Peptides have been in headline and after headline this year. The molecules gained even more attention this summer when an FDA advisory panel decided compounding pharmacies could prepare six peptides for patients with a prescription.
While many people, including wellness influencers and Health and Human Services Secretary Robert F. Kennedy Jr., tout peptides for everything from muscle growth to anti-aging properties, medical experts are more cautious about singing their praises.
During an AHCJ webinar I cohosted with health beat leader for AI and patient safety Karen Blum in August, health reporters who tuned in learned a lot more about the risks, potential benefits and the many nuances that often go overlooked in mainstream conversations about peptides.
The event featured Dhruv Khullar, an associate professor of health policy and economics at Weill Cornell Medical College, and Rachel Frank, a professor of orthopedic surgery at the University of Colorado School of Medicine.
For a complete recap of the conversation, I highly recommend watching the full recording with these excellent panelists, who are also open to serving as sources for any of your stories on peptides. Meantime, here are some of the key takeaways.
Consumer interest in peptides often comes from an encouraging place
While it’s important to be cautious when describing peptides’ purported — and largely unproven — benefits, preaching against them as a black-and-white issue may only turn readers towards non-credentialed wellness influencers and self-proclaimed experts.
Instead, consider their motivations. “We’re in this kind of moment that in some ways is really good, where people are very interested in their health … and for that reason, people are trying to understand what else they can do that might help them along that journey,” Khullar said. “But they also deserve good information about whether or not something that they’re putting in their body is going to help them or hurt them or just waste their money.”
Frank said she also understands peptides’ appeal; many of the athletes she treats ask about them for performance boosting or recovery. She doesn’t blame them: “They’re marketed as a shortcut. They’re injectable, fast-acting, advertised as ‘natural’ and popular with influencers, podcasters and prescribing clinics,” she said. “This just creates this storm, and then you stamp the approval of our HHS secretary on it, and why wouldn’t the public or a patient think that this is a legitimate thing to use?”
The peptide gray market is booming — and risky
Some peptides, like insulin and GLP-1s, have been proven safe and effective when used appropriately in the population they’re intended for, including people with diabetes. But people are getting many other peptides without a prescription from a physician, and turning to a sort of “gray market” instead, panelists said.
“You can get them anywhere with online resources,” Frank said, noting that one report even found that some New York City bodegas were selling them. And these aren’t just injectable forms; people are buying topicals, nasal sprays and IV infusions at places like wellness clinics.
“The big question is, are we legitimizing them? Are they safe? Are they regulated? And when you order something from shop A — whether that’s within the U.S. or outside the U.S. — and you order a specific peptide, is the vial that you get going to contain that peptide? And then is it going to be efficacious in the way that you think it is?” Frank asked.
Some potential consequences of those unknowns could include infections, abscesses from injection sites and even tumor formation since some peptides work in part by stimulating vascular growth. “There’s potential for all sorts of good and bad and certainly ugly in terms of how … people are trying to get better, live longer, be stronger,” Frank said.
Don’t confuse an FDA advisory vote with FDA approval
The FDA’s summer vote concluded that compounding pharmacies could prepare six peptides for patients with a prescription. But that doesn’t mean they’ve been “approved” by the FDA as safe and effective to treat disease.
“The underlying evidence gaps don’t just disappear, even if the access pathway has become legal through a compounding pharmacy,” Frank said. “It’s one step closer to getting safer products and legitimizing the products if this ultimately gets approved by the FDA … but it’s not the same as ‘this is a medicine that should be used for this disease.’ For example, while she has athletes asking her about BPC 157 for uses like injury repair, that particular peptide is only indicated for ulcerative colitis.
Similarly, Khullar cautioned against falling for “vibes-based authorization,” or the popular assumption that because so many people are using peptides, they must work and be safe. “I think we should really be questioning that,” he said.
Avoid promoting the concept that peptides are ‘natural’
Another common argument in favor of peptides is that they’re “natural” so they can’t hurt. Reporters should be careful not to endorse that line of thinking, panelists said. “Just because they’re not steroids — and steroids can be very beneficial in many applications — doesn’t mean that they’re natural or safe,” Frank said.
Khullar, for one, bought three vials of peptides from a compounding pharmacy and took them to a lab for testing. He found one had a small amount of lead, one had endotoxins — or “bacterial cell membrane fragments that suggest a compromised supply chain and impure water along the way somewhere” — and one had 50% of the dose advertised.
“If you said, ‘Here’s some Tylenol, it’s somewhere between 50% and 200% of the dosage,’ we wouldn’t want that,” Khullar said. “And that’s just the impurities … even if they are all pure and 100% what you think they are, we still don’t really know what they’re doing in the body.”
So proceed — and write — with caution.
