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I didn't know about the oral formulations, the only ones I've encountered for both Ozempic and Trulicity have been the injectables, (ouch ouch ouch), and even then supply was intermittent because demand outstripped it (particularly for those looking for quickie weight loss).

India makes half the pharmaceuticals you consume in the West, be they cheap or expensive. So it's not surprise I can get it for next to nothing, especially in bulk. So could anyone really, depending on their appetite for Chinese grey markets.

Oral formulations of semaglutide are less effective than a jab, but they're also cheaper, and you can just take more of them.

The long and short (and thin) of it is that it works for most people, and for those it didn't work on/couldn't tolerate it, there are both similar drugs that are likely better at the weight loss deal, and tens of billions of dollars being spent finding more.