A truly post-modern form of anti-authority: I refuse to inject things the government recommends but willingly inject things strangers on the internet write about and which originate from random Chinese laboratories.

There's a mind-boggling market of un[der]studied and un[der]regulated substances for people who desire peak health and performance, many of whom refuse to engage in regular physical activity or a regular diet.

They don't seem to be any happier for it. If anything, they live at a higher and more diffused state of anxiety. I think it is rather sad.

I think we are sort of in the worst of both worlds right now re: medicines/supplements/gray market.

FDA approval is expensive slow process. Doctors train for a long time and then work 40+ years entire careers, some without a ton of continuing education.

But then we have an entire gray market because enough legal and practical loopholes to drive a freight train through, such that people are self medicating with dubious substances of dubious origin of dubious purity sourced via dubious means.

Even if peptides work, you have no idea what side effects they have, or if the ones you are taking are even real, not contaminated/tainted in some manner, etc. Given a lot of the hype comes from social media for otherwise healthy people to take them for lifestyle / augmentation reasons.. to me the risks still outweigh the rewards.

Real solutions like regulatory reforms to find ways to bring down testing costs seem more important than reforms to make it easier to slap anything on the shelf at GNC as a completely untested “supplement”.

I'm here for two probably contradictory comments.

The first is collagen: I'd love to see Lowe's take on recent peer review which says boosting oral collagen does appear to show signs of improved joint pain and skin resilience. Obviously modulated through how protein deprived you are, but for older people, eating enough protein can be an issue: it's not rapidly absorbed so you need 3 squares a day to get to the higher numbers. Collagen powders and vitamin C (oj) at breakfast might kick start this.

The second contradictory point is that this entire thread makes me want to shout GELL MAN AMNESIA because it's an exercise in otherwise intelligent people who can distinguish between anecdata, their personal experience and some cold hard facts in their core field, but not when it's self injecting unknown chemicals from China bought off-script.

Peptides are a revolution and you don't need to know how they work to know that they work (for various people for various conditions). There is a tension between empiricism and fundamentalism with much of medical science focusing on fundamentalism. Now with the ability to collect and search large amounts of empirical data and communicate it peer-to-peer people are picking up on a lot of things that work without knowing why they work. I think people are just going to circumvent the fundamentalist and chase after whatever works.

I owe my health to early adoption of experimental peptides, I have life long ME/CFS and there is no known treatment for this nor is there any on the horizon. At least they finally have a diagnostic test and know it's not psychosomatic but I could have told them that from day 1. Most doctors are not researchers and have little understanding on statistics instead preferring to rely on discrete classifications and simple decision tress. As someone with hEDS from TNXB I am a walking bag of symptoms and yet not a single doctor could figure it out. I had to research it myself which involved post-doc level textbooks and research journals. I came across the work done by Prof. Khavinson (USSR) and it did appear to me that peptides were incredibly under-explored. Given the poor quality of life with ME/CFS I was willing to take serious risks so previous trials were helpful to give an idea on dosing and lethality, I went through most of the research peptides one by one. I actually waited on semaglutide a bit because I suspected there was a small minority who would have hyper sensitivity and I both expected that to appear in the data, which it did, and I expected to have hypersensitivity, which I did. Others who were less careful ended up with pretty bad gastroenteritis. Semaglutide has been the most effective and with it and a few others I am largely able to lead a normal life. I was getting gray market from the US but now I get it direct from China.

  > Peptides are a revolution and you don't need to know how they work to know that they work

I used retatrutide for weight loss and went from 199.3 lbs to just under 175 lbs. I kept daily notes through the process. Here's a quick AI one-paragraph summary if you're curious: https://pastebin.com/XACNYKvs

Overall I'm quite pleased with the effects and many of the properties of this treatment that people dislike are actually properties I was looking for. Essentially, for pharmacological interventions I want impermanent effects with a clear dose-response relationship and ideally minimal or no adaptation.

So the fact that people gain weight when they go off it and then lose weight again when they go on it was good. That meant it's fairly easily undoable. The fact that the more you take the more you lose also was pretty good to know though for the majority of the time I took less than any tested dose (and the effects were quite strong on those).

I did experience quite a bit of adaptation so I needed to up the dose until I was in the range tested by the end. I've been off it for a month now and been pretty much flat, but we've been traveling since I stopped and so a lot has changed (no more lifting, lots more eating, lots more walking).

Rough cost for the retatrutide is $1.25/mg.

I know a couple of people that should know better (phds in biosciences but now doing corporate management) taking expensive weird Chinese peptides that would probably be better off if they did some cardio a few days per week and ate better.

I'm not inclined to be a guinea pig for these. I suspect maybe later in my child's life they will have been proven long-term safe (or not). I'll be old or dead at that point. I'm really wary of putting anything not known to be standard food or medicine into my body.

I tried retatrutide for 10 weeks, here are my results: Before: 5'7, ~182lb

Bench 1rm: 315

Squat: 5x10 225

Deadlift: 5x5 315

After: same height lol, 154lb

Bench 1rm: 285

Squat: 5x10 205

Deadlift: 5x5 275

Suffered some anhedonia towards the end but that went away ~1wk after stopping. Overall pretty good, not any side effects. Definitely fixed my food craving problem. I didn't have a high intake of protein during the 10 weeks, so I suspect thats why I lost muscle mass :/

The author is missing a massive segment of that gray market: people who buy FDA-approved weight loss drugs (e.g., semaglutide or tirzepatide) at 2–5% of the brand-name price. This route carries some risk, but there are ways to mitigate it, such as performing third-party testing. I assume most people who do this couldn't realistically afford the brand-name drug anyway, making this their only viable treatment.

Lowe has a point, but the FDA has painted itself into a corner by (a) forcing up the costs and the various bureaucratic demands associated with clinical trials, (b) allowing drug advertising , but then forcing those comical "may cause death" disclaimers, both of which have become totally ubiquitous, and (c) inconsistently following its own rules, and in some cases flouting its own rules.

At this point, broscience is considered no less valid than actual clinical trials, and the FDA should blame itself for this. Not "human nature being what it is in this fallen world" in a sort of general or abstract sense.

Another point I could raise is that telemedicine has turned the entire prescription system into nothing more than a parasitic middleman/gatekeeper.

FDA reform is very badly necessary. That ought to come before harsher enforcement, and I think that much of the populace already intuitively understands this.

I really enjoyed having to wait 30 seconds for Cloudflare to let me into this website.

I take a small issue with the claim that we don't test peptides. Some of us test them extensively before injecting. Granted, probably the same people who also understand how little science there is backing up most of the popular peptides today. I enjoy being able to buy my own GLP1s, however, at least those which have made it through phase III trials succesfully. As tempting as the claims are about things like BPC-157 and such ... no thanks, that is past my comfort level a good bit.

It seems we are treating Peptides like drugs here. It's my opinion that amino acids regardless of how they are chained do not belong under and stricter regulation than food given I eat peptides every day from my food. Then again I do not believe in the concept of prescription drugs. Everything with a NDC code should be at the grocery store and I should be able to stock up on it without permission especially given how fragile global shipping is these days. Drugs risks do not enter into the picture given the fact I can buy ammonia and bleach along with a myriad of other dangerous compounds. Worse, I could crush up apple seeds from the veggie isle. One can also make just about anything using fourth thieves vinegar. Maybe put expensive high demand things like cocaine behind locked glass along with the underwear and condoms.

As a side note more dangerous than any drug is stopping a prescription drug cold turkey. Watch what happens when global trade to/from China and India are cut off for a year. Attitudes will change.

> My patient is refusing a drug studied in 170,000 people because of side effects that a 124,000-person analysis just confirmed do not exist — while injecting a compound studied in 14 humans, from unregulated sources, based on the recommendation of someone who profits from selling it. She’s probably not the only one. And those using it believe they are “doing their own research.”

Ok, and? At worst you waste a couple hundred dollars and deem the alternative therapy not worth it and go back to your doctor but I know dozens of people at my gym that used BPC 157 and TB 500 that fixed their chronic tendon/joint issues within weeks of starting the therapy that physios couldn't fix for years.

> a patient who is discontinuing her statin therapy - very inadvisably, given the clinical presentation described - but is enthusiastic about “BPC-157”

This feels new. I thought the methylene-blue-for-cancer types continued their medicine while taking other things as extras.

Personally, I've swung over to the laissez-faire side of medicine. At the end of the day, if you're an adult, it's your body. You should be given the chance to educate yourself. But if you want to inject yourself with a prion, like, go for it. Maybe you won't fuck up your own research.

(Marketing should be tightly regulated, possibly banned.)

I read the article but didn't get the tl;dr about peptides. What are they and what are they used for?

> For a chemist, “peptide” has a pretty clear definition: any relatively short chain of amino acids, and when they get longer we go ahead and call them “proteins”, although the dividing line is a matter of personal opinion.

So, it is not just chemist but molecular biologist too. And the above is also not entirely correct. Yes, the author refers to size as threshold, before something is called a "protein". But the term protein has additional meanings that a peptide does not automatically have. For instance, a protein typically has a specific 3D conformation. It may be "sticky" after degradation or unfolding, but for the most part a protein is something with a 3D structure. A peptide does not necessarily imply the same. A protein may also have several polypeptide chains - insulin is a simple example for that: https://en.wikipedia.org/wiki/Insulin#Structure (A and B chain)

> So the number of different possible peptides is just ridiculously huge.

That's no surprise either - that's due to the code used. You add to the code, so of course length plays a role, as does the variety. There is a DNA->aminoacid mapping. The first has four possibilities per slot; the latter 20 (or more if you include e. g. selenocystein or pyrrolysine; and you have various post-translational modifications too, so you have more variety per slot).

> For comparison, it has been about ten trillion seconds since Homo sapiens emerged as a separate species.

The whole species concept is IMO outdated. It was created before people knew that DNA codes for the complexity in pretty much any species (excluding RNA viruses but they have reverse transcriptase, at the least some viruses, so ultimately RNA->DNA).

> The other one (by Sarah Hood) relates all this to RFJ Jr.’s advocacy. The flip side of “the government shouldn’t be able to force me to vaccinate my kids” is “I should have the right to take whatever medicines I want to without the government getting in my way”.

I don't see why that would be questionable. Would people do as Trump tells them to do? I would not. If you see Trump as a lobbyist, how many private interests may his government have? If they have a commercial interest then their statements may be biased.

> You don’t have an LC/MS or an NMR machine in your garage, so you can’t be sure what it is you’re really injecting

Right, so the whole system depends on trust. This is already a problem because you have to trust not only the government but ALL who were involved in scientific publishing. There were lies told in science too: https://en.wikipedia.org/wiki/Retraction_in_academic_publish...

With India getting generic GLP-1s, the tech to "print" peptides will probably see costs fall off a cliff, so we're probably only looking at the tip of the iceberg with the amount of damages the reddit biohacker bros will accomplish. Men especially are feeling a lot more lonely and image-conscious and there are peptides people claim make them taller[1] or muscular[2].

1: https://www.reddit.com/r/endocrinology/comments/1jb2cce/grow...

2: https://r2medicalclinic.com/best-muscle-growth-peptides

I think it's disingenuous to frame this exclusively in terms of the people who are turning down medically approved options for unknown supplements.

Dealing with doctors is kind of a pain in the ass. I was very sick a month ago and my doctor is pretty "anti antibiotics", he wanted me to go over for an in person check-in. This was after 10 days of having symptoms that I did everything reasonable to take care of. I got on a call with another doctor (at a perfectly reputable hospital) who immediately prescribed antibiotics. It took 5 days of antibiotics just to feel somewhat better - all while using saline rinses, showering, sleeping, eating properly, etc. I still have a lingering cough. I am very reluctant to take antibiotics unless it really feels necessary, this was easily the worst sinus infection of my adult life.

My friend wanted to try out a weight loss medication. Their doctor refused because they felt that my friend hadn't tried hard enough without it. So they got some from another friend who hadn't ended their prescription because they also were worried of being cut off. They've lost weight, which has motivated them to exercise more, eat better, and are generally happier and healthier.

From the article,

> Unfortunately, point two is that we barely have any of these effects worked out - at least not to the degree that you would want before you start injecting them into your leg.

This is what was said to a friend whose doctor took them off of one of those GLP medications, basically. They didn't have enough evidence to know the risks of continued use, even at lower doses.

The reality is simply that there's a big gap right now between what people want and what people have access to. The supplement industry exists to fill that gap.

Medical professionals can complain about users taking these peptides, but plenty of people are not "anti medicine" while still feeling underserved. If doctors aren't in a position to have these conversations, people will go to Youtube or wherever else to look for answers.

Personally, I have mixed feelings about a number of medications requiring a prescription. I frankly do not see why my doctor is involved in me taking a drug unless it would be negligent to allow me to or if it would have community health impacts (ie: antibiotic resistant strains etc). I'm an adult, if I've been properly informed of risks, etc, then I'm inclined to say that it should be up to me to pay full price for some medication or not.

I know plenty of people getting their GLP1 from compound pharmacies. None of them went their first, their doctors wouldn't give them the medication (sometimes they were just a pound under the BMI limit, often because they had been slowly losing weight) so they went elsewhere. These aren't anti-vaxxers who won't take their medication, they're people who want help and there's a gap that companies are taking advantage of. The medical establishment needs to find a way to address that. Right now the answer appears to be compound pharmacies and nurse practitioners.

> In my own view (and it ain’t just me) you also have regulatory agencies to force people to show that their drugs actually have some benefit before they can sell them, too. But that’s going further and further out of fashion. Can’t get ahold of the New Hotness to inject into your upper thigh if there are a bunch of stick-in-the-mud folks asking for human data, infringing on your freedom and all.

Many of us will be dead before there's a medically approved treatment for something. Hell, I got eye surgery before it was FDA approved - I'd probably be blind (or at least far worse off) if I'd waited the years it took.

How many people taking supplements are "naturopaths" who reject modern medicine as opposed to just people who want to be healthier? I really wonder that.

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A lot of people are left alone with their health-issues, if you live in Canada and can only see a doctor if you are about to die, people try to change their health situation outside the "regulatory" system. These aren't health worriers, they are desperate to get their lifes back in order. Are there risks? For sure, but similarly untreated pain can damage more, especially mentally.