blood and creates bubbles.

In the old days, they used to call it bubble disease, these days, some call it the bends.

More on that in a minute.

- Hyperbaric medicine evolved because of diving.

And back in the 19th century when people were exposed to pressure either working in tunnels or bridges in a compressed-air environment or diving, they found that when they came back to normal pressure, they often had illness.

[oxygen regulators hiss] - [Evan] Scuba divers call them safety stops where they hang for three to five minutes every 15 feet on their way back to the surface.

That gives their bodies extra time to release that nitrogen buildup that happened during the dive.

But we're not just talking about water.

It turns out that depth alone increases pressure, and you can experience that underground too.

[jaunty old-timey music] And that's what workers building the Brooklyn Bridge discovered back in the 1870s.

The bridge was so massive.

Workers needed to settle the foundations of it around 78' in the ground under the river.

They used what are called caissons, which were developed in France, and where a bottomless chamber was lowered for workers to dig out the mud and sand.

Air was pumped down and that, you guessed it, created pressure.

But when they came up and out after their shifts, many had serious problems, they would bend over in pain.

In fact, that's how the bends became a term.

- Some of 'em couldn't walk.

And actually there were many people who died of decompression illness.

Many of the men, it was men in those days, who went back into the compressed air environment, found that their symptoms got better.

And so the notion of using pressure to treat bubble disease came about.

[airplane screeches] - [Evan] Now, let's think about what happens when air pressure decreases.

Yes, you can get sick going up as well.

Oxygen molecules start to spread out because there's no pressure, and that means no usable oxygen to breathe.

And there's a risk of what's called hypoxia.

- [Dr.

Moon] Most people can go to altitudes of 10 to 15,000' without really any problem.

At 18,000', you start maybe developing a little symptom of not quite feeling right.

At 25,000 feet, there's a potential to lose consciousness.

- [Attendant] Ladies and gentlemen- - [Evan] That's why airplane cabins are pressurized and why flight attendants do that oxygen demonstration every time.

Because if a window were to blow out while the airplane is at altitude, you only have a short period of time to grab that oxygen mask before losing consciousness.

- [Astronaut] I'm halfway inside the docking compartment- - [Evan] Astronauts in particular need training if something unexpected happens.

In the past, astronauts from the SpaceX program needed a training ground to learn what happens in a low-oxygen environment.

So they were taken up to 25,000' inside the chamber.

- What we did with them, we had one of those little balls with different shapes in, it's for children, where the child has to pick the right shape and put it in the right-shaped hole.

But at 25,000' after, you know, a minute or two of hypoxia, each of the individuals we took there was having difficulty.

- [Evan] But treating patients is the primary goal here, who were suffering from things like bacterial infections, hypoxia, and carbon monoxide poisoning.

It's called oxygen therapy.

- What the oxygen does is it competes with carbon monoxide for all of the proteins that carbon monoxide attaches to, and it displaces it so that it's exhaled into the air.

- [Evan] Inside the chamber, the patient receives 100% oxygen through what they call a head tent like this one.

The patient breathes the oxygen while the pressure increases.

- [Dr.

Moon] We have the ability to monitor the patient exactly as they would be in the ICU.

We can connect the patient's arterial line, electrocardiogram, to the hospital monitor, which then collects the data and stores it just as it would as if they were in a normal ICU room.

- [Evan] It's learning how the human body reacts to different environments that's critical in helping staff understand the doorways into treatments, and a better ability to not just help patients recover from illness, but shed light onto prevention.

- [Announcer] You can watch more "Sci NC" episodes anytime on our website or through the PBS streaming app.

- Modern flush toilets use a gallon and a half of treated water with every flush.

Now, most of you watching this might not think much about that, but in many parts of the world, wastewater infrastructure simply doesn't exist, and that is a major health problem.

So engineers are trying to solve this most basic of problems.

How do we get rid of human waste efficiently?

- There's a lot that divides us humans, but one thing we all learn from a young age is that everybody poops.

[water sloshes] And for all our advances in technology, humans haven't really figured out how to handle our excreta efficiently.

For one, half the world's population doesn't have access to a bathroom that properly stores and cleans sewage.

So that's a problem.

And two, although you might be fond of your porcelain thrown, it's wasteful by its nature.

Flushable toilets use a gallon and a half of treated, clean drinking water every time you flush.

That's why toilet engineers all over the world are trying to solve this most basic problem of what to do with our pee and poo.

- I usually say I clean up [beep] water for a living, which I know you can't use that, but.

So one of the big problems that we're trying to solve and one that I'm personally very interested in is we use drinking water to flush our toilets.

And as the climate continues to change, and as water becomes more scarce and we have more droughts and more fires, you know, we're gonna be using more and more drinking water and having less and less of it.

So we really need to conserve that precious resource.

- The gold-standard toilet is flushable and connected to some sort of water treatment, but it's expensive and takes an enormous amount of water, land and energy to lay pipes and build treatment plants.

And even then, modern sewage systems are far from perfect.

For example, every year, the U.S. spends a billion dollars to remove fatbergs which are essentially massive clogs made of wet wipes and cooking fats.

During the pandemic, these clogs went up by 50%.

Yep.

Everybody was using a lot more wipes and flushing them down the toilet.

But while our sewage system might not be the best, things could be crappier.

- In a lot of places, the toilet pipe just goes nowhere, out into the street or out into a creek or river.

- Toilets are absolutely a justice issue and a human rights issue.

So when you get contamination, particularly of drinking water with untreated wastewater, it spreads disease, most notably diarrhea, which kills about half a million children a year worldwide.

So digging a sewer under a city that already exists is tremendously expensive.

And when you look at a city like Mumbai or Kinshasa, you know, that are huge, millions and millions of people live there, the political will, the money to go and dig a new sewer under those cities, it's just not there.

It's very unlikely to happen.

- [Rossie] But that's where the toilet engineering comes in.

[machinery whirs] Brian, Lena, and their team are working on a toilet, they hope will use way less water and help communities that need access to affordable bathrooms that work.

It's called the Reclaimer.

And they're building it in this warehouse in the appropriately-named bay number two.

Sorry, I had to.

So this is a toilet?

- Well, this isn't exactly a toilet.

This is what we would call a a backend unit.

So if you think of the toilet as your front end, everything that happens after the toilet in terms of treatment is the backend.

Ideally, we envision this, or something like it, being an appliance you would have in your house that your toilet would be plumbed to.

What that appliance does is it receives the wastewater from the toilets and it treats it on site.

It's not potable, you don't want to drink it, but it's good enough for reuse.

We like to use it for flushing the toilets themselves.

So you have just sort of a continual reuse of water locally.

- [Rossie] But how does it work?

First things first, separate the poop from the pee.

The reclaimer filters out the poop, pushing it to a separate container so that bacteria can digest it over time.

- We then take the liquid fraction that's left, that goes to the inlet of the Reclaimer.

At the very bottom here you have what we call our feed tank.

So that's where the dirty water comes in.

And you can see it's pretty, pretty dirty.

You can even see it through the tank.

- Disgusting.

- Yeah, absolutely.

So the very first stage is what we call ultra filtration, and that's exactly what it sounds like.

We force the liquid through those straws, and the straw itself is what filters the liquid.

- [Rossie] The liquid travels through three more filtration chambers, one that uses granular activated carbon like you'd find in a Brita filter, one that removes ammonia, and one that zaps the water with chlorine to kill any foul-smelling bacteria.

And after that, the water can be used to flush the toilet again.

Brian's team is testing the Reclaimer in India at a cotton mill.

- A lot of the brunt of sourcing clean water for the family falls on women and girls.

And so women and girls can't have other jobs, or they have to travel great distances and miss school just to provide clean water for their family.

And so if there's a way that we can, again, conserve drinking water so that those trips need to be made less frequently, women and girls can live fuller, richer lives doing other things besides going to the well.

- [Rossie] The team is also hoping the Reclaimer can be used in the U.S. in places like Utah, California, or Nevada, all states experiencing record-breaking droughts and huge population growth.

- Right now we use a lot of water just to flush all of our waste to the treatment plant.

But if you're treating the water on site, you can use much less water and you can reuse it right where you need it.

I spend so much of my time in the lab and we often don't get to see our inventions and ideas out in the world.

And so that's been something that keeps me really motivated here.

[chuckles] But if you had told me two years ago I would be working with human waste and shoveling it into experimental toilets, I would not have believed you.

[laughs] - [Announcer] Follow us on Instagram for beautiful images of North Carolina and cool science facts.

- Surgery is complicated for many reasons, one of which is the incision.

It can get infected, it can also leave a scar, which is why the medical breakthrough of incisionless brain surgery is so incredible.

Producer David Hurst explains.

[ethereal music] - [David] The human brain is extremely complex.

This three pound organ has 86 billion neurons that form 100 trillion connections to each other.

Talk about mind blowing.

It's been called the most complicated object in the known universe.

- There is still so much that we have yet to understand about the brain, - [David] Along with being complex, the brain is also powerful.

It controls what we think and feel, how we learn and remember, and the way we move and talk.

Even one small abnormality in the brain can cause a range of symptoms.

That's the case with a disorder called essential tremors.

It's a brain disorder that causes trembling in certain body parts.

Dr. Charles Munyon is the head of functional and restorative neurosurgery at Novant Health.

He specializes in treating essential tremors.

- It seemed to me like there were a lot of patients out there who were suffering from disorders that might not be life-threatening, but who could have their quality of life dramatically improved if there were safe and effective interventions that somebody was willing to offer them.

- [David] One of those patients is Bruce Bush.

Bush first noticed a tremor in his hand about 15 years ago - When I would come back from the coffee bar at work, oh, I needed to open a door to get back into my office, and I found that I was not able to successfully transport the coffee.

- The essential tremor made it difficult for Bush to perform routine tasks around the house.

- For quite a while, putting in a screw has been a real job 'cause I have had only one steady hand.

- [David] Bush is from New York and he first came down to North Carolina in 2021.

He met with Dr. Munyon for a procedure to fix the tremor.

That procedure is called MRI-guided focused ultrasound or focused ultrasound for short.

It's a form of brain surgery that does not require incision.

Instead, it uses high-energy sound waves.

But only a handful of hospitals offer the treatment.

- We'll send their sound waves down into the brain.

Where those sound waves meet, they cause enough vibration that it actually translates into heat, and we're, in essence, able to make a very small burn that, in the case of tremor, interrupts a circuit in the brain that's causing dysfunctional activity.

- [David] Bush traveled back to North Carolina to receive a second treatment after he started having tremors in his other hand.

He hopes this time around is as successful as the first.

- The interest here centered on the fact that there was nowhere in between Northern Virginia and Southern Florida where patients could go for this procedure.

- [David] Dr. Munyon says focused ultrasound does not completely get rid of the tremors, but over 90% of the time, the treatment restores the ability of patients to perform their daily activities.

- When you have a tremor, you spend a lot of time, even subconsciously, planning how to make a motion so that the tremor will not interfere with it.

Based on my experience from last time, I'm expecting that my brain will be more relaxed because I'll be able to do things naturally.

- [David] And that's what happened the second time around for Bush as his ability to write was restored just minutes after the procedure.

- So this was taken on the MRI table before they started the actual procedure.

So after the first sonication this is the change I saw.

As I was drawing it, I was like, "Look at this!"

- [David] This groundbreaking treatment has positive implications for Bush's future, and it also has other life-changing implications for the future of medicine.

The FDA has approved focused ultrasound to treat seven conditions, including: cancer that has spread into the bones, Parkinson's disease, and prostate cancer.

It's also in various stages of testing for more than 160 other medical conditions.

- Functional neurosurgery is still, I think, very underutilized.

There are a lot of patients out there with epilepsy or with movement disorders who could very likely benefit from one of these procedures and who just haven't either found a way to or don't even know that they can sit down and discuss them with a neurosurgeon.

- [David] It's a treatment that is helping make the brain a little easier to understand and changing lives for the better.

- [Announcer] Check out our weekly science blog to take a deeper dive on current science topics.

- And that's it for "Sci NC" for this week.

If you want more "Sci NC," be sure to follow us online.

I'm Frank Graff.

Thanks for watching.

[gentle inquisitive music] [gentle inquisitive music continues] [gentle inquisitive music continues] [gentle inquisitive music continues] [gentle inquisitive music continues] - [Announcer] Quality public television is made possible through the financial contributions of viewers like you who invite you to join them in supporting PBS NC.