Last Monday Taoiseach Micheál Martin posted on social media about his delight at attending the unveiling of a primary school’s new playground equipment that is “part of Novo Nordisk Ireland’s ongoing Play at Primary School Initiative”.
The initiative by the manufacturer of Ozempic and Wegovy involved providing nine Deis schools with equipment, with plans to expand to more schools during 2025.
On the face of it, new playground equipment seems a commendable and worthwhile initiative. But the question has to be asked: what’s in it for Novo Nordisk, which has a track record in sophisticated public relations campaigning?
Fundamentally, there are potential ethical considerations with any company or industry paying for children’s playground equipment. But Novo Nordisk deserves additional scrutiny given its marketing practices.
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In 2023, the Danish drug manufacturer was suspended by its own industry body in the UK for two years over its sponsorship of weight management courses for health professionals.
This is the most severe punishment that the Association of the British Pharmaceutical Industry has issued and was only the eighth occasion in the past 40 years the ABPI board has issued such a significant sanction. It led to the Royal College of Physicians and the Royal College of General Practitioners ending their partnerships with Novo Nordisk.
The suspension occurred because Novo Nordisk paid for a “large scale Saxenda [a weight-loss drug] promotional campaign […] which was disguised” and included “heavily biased” information. The ruling outlined “serious concerns about Novo Nordisk’s culture” and raised further concerns about Novo Nordisk at the global level. In March 2025, the ABPI voted to readmit Novo Nordisk as a full member on the basis that it “now had the systems and culture in place” to resume self-regulation.
But Novo Nordisk was since found to be in breach of UK marketing regulations on several more occasions.
In Ireland, issues have also emerged. Through a freedom of information request, I obtained an inspection report by the medicines watchdog, the HPRA, of Novo Nordisk’s advertising-related activities for the period January 2021 to May 2023.
My findings that the pharma company broke rules around the advertising and marketing of its medication to healthcare workers over three years were reported in The Irish Times on Friday.
The HPRA found “a significant number of non-compliances” with Novo Nordisk’s advertising and “educational” activities.
[ Maker of Ozempic and Wegovy broke advertising rules, regulator findsOpens in new window ]
They outlined that the “level of control and governance that was in place for educational activities, promotional and non-promotional meetings with healthcare professionals, advisory boards and medicinal product advertising were deficient”.
Issues outlined included presentations to healthcare professionals that were “unbalanced” in nature. It also found the omission of important and legally required drug information relating to adverse reactions, precautions and contraindications in materials intended for use with patients and in a promotion to healthcare professionals.
A teaching guide intended for use with patients included advertising for a prescription-only product, which is not legally permitted. The HPRA also observed compliances with requirements. In response to the HPRA review, Novo Nordisk outlined a range of procedural changes. This includes extensive reviews of slides presented by third parties for work affiliated to Novo Nordisk; the removal of materials in breach of regulations; updates to internal guidance; and the introduction of relevant training processes.
A spokeswoman told The Irish Times that the company “addressed the findings to ensure compliance with industry regulation and this was completed to the HPRA’s satisfaction immediately following the inspection” and that its focus “remains on meeting the needs of patients, healthcare professionals and partners”.
Between 2016 and 2023, Novo Nordisk has reported making payments valued at over €6.6 million to healthcare organisations, a patient organisation and healthcare professionals, based on my analysis of Novo Nordisk’s disclosures on transferofvalue.ie – the pharmaceutical industry’s record of direct or indirect financial support or “transfers of value” to healthcare professionals – and the disclosures of patient organisation payments Novo Nordisk makes on its website.
It’s not clear whether this is the full picture: research I was involved with has highlighted significant shortcomings with the Irish payment declaration system. In the UK, Novo Nordisk has been found to be underreporting payments to the value of almost £8 million (€9.5 million) to 150 doctors, patients, journalists and healthcare organisations.
One might ask why €6.6 million in payments to individuals and organisations in our health system would be problematic? The pharmaceutical industry describes these payments as being for education, research and healthcare. But payments such as these have well-recorded effects on prescribing practices, and are linked to recipient organisations favouring the positions of the funder.
Novo Nordisk has made payments to help set up patient organisations, to pay senior decision makers in the Irish health system consultancy fees, and to help fund clinical guidelines on obesity in Ireland. Guidelines and patient organisations are important endeavours, but there are valid concerns about industry funding, as international evidence shows that it can influence important organisations and initiatives. When it comes to Novo Nordisk paying senior health system decision makers as consultants, significant scrutiny is necessary given the influence they have over our health system.
Nothing here is intended to question the benefits of Novo Nordisk’s approved medicines – if a medicine is approved for use in Ireland then the evidence shows that it meets the required standards for benefits and risk. What we should question is whether the drug maker’s marketing efforts are affecting the decision making of our politicians, policymakers, prescribers and healthcare organisations. These decisions should be based on evidence only, not who has paid for our playgrounds, our conferences or our lunches.
Novo Nordisk is applying to the State to reimburse its weight loss drugs for a much larger group of people. This decision has the potential to put unprecedented pressure on the State’s health budget, potentially more than doubling state expenditure on medicines to €10 billion. The drugs are so expensive that US researchers have suggested it would be less expensive for the United States to just buy Novo Nordisk than to reimburse its weight loss drugs.
There’s a reason that the College of Psychiatrists of Ireland ended pharmaceutical industry partnerships in 2010 and the Irish College of General Practitioners last year voted to phase out pharmaceutical industry partnerships. It’s because, as the College of Psychiatrists put it, the college’s aims do not always align with the industry’s aims and there is a need for the college to be able to provide “independent appraisal of the value of specific drugs”.
Our health and education systems struggle for funding for important initiatives. Pharmaceutical companies and other industries sometimes step into this void. But we need to ask if there are hidden costs to this funding, costs that may not be worth paying for.
James Larkin is a senior postdoctoral fellow in the department of General Practice at RCSI
