Fresh Air - The Ozempic Revolution

Episode Date: January 4, 2024

Bloomberg News reporter Emma Court explains how these so-called "miracle" weight loss drugs work, and discusses side effects, long-term impacts, and what it all means for the body positivity movement.Also, John Powers reviews Michelle Yeoh's Netflix comedy-thriller series The Brothers Sun.Learn more about sponsor message choices: podcastchoices.com/adchoicesNPR Privacy Policy

This is Fresh Air. I'm Tanya Mosley. Looking to get back in your type 2 diabetes zone? Once Weekly Ozempic can help. No doubt you've seen this commercial for Ozempic. Or maybe you've heard about the shortages, or that Oprah and Elon Musk are using a new class of drugs like Ozempic to lose weight. Or maybe you're on them yourself. Ozempic, which is the brand name for semaglutide, is an injectable prescription originally used to treat type 2 diabetes. But over the last few years, Ozempic and other drugs that are classified as GLP-1s have also revolutionized the treatment for obesity, with roughly two out of three adults in

America classified as overweight or obese, these drugs now have people talking about weight loss in new ways. Even Weight Watchers now offers prescriptions of these drugs to help lose weight, and researchers are looking into how they might help with other conditions like heart disease and addiction and polycystic ovary syndrome, Parkinson's, and even some cancers. But there's still a lot of research to be done. And meanwhile, the prospect of finding a cure for obesity has thrown the demand into overdrive with shortages all over the world, widening the divide on who has access and who can pay out-of-pocket for drugs that most insurance companies don't cover for weight loss.

Emma Court has been reporting on Ozempic and this new class of weight loss drugs for Bloomberg. She produced a podcast about the myths and realities of dieting called Losing It. And Emma, welcome to Fresh Air. Thanks so much for having me. I've heard that not since the 90s with the introduction of Viagra has there been a bigger accident in the world of medicine. And Viagra, has there been a bigger accident in the world of medicine? And Viagra, just to remind people, was originally created to treat high blood pressure, but then people started using it to treat erectile dysfunction. And Ozempic was originally created to treat type 2 diabetes. So how was it discovered that it could also help people lose weight? Basically, the story of this class of drugs really dates back to around the early 2000s when they had just started developing

these new diabetes drugs known as sort of GLP-1s. They're named after the gut hormone that they mimic, glucagon-like peptide 1. And these drugs just first started coming to market in the early 2000s. And they were developed to help people with type 2 diabetes manage their blood sugar levels. They basically stimulate the pancreas to release more insulin and people with type 2 diabetes have trouble naturally regulating their glucose levels. And these drugs, even back then when they were first coming out for diabetes, that these drugs kind of seemed to help with weight loss too. They produced small amounts of weight loss. The pharma industry wasn't super quick to jump on that. They'd been burned in the

past with these earlier generations of weight loss drugs that had caused safety scandals and produced recalls like FanFan. And they were kind of gun shy. And then eventually, one of the things we started seeing was that the weight loss was improving with the new generations of diabetes drugs. So they were seeing a little bit more weight loss. And you saw companies like Novo Nordisk, which is widely considered the leader in this field. They were the first to bring a highly effective weight loss drug to market. They make that drug Ozempic. Ozempic is not technically approved for weight loss. It's approved for diabetes, as you mentioned.

But they also brought this newer version, higher dose version of Ozempic called Wagovi to market more recently. And so Novo Nordisk saw these improving amounts of weight loss. They started studying this higher dose version for weight loss specifically. And that's kind of how we get to the Ozempic craze today, basically. Well, I mean, I remember it's been maybe a little bit over a year ago. I began seeing all of these social media posts, all of these TikToks about Ozempic and Manjaro. And then everybody was talking about it. So how did it go from, oh, it's helping diabetics lose weight as a side effect to being

the most sought after weight loss drug in the world? Was it with the approval of Wegovi, which is basically the same ingredient as Ozempic for weight loss drug in the world? Was it with the approval of Wegovy, which is basically the same ingredient as Ozempic for weight loss? It's still a little mysterious exactly what happened, I would say. But what we saw was in 2021, Wegovy from Novo Nordisk gets approved as an obesity treatment. And it's shown that it can take off about 15% of a person's body weight, which is quite a lot. Earlier generations of weight loss drugs didn't do even nearly as much. And so Wagovi gets approved and very quickly, there's a lot of demand for it. And it actually falls into shortage by the end of that year. So the company starts having some manufacturing issues

and there's a shortage. And I think at some point during the time of the shortage of this new treatment, people kind of put two and two together. They said, okay, there's a cheaper version of this drug that's in shortage already, so we can't get it. And it's available for diabetes, but it's, you know, a lot of people think of these things as the same thing, even though they are different doses and they've been studied for different purposes and in different patient

populations. And so I think it seems like people are like, okay, let's just use Ozempic then. It's cheaper anyway, and we can actually get it. So you see that drug really taking off on places like TikTok and people showing off how much weight loss they've been able to achieve. And it gets really, really viral from there. We've heard all kinds of prominent people talk about taking versions of these drugs at this point. Elon Musk has said he's used one of these drugs for weight loss. We've heard more recently Oprah say she's been using it for weight loss maintenance. And I think the word of mouth has been extremely, extremely powerful. We haven't seen, usually the pharma industry spends a lot of money and invests a lot into getting the word out about

these drugs. We've all seen the commercials, right? But even though you've seen the Ozempic commercials, these are Ozempic commercials for Ozempic for diabetes. Novo Nordisk can't promote that drug for weight loss. It's actually the name, the jingle, that's all for diabetes. And yet people are still gravitating to it for this other purpose as well. So I want to step back a little bit because this is the time of year when people are usually making resolutions to lose weight. So I definitely want to talk about how these drugs are changing a lot of things like the diet industry and our cultural views about bodies and weight loss. But can you first tell us how these drugs work? What are they actually doing to the body and the brain? Yeah, and I think it's a really interesting time of year to be having this discussion for sure. Very timely. So when we talk about these drugs, there are some newer versions that are now coming out with

slightly different science but largely when we're talking about this like ozempic wigovi these are drugs known as glp1s and so they mimic a naturally occurring gut hormone called glucagon-like peptide one um and when they do that um they have different effects in the body. For people with diabetes, the important effect is stimulating the pancreas to produce more insulin and bring down blood sugar levels. But in weight loss specifically, it has a variety of effects in the body, including sort of acting through the brain, activating the brain to promote feelings of satiety and lessening appetite. So, you know, it sounds kind of complicated, but in essence, these are appetite suppressants, right? You feel fuller because you've been taking these weekly injections. You eat less and you lose weight.

It's being researched now as a potential aid to help with addictions, alcohol addictions, drug addictions. So there's something that is happening within the brain, chemistry, or something like that, that is changing the way people, their relationship with maybe addictive behaviors. Yeah, and it's thought that the relationship there has to do with dopamine, so that sort of famous hit of pleasure we get when we're doing something like, you know, eating delicious cake or maybe drinking alcohol or things like that. So it's thought that that's where some of these anecdotal reports of, you know, reduced drinking and reduced online shopping and things like that. There have been studies that people aren't shopping as much if they're on Ozempic or a semaglutide.

We've heard reports. I mean, I've talked to patients who really do call this a miracle drug, right? They say that these drugs are completely changing everything that they've struggled with in their lives. I mean, I've heard it all, right? I have less anxiety. I'm online shopping less. Again, these reports have reduced alcohol use. Again, these are things that need to be studied.

They're mostly anecdote at this point, but it's certainly an intriguing thought. And we have seen drug companies start investing in research, not in addiction, but in areas like Alzheimer's and brain disease and things like that. What you're saying is also what makes this so fascinating because within the medical industry, there's also anecdotal conversations or evidence that people might be on these drugs and then no longer need other types of drugs that they've used to combat things like high blood pressure, things that are attributed to obesity. Right. So this is a very important part of the discussion around access and

whether insurers should pay for these medications is sort of, okay, if these drugs help people lose weight, do they make people healthier as well? And we've seen that there are markers of things like cholesterol levels reduce when you're on these drugs. We have seen indications that people's health may improve when they are on these drugs and they're losing weight. But the bigger question is sort of, well, does this actually reduce other diseases that are associated with higher weights? Do we see these drugs actually improving health outcomes? And I know a lot of people think of weight as the same thing as health, but they are two distinct subjects and two distinct entities. And so what the big push has been by the pharma industry is to try to prove these are drugs that are going to reduce costs for insurers in other respects.

And we had this big, important trial come out last year from Novo Nordisk, the company that makes Ozempic and Wigovi in August. And the study looked at adults who had previously had heart issues like strokes and put them on Wigovi and wanted to see, does this reduce your risk of having another heart incident like a stroke? And they actually found that it did. It brought down the risk of heart, these kinds of heart issues by about 20% relative to a placebo. And it was a big, important study. We're kind of still digging into the details of that research,

but it could be an important factor in terms of getting insurers, at least for this specific group, so people with a high risk for further heart incidents. This could be an important factor in getting insurers to maybe start widening access in certain populations, but I would expect it to be kind of a long slog. Many insurers do not cover these weight loss drugs. You actually reported that Medicare puts weight loss in the same category as balding and erectile dysfunction. So a lot of people, some groups of people are getting access to it, but others are not. Does it come down to the individual doctor and who can pay? And of course, an insurance, they will send it to the insurance company and then the insurance company will say, I won't, we won't pay. But yeah, how is this working out for people? Why is there such a

vast difference in who has access and who doesn't and who gets coverage and who doesn't? I think this is one of the things that I think makes this moment in time so kind of full of promise, right? People who haven't had access or the ability to take medication for this area, you know, may now have the opportunity to do so. But then you have this enormous barrier of insurance coverage. And it's really interesting because I think, you know, we tend to think that insurers will cover medications eventually, right? That they'll, you know, if a drug is for a medical condition that the insurer will, you know, pay for it. Like maybe it'll be a huge hassle and maybe you'll have to really fight

them for it. And maybe if the drug is really expensive, you might have to go to some really extreme lengths. But if a drug is needed for your medical condition, you'll probably be able to get insurers to cover it. This is one of those weird areas where insurers don't treat obesity drugs like a diabetes drug or like a drug for, I don't know, cystic fibrosis or sickle cell anemia or something like that. They treat it in a kind of different way. There's sort of some historic precedent of insurers treating these medications as if they're more aesthetic. And so you actually have Medicare, which is the U.S. program for covering older individuals in America. With health insurance, Medicare doesn't cover obesity drugs at all as just a category. They don't cover weight loss drugs. And then we know private insurance, the data varies, but we've found that about three quarters of private insurers typically don't cover these medications. My colleagues and I also did kind of a cool survey

of state Medicaid plans. Medicaid plans cover low-income individuals. And we found last year that only 10 of, obviously, 50 state Medicaid plans offer broad coverage. There was some sign of change. We found that about four were adding, had added obesity drug coverage since 2021, which is when Wigovi became available. And eight told us last year that they were considering it. But these numbers kind of speak to this overarching issue of access,

right? I think it'll be really interesting to see how things evolve in the future. Right now, we're seeing people are getting access either because they have a really persistent doctor, but that can't change your insurance coverage policies at the end of the day. Or we're seeing people who are willing to pay out of pocket, which is a very expensive proposition. They're willing to pay, and it's expensive. How expensive is it? It depends on the drug, but generally this class of drugs is going to run over $10,000 a year at list prices. People may find coupons and things

and ways to bring that price down a bit, but at the list price in the US, that's over $10,000 a year. And these drugs are supposed to be taken for the rest of your life, by the way. Right. Because when people stop taking it, they've reported gaining weight, gaining their weight back, sometimes even more. Right. So we've seen in anecdotal reports and also in studies that the pharmaceutical companies have done that when people stop taking these medications, they tend to regain weight. Now, the exact degree seems to vary a lot, but generally, to keep the weight that you've lost off, people will need to stay on these drugs, likely long term. Although there's certainly a lot of interest in finding

ways to get people off the drugs and keep the weight off. And I'm sure there'll be a good deal of research into how to do that most effectively. You know, I was reading how the UK has a ban on the use of Ozempic for anything other than the treatment of type 2 diabetes. And I think Belgium is also considering a temporary ban like this too. We are seeing news stories all the time about shortages here in the U.S. But I mean, there's so many loopholes because it really comes down to who can afford to buy it online, to pay full price. $10,000 a year is pretty expensive. But there are also these social and economic equity issues at play here because only a fraction of the people in your reporting, you say, can benefit from

actually having the means or access to them. How many people are on Ozempic? Because it feels like everybody's on it. I wish I had a better answer. I know, it's a rhetorical. We don't totally know. But I think maybe a good counter question would be, does it really matter? Which is like to say that I find it really interesting this moment of like, are they on Ozempic or not? And the fact of the matter is, you know, I think there's some stigma that's feeding into the way we are thinking about this, right? This person doesn't deserve to lose weight easily, right? They should have to work for it or, you know, even they, you know, obviously there are definitely a lot of cases of like thin people who are using Ozempic to shed a few pounds.

And that's, you know, not what these drugs were developed for. But if a person is genuinely medically eligible for these drugs and their doctor prescribed it to them and they're taking it as indicated and they managed to get their insurer to cover it or, you know, God forbid, they're paying out of pocket for it. That's their decision, right? And it's actually a perfectly legitimate decision to make. People who are getting these medications are doing it typically because they don't have better options, right? They want to be healthy. They're concerned. Their doctors told them to be concerned. And I think we have to respect that decision and stop putting so many judgments on it. If you're just joining us, my guest is Bloomberg health reporter Emma Court. We're talking about the surge in popularity of new weight loss drugs like Ozempic, Wegovi, and Monjuro. We'll hear more of our interview after a break.

And John Powers will review a new Netflix series starring Michelle Yeoh. I'm Tanya Mosley, and this is Fresh Air. This is Fresh Air's Anne-Marie Baldonado. If you're already a Fresh Air Plus supporter, you may have heard Terry talking about the first daily national broadcast of the show in 1987. It was still like making a national debut both to the audience and to program directors because we weren't on that many stations to start with. Dave Davies talking about his job driving a cab. This is a fascinating city of many diverse neighborhoods. It was fun to just tool around in a cab all day.

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Today we're talking to Emma Court. She's a reporter for Bloomberg and has been reporting on Ozempic and the new class of weight loss drugs that are being touted as miracle drugs. She's produced a podcast for Bloomberg about the myths and realities of dieting called Losing It. Previously, she worked for Dow Jones Market Watch and Business Insider, where her reporting focused on the big business of making medicine.

She's currently on a fellowship with the Knight Badget at Columbia University. Have there been any long-term studies on use of these drugs? Yes, and there's a caveat. So in order to get weight loss drugs approved, because there's such a long and terrible safety track record in this category, developers do have to run pretty long-term studies. They can't just study for these drugs for a couple months or even a year. They're multi-year, very large studies.

And so Wigovi comes with a pretty lengthy research track record behind it. So does Zepbound. And one thing that proponents of these drugs really emphasize is that they've been used, GLP-1 specifically, have been used in diabetes for almost 20 years, over 20 years at this point. And so they say, we have this long track record of using them in people with diabetes. We basically know what they're all about. You know, they have some, they can have some pretty nasty side effects, you know, gastrointestinal issues like nausea, diarrhea, constipation. And how serious are those?

It's a good question. It really varies per person. You know, there can be some more serious side effects like pancreatitis, which is inflammation of the pancreas that can be quite dangerous. But some people just take these drugs and they feel so ill that they just can't stay on them. And that's a reality, quitting these drugs due to the side effects. That's a reality of even things like nausea and diarrhea. If you're on a lifelong drug, that's a really, really unpleasant prospect. I mentioned that Weight Watchers now offers prescriptions. How have these drugs impacted

the weight loss industry? It's been a really fascinating shift to watch. Weight Watchers didn't really offer weight loss drugs before. And they're kind of famous for their lifestyle focused program, the points and the weekly meetings and things like that. But we've seen programs like that, these lifestyle-oriented, big kind of diet industry players, start making a shift as it became clear that Ozempic was not something that they could just ignore. So we saw recently Weight Watchers acquired a telemedicine company that prescribes drugs like Ozempic for weight loss. And we also saw another big rival, Noom, get into the prescription weight loss business itself. And I think, you know, a lot of, it's been interesting, especially for Noom, which had a lot of momentum around its app during kind of COVID, right? Everyone kind of got on Noom. They were sitting at home and they were getting a little nervous about the way the number was creeping up on the

scale. And there was a lot of buzz around Noom's program. And I think that buzz quickly shifted to Zempik. Because the buzz around Noom was that that app really promotes mindfulness. And so then it switched to, we will now offer a prescription for this new miracle drug. Well, that's not exactly, I think, what the company would say, but I agree that it's been really interesting to see companies that were so single-mindedly focused on lifestyle as the solution kind of jump on the bandwagon, right? And I actually, my colleague Ellen Hewitt and I did a profile of Weight Watchers getting into the prescription drug business for a business we cover last year. And we spoke with members,

Weight Watchers members who were kind of these diehard core, longtime Weight Watchers members, who were kind of these die-hardcore, long-time Weight Watchers fans, and they felt really betrayed by the shift Weight Watchers was making. They felt like Weight Watchers had put out its plank on one philosophy and was kind of jumping ship and changing their stance and getting aboard, like you said, the Miracle Drug Train. And I think these companies would say, this is a highly effective new option that we're offering to our members, our patients. It's important to provide access. We vetted this stuff. But it's hard, you know, to not also see the way that just in general, there's been a big rush to get on top of this and to offer the stuff.

We hear all the time, at least in me reading and seeing the research about these med spas that are offering compound versions. First of all, what are compound versions? And then what are the risks to taking them? Yes, it's a very interesting area. Essentially, compounded drugs have long existed. Actually, lots of people take compounded drugs. Pharmacies can mix up versions of drugs in various instances in order to make it available, for instance, in times of shortage. That's sort of the reason drugs have been compounded for this purpose. There have been recurring shortages of these diabetes and weight loss drugs due to the intense interest in this area of late. And so compounded drugs are pharmacy-made versions. And people have been buying cheaper versions of so-called Ozempic

from these compounding pharmacies. It's kind of a gray area. We've seen pharmaceutical companies recently start actually suing these med spas and the compounding pharmacies and try to get the stuff to stop. It doesn't seem like the most, it's not like FDA regulated, so it's not something where you can say, I'm taking this drug and it's got the FDA seal of approval, they've inspected the factory, they've looked at the safety record, things like that. And there can be differences in the drugs. You're not guaranteed to get the drug that was studied by Novo Nordisk.

You might get some different version made with different ingredients. So it's not the most above-the-board source of getting weight loss drugs, I would say. In thinking about supply and demand, you mentioned the two drug makers who dominate this sector, Novo Nordisk and Eli Lilly. Why is it not as simple as just making more of the medicine to keep up with the demand? That's a question many patients have been asking. And what we've heard from the drug companies is, you know, demand is a moving target. And, you know, now it's not even an issue of, you know, we heard from, you know, Eli Lilly's CEO leadership recently.

It's not really even a matter of not being able to make enough. It's that demand is so high, we just can't keep up. It's not a shortage because we don't have enough supplies or whatever. It's because we just cannot keep up with the demand. When I first started writing about them, almost nobody was paying attention to the fact that Novo Nordisk had developed this highly effective weight loss drug. It just wasn't on people's radars. And the pharmaceutical industry is highly regulated. It makes long-term plans. You have FDA-regulated factories.

You have this kind of long time horizon you're working with. And so when a drug is getting approved, you're thinking about, well, what's the demand that's going to exist for it? And Novo Nordiska said we were pretty taken off guard by how quickly this drug got picked up by patients and doctors. So that was kind of initially what they've said was the problem. And I think that's only continued. We've only continued to see the demand rise for these products. And so, yeah, the companies are trying to make more, but that requires making investments in factories,

doing all kinds of things that will take years to pan out and will take years to result in more supply of Govee or Zepound or other drugs. And in the meantime, that is resulting in a situation where you have a lot of people competing for a limited amount of drug. That's resulting in shortages of drugs being used by people with diabetes who, um, you know, are saying we need these drugs. Um, we can't have them taken away from us,

um, because of this recurring weight loss frenzy. Right. Um, and it's causing all kinds of, um, difficult situations for people. Um,

we have seen pharmaceutical companies make big investments in factories but the short answer is it's going to take a while for that to really realize more pharmaceutical drug our guest today is bloomberg health reporter emma court talking about the new class of weight loss medications like ozempic that are surging in popularity we'll continue our conversation after a short break. This is Fresh Air. the body positivity movement that has also been happening over the last few years. But what we're seeing is a lot of making fun in pop culture about the use of Ozempic and other weight loss drugs. Everyone on social media is kind of guessing who's on Ozempic. You mentioned this, like what celebrity is on it? I want to play a clip that illustrates this. It's by performance artist Ari Dyan, and she's singing her song, Ozempic Wegovi Manjaro. Let's listen. And me keep up with the Kardashians I want to be so super thin I used to want an hourglass But now I'm starving out my ass

Toes up the tide Some maglite And when they ask I'll say I'm eating right Ozentic would go beat Manjaro No more sorrow I don't care about my face, just a little tiny waste. Put that shot in me.

Put that shot in me. Okay, that song's going to be in my head for the rest of the day. That's performance artist Ari Dyan, and it's a satirical take on the use of these drugs like Ozimbic to lose weight. But there is this movement of shame that we're seeing. Oprah made this announcement, you know, that she's on it. And she says, like, obesity is a disease. It's not about willpower. It's about the brain. But I'm thinking about the body positivity movement and embracing all body sizes. We had a conversation last spring with Virginia Sol Smith, who wrote the book Fat Talk. And she pointed out over and

over in this book that there is not a correlation between obesity and automatically having health conditions, health problems. But is the popularity of drugs like Ozempic possibly eclipsing that movement? Yes, I think so. And I think the movement thinks so as well. I've spoken with fat acceptance advocates who are very concerned about this. They're concerned, especially about these drugs increasing fat discrimination and stigma in society because now you can say, well, why don't you just take Wigovi, right? You know, you should just lose weight on Wigovi and then you won't be living in a big body anymore, right? So I think there's a lot of, you know, interest in what is, what are the effects of these drugs going to be culturally? And, you know, and by the way, the advocate I mentioned, who I spoke with, said, you know, advocates are also concerned about, are these drugs as good as we're being told they are, right? We want to see the evidence. We want to make sure that these drugs actually do improve people's health and they don't just help people lose weight, right? And they, you know, we're

in the early stages of research like that being done. We've, as I mentioned before, seen some research finding that people who have previously had things like strokes had their stroke risk cut by being on Wigovi. And there are other studies like that in process looking at health outcomes being improved by weight loss on these drugs. But, you know, we still don't, we're still not there yet in terms of saying these drugs make people healthier, period. And so I think it's an interesting moment in time. There's also a lot of concern, are people going to be told to take these drugs merely based on their weight, right? So if you're an otherwise healthy person, but your body mass index is considered obese. By the government standards, our doctor's just going to tell you to get on these drugs and not look at other markers of your health, not look at, oh, actually your cholesterol is fine, your blood pressure is in a good range,

things like that. So it's an interesting moment. and legitimate concerns yeah it's a very legitimate concern you know honestly for all the way that song was very clever and funny um but it can kind of feel like the enthusiasm has gotten away from us right like you know are we swinging wildly from being a you must diet and exercise society to being an ozempic society. What does it say about us? I mean, have you ever seen anything like this, where the pharmaceutical industry, medical doctors, institutions like Weight Watchers that have been around for decades

and teaching these healthy ways of living, in a matter of a year or two are jumping on this bandwagon. In a lot of ways, our conception as a society of what is a disease is very cultural and societally based, right? So if you think about the way that, for instance, mental illness has, our perception of mental illness has changed a lot over the last several decades. Disease is kind of a societal construct in a lot over the last several decades. You know, disease is kind of a societal construct in a lot of ways. It really has to do with how people perceive it and how things are categorized.

You know, and a lot of the time, like we have seen medical treatments and pharmaceutical, you know, involvement in areas actually change the way conditions are perceived, right? You can take medication for high cholesterol. You know, that might've been controversial at one point, but it's not really controversial today. You can take medication for erectile dysfunction. You thought it was interesting, the comparison to Viagra. Well, it can feel like a similar ebullience, right? It can feel like a similar, wow, this thing is available and everyone's really excited about it and the pharmaceutical industry has dollar signs in their eyes.

Obviously, they're different things and I don't want to trivialize weight or obesity by comparing it to ED at all, but there's a similar sort of, the environment and the atmosphere can seem a little similar in terms of the excitement, for sure. Emma Court, thank you so much for your time

and your reporting. Thank you. This has been lovely. I appreciate you having me on. Emma Court is a reporter for Bloomberg. This is Fresh Air. In the new Netflix comedy-drama The Brother's Son, a legendary Taiwanese assassin travels to Los Angeles to protect his goofy younger brother and his formidable mother,

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If you want to know about politics, you go to Mrs. Chang. She works at the mayor's office. And if you want to know about the church, ask Mrs. Liu. Her husband is the pastor of the Chinese church. And if you want to know anything about Pastor Liu, ask Mrs. Wang. She is having an affair with him. And rumor has it, she gave him herpes. Now, if you've seen much Chinese pop culture,

you'll know that it often possesses a slightly delirious mixture of tones. The brother's son is closer in spirit to Hong Kong than to Hollywood, in the sense that it dishes up seemingly everything. Action sequences, cornball buffoonery, romantic interludes, soap opera twists, touching tales of illegal immigrants, and sly jokes about Asian American life, including a parody of the mansion where the actor John Cho supposedly lives. All of this is fueled by wall-to-wall pop songs. Although the show's uneven,

The Brother's Son offers a nifty glimpse at Chinese immigrant life in L.A.'s San Gabriel Valley, with its mini-malls, low-rent travel agents, and terrific restaurants. The show correctly identifies the bakery that makes the best egg tarts. We meet an admirably wide range of Asian-American characters, from nerdy to comically feckless to downright dangerous, and we get an amusingly offbeat look at the conventional divide between immigrant parents who want their kids to be professionals and the kids who want the sort of fun, creative jobs you get to do in America. In their different ways, all the sons attempt to save the family. Charles with ultraviolence, Eileen with chicanery, Bruce by working to force them out of crime altogether. Yet they all have dreams that are being thwarted by the very family they're trying to save

Just as Bruce wants to be on stage and not in med school Charles is trapped being a killer He's a wannabe baker who's actually happier in the kitchen Trying to learn how to make the churros that wowed him when he first hit L.A. Even though the show is officially about the brothers, its true center of gravity is the Oscar-winning Yeo, who possesses the ease and emotional weight that turns their mother into the show's most compelling character,

a smart, strong woman who calmly but firmly reveals her own ambitions. As the jokes and bodies fly all around her, Yeo makes Aileen the still point of a madly spinning world. John Powers reviewed the new Netflix series, The Brother's Son. Our technical director and engineer is Audrey Bentham. Our interviews and reviews are produced and edited by Amy Sallet, Phyllis Myers, Roberta Shorrock, Anne-Marie Baldonado, Sam Brigger, Lauren Krenzel, Heidi Saman, Teresa Madden, Seth Kelly, and Susan Yakundi. Thea Chaloner directed today's show. Our digital media producer is Molly C.V. Nesper.

My co-host is Terry Gross. I'm Tanya Mosley.