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Globe and Mail
17 minutes ago
- Globe and Mail
Explore the emergency room closures in your area with our interactive map
This project aims to document every instance in which a hospital emergency department (ER) in Canada closed its doors – temporarily or permanently – since 2019. For each closure, The Globe and Mail captured the ER's name, start and end times, and the reason for the disruption. Explore the interactive map below to browse ER closures across Canada, as compiled by The Globe and Mail. The analysis focuses exclusively on emergency departments. It does not include closures or service interruptions at walk-in clinics, urgent care centres or community health centres. To compile a complete list, The Globe asked each province and territory for a list of all ERs under their jurisdiction. If an ER was permanently closed or converted to a clinic, its closure hours were no longer counted beyond that point. Closures were classified into three categories: These are unplanned, one-off disruptions. An ER is considered temporarily closed if it shuts down with little advance notice and the closure does not follow a recurring schedule. Recurring reductions in service hours (e.g., overnight or weekend closures) that persisted for at least two consecutive months. Short-term reductions – such as during holidays – were still considered temporary. Importantly, scheduled closures that began before 2019, the starting point of this project, are not included in this analysis. This is to avoid attributing long-standing schedules as new disruptions. In some jurisdictions, the data did not distinguish between scheduled and temporary closures. In such cases, all disruptions were grouped under a general 'ER closures' category. These occur when an ER remains physically open but is unable to provide full emergency services. Common examples include: Some records lacked specific start or end times. In those cases, The Globe imputed missing values using the average duration of similar disruptions at the same ER. This approach was used in: Health authorities in the territories reported no closures of service disruptions.
Globe and Mail
17 minutes ago
- Globe and Mail
Canadian ERs closed their doors for at least 1.14 million hours since 2019, records show
The freak accident happened as Derrick Maloney and a co-worker were cutting up the last of the birch wood on a chilly spring morning in Bonavista, a Newfoundland town about 3½ hours from St. John's. Mr. Maloney, 51, was swinging a freshly cut log into a bin when his left hand hit his colleague's roaring chainsaw. Metal tore through his safety gloves, ripping his hand from pinky to wrist. He kept his glove on, cradled his hand and jumped into his co-worker's pickup truck. Blood pooled in the floor mat as the pair raced to the Bonavista Peninsula Health Centre, a few minutes' drive away. But when Mr. Maloney tried to get inside, he found the doors locked. The day of his accident, Friday, April 11, was one of nine days so far this year that the emergency department at Bonavista's only hospital had been closed for some or all of the day and night because of a staffing shortage. The province's health authority issued a news release the day before, saying that the ER would be shuttered for 48 hours, and that patients requiring emergency care should call 9-1-1 or head to a hospital in Clarenville, 110 kilometres away. Mr. Maloney, who wasn't aware of the closure before his accident, tried an old ER entrance. It was locked, too. He figured someone must be inside the 10-bed facility, so he slipped in through an outpatient door and found a nurse. She staunched his bleeding and put him in an ambulance to Clarenville, where he underwent emergency surgery that saved his hand. He was fortunate. Two years earlier, on another day when the Bonavista emergency department was closed, a resident died of a severe asthma attack while an ambulance transported him to an ER that was open. 'What I'm always thinking about every night is how severe it could have been,' Mr. Maloney said. 'Suppose it would have been my full hand was chopped off? Or a heart attack? Or the jugular vein cut? There's nights I can't even sleep because I think about how bad it could have been.' He is hardly alone in wondering if the emergency department in his community will be open when he or someone he loves needs it. Temporary ER closures, often announced with scant notice, have in recent years become a fact of life in rural Canada, The Globe and Mail found in an investigation of a crisis affecting small towns from coast to coast. Temporary closure or other disruptions in services increased significantly in recent years, with some small-town emergency wards shuttering for months. Yet there is no national dataset documenting the scale and scope of this new phenomenon. The Globe tried to gather six years' worth of ER closure statistics as part of its 'Secret Canada: Your Health' project, which looks at important health care data that isn't systematically tracked or made public. Only officials in New Brunswick and Manitoba were able to provide a detailed set of closing statistics covering nearly all of our requested time span, going back to 2019, the last year before the upheavals created by the pandemic. Other provinces didn't have data for the entire period, or referred The Globe to old news releases or to local health authorities. British Columbia supplied data seven months after an access to information request was filed. The information, which only covers the period starting in 2023, arrived two days before the publication of this article, too late to be included in The Globe's analysis. The data The Globe collected show that this is almost exclusively a rural problem that touches all provinces, but particularly Manitoba, with 70 per cent of ERs having experienced closures, Nova Scotia (66 per cent) and Saskatchewan (57 per cent). Collectively, Canadian ERs closed their doors for at least 1.14 million hours since 2019 – the equivalent of 47,500 days. Temporary closures mostly peaked around 2022 and 2023, and gradually decreased since. The improving numbers underline the efforts by all provinces to recruit health care professionals and convince them to practice in outlying regions. However, the drop in temporary closures is also in part due to the permanent shuttering of some ERs – thus excluding them from our tallies – as well as the conversion of some emergency wards to a different type of service and a permanent reduction of hours at some ERs. Newfoundland, for example, relies more on virtual care, with a physician only available remotely. Nova Scotia converted nine ERs into urgent treatment centres – which don't deal with life-threatening cases, don't receive ambulances and see patients only by appointment. In response to this crisis, some local staffers and communities have been rallying to stave off impending ER disruptions – most notably in Rivière-Rouge, Que., where residents didn't just march in protest but also petitioned the courts successfully to suspend a scheduled closure, and are now actively co-operating with officials to retain new health care workers. But efforts like this can only make so much of a difference, and the closures continue across the country. For the fourth year in a row, Doctors Manitoba, which represents physicians in the Prairie province, warned residents to expect and plan for rural ER disruptions this summer. The group's president, Nichelle Desilets, said only 20 out of 72 rural hospitals would keep operating around the clock. 'We are still struggling with staff shortages, physician shortages, nursing shortages.' Since 2019, at least 34 per cent of Canadian ERs had an unplanned, short-term closure or a planned, long-lasting reduction in hours, usually shutting down on nights or weekends or both. 'The ultimate effect of all that is the patient suffers,' said Aimee Kernick, president of the Canadian Association of Emergency Physicians. It is 8:45 a.m. on the Friday before the Victoria Day long weekend, and Tim Vine is once again scrambling to prevent a closure of the ER in Thessalon, a Northern Ontario town of just more than 1,200 people that sits along the TransCanada Highway between Blind River and Sault Ste. Marie. A notice has already been posted to the hospital's website warning it will be closed on Saturday, just as it was three days earlier when Mr. Vine and his colleagues couldn't find a doctor to parachute in for a shift at the small facility. 'I was just talking with the medical affairs co-ordinator to say that we've got a bit of a cobbled-together strategy that we might be able to pull together to avert the 24-hour closure,' he said. 'This is our life. We've got four other vacant positions next week: two in Thessalon, two in Richard's Landing, and we're continuing to work on those.' Mr. Vine has been the chief executive officer of the North Shore Health Network, which oversees three small Northern Ontario hospitals, since January, 2023. He is the seventh person to hold the job in seven years. His medical affairs co-ordinator, who is also his executive assistant, is additionally serving as interim physician recruitment co-ordinator, a role that Mr. Vine said has devolved into 'air traffic control' for locums, the term for doctors who work somewhere on a temporary basis Although provincial funding is available for the equivalent of 5½ full-time doctors to provide all primary and emergency care to the Thessalon area, only two have settled there. They practice nearby, in the town of Bruce Mines, and cover the Thessalon ER when they can. The rest of the time, Mr. Vine and his colleagues fill the schedule by firing off increasingly desperate texts and e-mails to locums, offering whatever bonus pay they can spare from a hospital budget already in the red. If they fail, the ER closes temporarily. Small towns such as Thessalon have increasingly struggled to attract permanent staff. Only 7 per cent of physicians were based in rural Canada in 2023, the most recent year for which the Canadian Institute for Health Information has published data, while about 18 per cent of the population, or nearly one in five Canadians, live in these areas. The share of doctors practicing rurally has eroded over time, falling from about 10 per cent in 1983, according to CIHI. The share of nurses working in rural and remote areas also fell to 9.6 per cent in 2022, down from 11.1 per cent a decade earlier, CIHI says. Part of the reason rural communities can't find the doctors and nurses they need is that medical professionals are no different from other Canadians in their desire to leave small towns. 'The urbanization of society' makes rural recruitment tougher all the time, said Newfoundland and Labrador Health Services chief executive Pat Parfrey. 'The children of people living in these more isolated communities are moving into urban areas where they want to bring up their families.' Complicating matters further is the fact that young doctors who do choose rural medicine don't practice the way their forebears did. Gone are the days of mostly male country doctors who could work around-the-clock with the support of homemaker wives. As doctors worked fewer hours on average, patients – and the advancement of medicine itself – demanded more of their time. A rising tide of chronically ill seniors meant longer appointments, while increasingly complex diagnostics and treatments meant new doctors were more comfortable specializing in narrow areas of medicine, or working with interprofessional teams that aren't always available in small communities. These trends bubbled beneath the surface, then spilled into the open as the worst of the pandemic receded, said Gavin Parker, president of the Society of Rural Physicians of Canada and a doctor in Pincher Creek, Alta. In the years before COVID struck, some rural ERs relied 'on the graces of people being willing to all but kill themselves in order to keep it open,' he said. As a result of the pandemic, many of those exhausted doctors and nurses retired, cut their hours or moved away, he said. Since small towns usually rely on the same doctors to staff ERs and family medicine clinics, primary care deteriorated, forcing more patients to the ER for non-urgent care. The result was that more and more rural emergency departments turned to locum doctors and travel nurses, often from expensive for-profit agencies, to keep the doors open. 'We're getting multiple e-mails a day, and oftentimes with large financial incentives – potentially getting three times the pay I would make in a shift to work a shift elsewhere,' Dr. Kernick of the Canadian Association of Emergency Physicians said. Some rural B.C. hospitals are offering locums more than $3,000 for an eight-hour ER shift this summer, according to an e-mail from the province's Northern Health authority viewed by The Globe. At the same time, officials at Dr. Kernick's main workplace, the 65-bed Saanich Peninsula Hospital on Vancouver Island, often e-mail her and her colleagues, begging them to work extra hours because the emergency room is jammed. The hospital's ER has been closed from 10 p.m. to 7 a.m. daily for two years on what is supposed to be a temporary basis. 'We are all overworked and overstressed,' Dr. Kernick added. 'To protect ourselves and preserve our ability to keep working, money is not enough any more.' Rural hospitals that keep their ERs open without interruption usually have a stable group of local physicians, said Sarah Newbery, a rural generalist and the associate dean of physician workforce strategy at the Northern Ontario School of Medicine. Dr. Newbery is one of seven doctors contracted to provide all primary care and emergency services to the northwestern Ontario town of Marathon, population 4,000, and two nearby First Nations. If a gap in staffing looms at their 10-bed hospital, one of the doctors will usually cancel his or her family medicine clinic for the day to cover the emergency room. 'If our emergency department was closed, I would not want to be seen in the grocery store or the post office or mowing my lawn,' Dr. Newbery said. 'I think one of the things that happens in small places is rural docs step in and keep the emerge open because it's the thing they can live with.' The alternative is leaving patients in the lurch, especially in places where the next open hospital is an hour or more away. Mary-Jane Thompson emphasized that point when she made the long drive from Thessalon to Toronto to speak at Queen's Park in mid-May, one day after another last-minute ER closure occurred at the hospital where she was born. Thessalon began experiencing temporary ER closures in 2023, with a total of 11 recorded as of April 30. 'When I had a stroke in 2003, Thessalon Hospital saved my life,' the retired teacher said, choking back tears as she addressed a news conference. 'When my husband had a heart attack in 2013, he was stabilized in Thessalon Hospital and is alive today because of it. We are two of thousands over the years who are alive and well because of the Thessalon Hospital. Now our little hospital is in serious trouble.' As she spoke at Queen's Park, Mr. Vine and his colleagues were working to bail the hospital out of trouble, at least for the May long weekend. They managed to avert the previously announced Saturday closure, but the struggle to prevent them in the future continues. A little more than two years before Derrick Maloney's chainsaw accident, another Bonavista resident encountered a locked door at the town's ER. Charles Marsh, a 78-year-old carpenter who helped construct Bonavista's fire hall, RCMP station and other buildings, drove to the emergency department on Sunday, Feb. 19, 2023, because his asthma was acting up. On the phone that night, he told his daughter, Shelley Marsh Gosselin, that he left without being seen because the ER was closed and wouldn't reopen until Tuesday. 'He said, 'Someone is going to die over this,'' Ms. Gosselin recalled in an interview. 'And the next day, it was him.' Mr. Marsh called 9-1-1 the morning of Feb. 20 after a night of struggling to breathe with the aid of puffers and asthma medications. He died of a severe asthma attack in an ambulance en route to the nearest open ER. The late Mr. Marsh has become the face of a fight to keep rural ERs in Newfoundland open. A group of concerned citizens put his picture on posters they waved during frequent rallies outside the Bonavista Peninsula Health Centre, demanding an end to temporary shutdowns. Mr. Marsh's death happened at the peak of the local crisis. The Bonavista ER was closed for 560 hours in February, 2023, or the equivalent of just more than 23 out of 28 days, more than any month since July, 2021, the earliest date for which The Globe obtained data in Newfoundland and Labrador. The situation has since improved as Newfoundland and Labrador Health Services, the agency in charge of day-to-day operations of the health system, stabilized staffing in Bonavista. The number of closed days fell to one or two a month through most of 2024, with two uninterrupted months of service last August and September. This year, however, closures have ticked up, and the ER was shut for just more than 56 hours in April, including during Mr. Maloney's chainsaw accident. The overall improvement occurred because four doctors now have contracts to cover the Bonavista ER on a regular basis, although NLHS officials would not comment on the terms of their deals or say if any live in Bonavista full-time, citing concerns for their privacy. As well, the provincial government began offering six-figure bonuses to doctors willing to sign contracts to cover the Bonavista ER as part of a regular rotation, offsetting a disparity in the pay structure that used to make shifts at small rural hospitals less lucrative than those at larger facilities. 'How we recruit to rural towns needs to be different than it was 30 years ago,' said Desmond Whalen, senior medical director for Newfoundland's eastern-rural zone, which includes Bonavista. 'We're not going to recruit Wilfred Grenfell any more,' he added, referring to a legendary British doctor who set up shop on the Labrador coast in the early 20th Century and 'made medicine his life, 24/7.' Modern doctors crave work-life balance, Dr. Whalen said, and that means modern health-system leaders may have to recruit groups of doctors willing to work regular rotations in rural communities without moving there permanently, with virtual emergency care as a back-up. That's how his province is tackling the challenge. Bonavista Mayor John Norman said the locals protesting outside the hospital fail to appreciate all the town council, NLHS and the provincial government have done to improve medical care for the 8,000 or so residents of Bonavista and the surrounding area. A new wellness centre offering primary care, mental health and addictions and other services opened in 2022. The hospital opened a new, larger emergency facility in November of 2023 – a move that Mr. Norman says he believes will help with the recruitment and retention of health professionals. ER closures are 'certainly stressful for a lot of people in the area when you're used to having a health care facility available to you 24-hours-a-day, five minutes away,' Mr. Norman acknowledged. 'What we have constantly highlighted to people is that this is a national issue, and there are literally a thousand health facilities across the country that do not have enough staff.' The Globe's data back that up. Other ERs in Newfoundland and Labrador were closed more often than Bonavista's, where emergency service shutdowns from 2021 to April 30 of this year were the equivalent of just more than 78 days. In New-Wes-Valley, the ER was shuttered for the equivalent of 215 days in the same period. In Harbour Breton, Baie Verte and Buchans, temporary closures added up to 201, 139 and 124 days, respectively. Two other ERs on the Avalon peninsula weren't operating for months in 2022 and 2023 before reopening as urgent care centres with limited hours. Converting emergency departments from 24/7 operations to clinics is how Nova Scotia has decided to work within the constraints of long-time staffing shortages. The province is the only one required by law to report annually on how often ERs are closed. The most recent publication, for 2023-24, tallied fewer hours of temporary closure provincewide than in past years, but that is because, since 2020, the province has turned nine emergency departments into urgent treatment centres that don't accept ambulances or see patients without an appointment. New Brunswick, meanwhile, has mostly avoided temporary ER closures since the pandemic by staffing with travel nurses hired from other provinces by for-profit agencies. The province spent more than $173-million on travel nurse contracts between February, 2022, and March, 2024, according to the province's Auditor-General, who reported on the phenomenon after a Globe investigation of one Toronto staffing company. The presence of a hospital and its emergency department is an anchor in many small communities; closures will alter the local way of life, forcing new routines on people. One of the hardest hit zones in The Globe's survey was Manitoba's Interlake region, north of Winnipeg. In that area during 2023, Arborg, a town of 1,300 people, saw its hospital ER shut down for nearly 292 days, or about 80 per cent of the year. To the west, in Eriksdale, which had a population of about 700, the emergency ward closed more than 323 days during that period, about 89 per cent of the year. Many Interlake residents keep printouts of the ER schedules handy and expect to have to drive out of town if they need an open ER, according to community activist Keith Lundale. For Eriksdale residents, accessing ER care means motoring 30 minutes north to Ashern's Lakeshore General Hospital. For residents of Arborg, it means an hour-long drive south to Selkirk's Regional Health Centre. Dr. Desilets, the president of Doctors Manitoba, said these disruptions had a ripple effect, destabilizing larger ERs – such as those in Selkirk, Brandon and Winkler. 'We're hearing more calls for help for the bigger hospitals, the hospitals that in my mind never closed.' In larger cities, the problem of long waits in ER corridors before people get admitted to inpatient beds has become known as 'hallway medicine.' Mr. Lundale has his own coinage for the situation in his region. 'It's highway medicine. That's what it is.' There used to be a red sign outside Arborg's hospital signalling when emergency services weren't available. But Arborg hasn't had a functioning ER since Nov. 6, 2023. 'We just assume it's closed. They used to put up a sign. Now the sign is gone,' Mayor Peter Dueck said. The ER isn't permanently shut down but 'emergency department services in Arborg remain suspended,' Interlake's regional health authority told The Globe. 'There'll be an uprising' should officials ever try to close Arborg's emergency for good, Mr. Dueck said. Steven Lewis, an adjunct professor at Simon Fraser University who spent decades as a health policy researcher in Saskatchewan, argues that some tiny communities would be better off if officials closed struggling ERs permanently, rather than subjecting residents to unpredictable hours. They could redirect patients to reliable regional trauma centres while beefing up local ambulance service and primary care. But as Mr. Lewis learned when he studied the aftermath of the Saskatchewan NDP's decision to convert 52 rural hospitals into nursing homes and wellness centres in 1992, resentment over hospital closures can smoulder for years. 'People were lingeringly furious that the H was taken off their facility,' he said, 'even though they said years later, 'Nothing bad happened to our health.'' Rural people have a strong bond to their hospital, said Richard Fleet, the research chair in emergency medicine at Laval University. 'It's a major employer. It's the place where people were born and people died, and so there's lots of history in the community.' Just weeks before COVID-19, Dr. Fleet launched the Living Lab Charlevoix, a research hub on rural medicine that tested initiatives in Charlevoix, downriver from Quebec City. In June, 2021, citing a summer nursing shortage aggravated by the pandemic, the local health authority announced that the ER at Charlevoix's Baie-Saint-Paul hospital would close at night until the fall. Dr. Fleet contacted the health authority CEO and offered to help. The hospital nurses hadn't been consulted but were adamant they didn't want the ER to close. They got together to craft a flexible schedule, some postponing their vacations, others agreeing to work longer hours daily in return for fewer days per week. Within days, the health authority was able to announce that the ER disruption had been cancelled 'thanks to the exceptional mobilization of the nursing personnel.' Another example of people rallying to prevent a closure took place 2½ hours north of Montreal, when people in Rivière-Rouge learned late in 2023 that the local ER would no longer operate at night. At an emotional council meeting on Dec. 6, 2023, François Minogianis, a local first responder, asked the councillors to consider taking legal action. 'It's clear these decisions were taken by people who wouldn't have to live with the consequences,' he told the gathering. Mr. Minogianis told The Globe in an interview that he was particularly worried because hospitals that don't have a 24/7 emergency lose their eligibility to hire locum doctors. The hospital had been relying heavily on out-of-town physicians and private agency nurses. The town sought an injunction to stop the shutdown. Its bid was initially rejected. However, it won on appeal, thanks to words from doctors, nurses and a cancer patient, Martine Riopel. In an affidavit, she informed the judges that chemotherapy made her more vulnerable to infections and she had to get checked at an ER if she ran a fever. The anxiety from an extra hour of nighttime driving to find another ER would be unbearable, she said. 'When I learned that they were going to close the emergency, I panicked a bit. I thought it made no sense,' Ms. Riopel told The Globe. The Quebec Court of Appeal granted an injunction, citing the irreparable harm people like Ms. Riopel risked. But the injunction was just a reprieve, Louise Guérin, the president of the Rivière-Rouge citizens' committee, said. 'It wasn't sustainable if we didn't take action. So we had to find solutions.' Officials and activists learned to work together to make the hospital appealing to new health care workers. While the health authority recruited personnel from French-speaking countries such as Mali, Cameroon and Morocco, residents set out to help integrate the newcomers, to make sure they wouldn't be tempted to relocate to Montreal. Calling themselves 'godparents,' they picked up new hires at the airport, provided furnished lodging, assisted with registering children to school. Ms. Riopel, whose testimonial was instrumental in preserving the emergency's night operations, also got some good news. Her cancer was in remission. 'I am a fighter in life ... I was very determined to make it,' she said. 'So for the ER, it was the same thing.' Even as temporary closures of emergency departments become more common, no systematic protocol documents this trend. No formal channels tally ER closures nationwide, the Canadian Medical Association noted last fall as it urged Ottawa to appoint a chief health accountability officer to oversee bilateral health funding. Many provinces didn't begin tracking closures until after the pandemic started. The Globe and Mail set out to quantify these disruptions as part of its Secret Canada: Your Health project, which strives to bring to light data authorities don't make public or don't track nationally. The Globe tried to record every instance where an ER was closed since 2019. For each incident, we wanted to capture the location and date and time of the event, when the ER reopened, and the reason for the closure. We contacted provincial and territorial health authorities and, in some cases, health ministries. Most told us to file access to information requests. A few referred us to press releases or official reports. Most couldn't provide detailed information on ER closures, leaving The Globe to sift through a mix of time-limited official data, news releases and local media reports. In British Columbia, an access to information request filed seven months ago only arrived two days before publication, too late to be included in The Globe's analysis. 'This is something government needs to be tracking and reporting to Canadians,' former CMA president Joss Reimer said. 'We shouldn't be relying on news organizations to track health data and share what's happening on an ongoing basis.' Academics also found it difficult to obtain data on rural medicine, where most ER closures occur. At the University of Regina, Nuelle Novik led a project on rural health care released last year by the Saskatchewan Population Health and Evaluation Research Unit. Saskatchewan didn't have automated tracking of service disruptions until late in 2023. The report had to rely on access to information data, which only recorded disruptions lasting more than 24 hours. And in 18 per cent of cases, the type of services affected wasn't identified. 'So that could include some emergency services… who knows,' she said. More methodology details can be found here.
Globe and Mail
an hour ago
- Globe and Mail
Why I Think Viking Therapeutics Is an Asymmetric Growth Opportunity
Key Points Wall Street's smartest money has quietly amassed over $150 million in bullish positions, with Goldman Sachs eliminating all downside hedges. Despite trading near 52-week lows due to biotech industry headwinds, Viking's oral GLP-1 drug shows unprecedented tolerability that could revolutionize obesity treatment. Upcoming phase 2 oral data expected in October or November 2025 represents a rare binary event where the market significantly undervalues the upside potential. Most investors have written off biotech stocks as a graveyard of broken dreams. While artificial intelligence (AI) captures Wall Street's imagination, the biotech industry -- once the crown jewel of innovation -- has been left for dead. But beneath the wreckage, Wall Street's sharpest funds are quietly positioning for what could be the most significant metabolic breakthrough in a generation. A differentiated player in the GLP-1 gold rush Viking Therapeutics (NASDAQ: VKTX) is developing VK2735, a dual GLP-1/GIP receptor agonist for obesity treatment. The company reported stellar phase 2 results in February 2024, showing 14.7% weight loss at 13 weeks with the injectable formulation. But here's what makes Viking different: Its drug demonstrated unprecedented tolerability with a 13% discontinuation rate that was no higher than placebo -- a stark contrast to competing GLP-1 drugs. In obesity treatment, tolerability isn't a luxury -- it's key to real-world adoption. Viking's breakthrough with VK2735 isn't just efficacy; it's safety. The drug's 13% discontinuation rate matched placebo -- unlike Wegovy and Zepbound, which see discontinuation rates typically five to 10 percentage points higher than their placebo groups. Tolerability indistinguishable from placebo could expand the entire obesity market -- not just capture share. The obesity drug market is projected to reach $200 billion by 2030, yet current treatments face significant limitations. Novo Nordisk 's Wegovy and Eli Lilly 's Zepbound require weekly injections and cause severe gastrointestinal side effects in many patients. Viking's oral formulation, currently in phase 2 trials with data expected in the October-to-November time frame, could be the first pill to roughly match injectable efficacy without the tolerability issues. Here's what Wall Street might be missing: Viking's superior tolerability profile doesn't just mean competing for market share -- it could lift the roof on the entire obesity category. With no greater discontinuation than placebo, VK2735 could dramatically expand the addressable market by reaching patients who currently avoid or quit treatment due to side effects. An effective, well-tolerated oral option could double or triple the number of patients seeking treatment. The numbers tell a compelling story: Viking showed a near-perfect dose-response relationship, with tolerability no different than placebo -- something no other GLP-1 developer has achieved. Every major pharma has tried and failed to create an effective oral GLP-1, with Pfizer discontinuing its program due to safety issues and an exceptionally high discontinuation rate (> 50%). Viking appears to have cracked the code based on the early data, and Wall Street seems to know it (more on that later). Why is the stock trading near 52-week lows? Viking's stock has plummeted 64% from its 52-week high of $81.73 to around $27 as of July 2. This devastation reflects broader structural damage in the biotech space rather than company-specific issues. Since interest rates have flipped higher, biotech as a whole has been crushed, leaving a bad taste in investors' mouths. The 2022 biotech collapse has created a vicious cycle. Great opportunities are no longer getting flagged for investors, as AI stocks dominate headlines and capture imaginations. Meanwhile, GLP-1 drugs have shown a mixed bag in clinical trials lately, suggesting to some that a top in efficacy and safety is near. But I believe that's shortsighted thinking. VK2735 has shown a differentiated clinical profile, with tolerability nearly indistinguishable from placebo in early studies -- something no other GLP-1 has achieved. While it's far too early to declare victory, the data suggests Viking may have solved one of the key challenges that has plagued obesity drugs. This widespread biotech pessimism has created the kind of mispricing sophisticated funds live for: quality assets trading at distressed valuations. It's the very definition of an asymmetric opportunity. The institutional positioning tells a different story While retail investors panic, institutional behavior reveals extreme confidence. Per the latest 13F filings, Balyasny Asset Management holds $71 million in bullish positions, up 542% from the previous quarter. Citadel owns $32 million, Susquehanna has $36 million, and Jane Street holds $17.5 million. Combined, these sophisticated quantitative funds have accumulated over $150 million in bullish positions. More telling is what Goldman Sachs just did: It eliminated 100% of its put positions while increasing calls by 350%. When one of Wall Street's premier trading desks removes all downside protection, it's signaling extreme confidence in the outcome. These institutions aren't speculating randomly -- they're arbitraging what they see as a massive market inefficiency. Their models likely show the same disconnect: a drug with tolerability on par with placebo, and a validated mechanism trading as if it has a 96.5% chance of complete failure. For quant funds that live and die by probabilities, this represents a rare mispricing opportunity. The divergence between institutional longs and retail shorts has reached an extreme. Short interest just increased to 30% of float as of June 13, up from 26% the prior month -- even as the smart money accumulates massive call positions. For context, 30% short interest is extraordinarily high for a clinical-stage biotech, putting Viking in the 99th percentile of U.S. equities for bearish bets. This sets the stage for a classic capitulation moment, where good news could ignite both fundamental revaluation and a violent short squeeze. A manufacturing partner validates the opportunity Manufacturing is the Achilles' heel of most small-cap biotechs. Viking solved this early. In March 2025, the company inked a $150 million manufacturing deal with CordenPharma -- one of the world's premier peptide contract development and manufacturing organizations (CDMOs) -- giving Viking turnkey capacity for 100 million autoinjectors and 1 billion tablets annually, without dilution or costly infrastructure builds. This agreement removes a major overhang that has plagued other clinical-stage biotechs, as well as serves as a clear green flag that the broader market has curiously decided to ignore. After all, such an agreement would not have been signed without deep due diligence and extreme confidence in VK2735's clinical profile. Why? There is a tsunami of demand for GLP-1 manufacturing capacity right now. The asymmetric setup ahead of oral data The phase 2 oral data release expected in the fourth quarter of 2025 represents a rare asymmetric opportunity. Based on the dose-response curves from the four-week data showing 6.8% weight loss, the oral formulation could potentially approach injectable-like efficacy. The full 13-week phase 2 data will reveal how close the oral formulation can get to the 14.7% weight loss seen with the injectable. At today's $3 billion market cap, Viking trades at a fraction of the value created by successful GLP-1 drugs. Eli Lilly has added over $300 billion in market value since Mounjaro's 2022 launch, while Novo Nordisk saw its valuation surge from under $200 billion to over $600 billion at its peak as Ozempic and Wegovy transformed the obesity market. Even with recent pullbacks, both companies have captured hundreds of billions in incremental value from their GLP-1 franchises alone. The market's high bar for new entrants was evident when Amgen 's MariTide showed 20% weight loss but disappointed with 11% discontinuation rates in its phase 2 trial. When the data was released in November 2024, shares fell nearly 5% that day despite the solid efficacy. Yet Viking's parity with placebo appears to clear that bar with room to spare. If Viking's oral drug approaches the injectable's efficacy, the stock could see immediate revaluation to $200 to $300 per share, with longer-term potential exceeding $500. At current levels, the market is implying just a 3.5% probability of success for VK2735. That's absurd when you consider that metabolic drugs with positive phase 2 data typically have 45% to 50% success rates through approval. With VK2735's validated mechanism and placebo-like tolerability, a reasonable probability may range from 45% to 70% -- significantly above the market's implied odds. Even using just a 25% success rate -- below the industry average -- suggests the stock should trade above $100 right now. At $27, the market is pricing Viking as a lottery ticket. The data says it's closer to loaded dice. The risk-reward setup has convinced me to take a leveraged position through deep out-of-the-money call options -- admittedly a speculative position that could expire worthless. But with Viking having about $7.50 per share in cash, even equity investors have defined downside risk in a worst-case scenario. Add in 30% short interest providing squeeze fuel and institutional positioning at extreme levels, and the asymmetric opportunity becomes clear. Time to look past the biotech wreckage Key risks include potential safety issues emerging in larger trials, manufacturing scale-up challenges despite CordenPharma's support, and commercial headwinds such as payer reluctance to cover costly new obesity treatments. But the statistical improbability of VK2735's tolerability profile, combined with the manufacturing validation and institutional positioning, suggests the smart money sees something the broader market is missing. My personal take on the maximum upside? If VK2735 secures oral GLP-1 leadership and achieves widespread commercial adoption, a strategic acquisition could command valuations approaching $750 per share within the decade -- though this remains a highly speculative scenario contingent on flawless execution. A lot has to happen between now and then to make this come to fruition. But the seed has been planted. VK2735 has a real shot at bending the curve on the obesity epidemic. Markets move in cycles. "Returning is the motion of the Tao," as Lao Tzu wrote -- when one extreme is reached, movement toward the opposite begins. Biotech will rise again. Viking offers investors a chance to front-run that rotation -- not by chasing speculative names, but by owning a promising asset with game-changing potential at what may prove to be generational lows. As biotech's cycle inevitably turns, those positioned early in assets like Viking may capture the steepest part of the revaluation curve. 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See the 10 stocks » *Stock Advisor returns as of June 30, 2025 George Budwell has positions in Pfizer and Viking Therapeutics and has the following options: long January 2026 $55 calls on Viking Therapeutics, long January 2026 $60 calls on Viking Therapeutics, and long January 2027 $60 calls on Viking Therapeutics. The Motley Fool has positions in and recommends Amgen, Goldman Sachs Group, and Pfizer. The Motley Fool recommends Novo Nordisk and Viking Therapeutics. The Motley Fool has a disclosure policy.
