A Little Dose of Healthy Skepticism
Who to trust in the healthcare world?
This is the final installment of a three-part series. Read part one, part two, and part three.
Part 4: 2024 RAADFest and Healthcare Skepticism
In 2024, the Revolution Against Aging and Death Festival – commonly known as RAADFest – was held in Las Vegas. The high-stakes wagers of Sin City proved a fitting ambience for the rather unsettling gamble Dr. Kent Holtorf saw fit to take in the festival’s convention hall, which had been converted into a RAADClinic offering attendees the chance to sample bleeding-edge longevity treatments on the spot. Holtorf’s offering? Peptide injections administered directly at his booth. According to a ProPublica report, two women who’d received these injections left the festival fighting for their lives.
The women, ages 38 and 51, had both described feeling as if their tongues were swelling upon leaving Holtorf’s booth. Both were taken by ambulance to the hospital. One was already intubated upon arrival, and the other couldn’t open her eyes or communicate with doctors. Fortunately, both women recovered. According to the Lifespan Research Institute, the Las Vegas Police Department reported that “up to seven people sought treatment after receiving the peptide injections at Holtorf’s booth,” though RAADFest sponsor Coalition for Radical Life Extension reported that “the Southern Nevada Health District…[confirmed] only the two severe cases.”
Holtorf told ProPublica he was “so freaked out,” because none of the women’s symptoms “made any sense.”
“Of course, I want to get to the bottom of it,” he said. “But almost assuredly it will come out that it was not the peptides.”
Holtorf’s view was at least partially corroborated by Dr. Amy Gutman, a Florida emergency room doctor who was also in attendance at RAADFest. Gutman felt the women’s symptoms were consistent with an allergic reaction, a rare occurrence with peptide injections. More likely, it was whatever secondary agent the peptides had been compounded with that caused these women to become ill.
The incident was paradigmatic of the kind of worst case scenario that dogs the nascent field of longevity science. Arkadi Mazin sums it up well in his report for the Lifespan Research Institute:
“What happened at RAADFest highlighted some well-known problems and contradictions in the longevity field…There is a sense of urgency that pushes some people to offer and others to try therapies that have not been rigorously tested for safety and/or efficacy. Many rightfully lament the increasingly lengthy and expensive regulatory process, which is not properly suited for rejuvenating therapies. There is a growing push to extend the ‘right to try’ to all patients and all reasonably safe therapies, and to accelerate clinical trials by relaxing certain regulations and transitioning towards cost-effective methods, such as human organoid and in silico models.”
These issues will be familiar to anyone with even a passing interest in longevity science. The long and demanding regulatory process that seems to grow lengthier and more bureaucratic with each passing year. Rising public skepticism toward a federal agency that appears to be withholding – and in some cases has actually withheld – lifesaving treatments from average Americans while one percenters like tech entrepreneur Bryan Johnson appear to be gleefully purchasing longer lives. Consumer urgency and even indignation arising from the idea that lifespan extension may not be an option within one’s lifespan: not because the scientific method is a slow and precise process that cannot be hurried along with market demands, but because science is something being “kept” from the average person by greedy elites. Direct-to-consumer telehealth company Hims & Hers articulated this view plainly in their “Rich People Live Longer” Super Bowl ad:
Within its first twenty seconds, the ad evokes ultra-wealthy pop culture mainstays with whom most any American will be familiar. There’s a Kris Kardashian-like woman getting a deep-plane facelift straight out of A Clockwork Orange. There’s a Jeff Bezos-type popping a bottle of champagne as he prepares to board a rocket to another planet. There’s a trim, pasty-looking man stationary-biking while wearing an oxygen mask and lying in what looks like an infrared tanning bed that is a clear recreation of Bryan Johnson’s multimillion-dollar longevity protocol. I’m sure I’m speaking for many of us when I say that it’s not a challenge to roll one’s eyes at these images: indeed, we hardly need to see the average Americans doing so in the Hims & Hers Superbowl spot to know precisely the feeling the telehealth company would like to remind us of. Or, to rephrase it in marketing terms, how they’d like us to feel in that moment.
Which brings us back to a truth that will feel uncomfortable for longevity enthusiasts, biohackers, and FDA skeptics alike: just because self-interest has been known to rear its head at the federal level, that doesn’t magically absent it from the private sector.
While it is in fact true that vast wealth can afford someone access to legal loopholes and extra-regulatory treatments, it’s also true that not all of these treatments have the data to prove their efficacy, or even their safety. (This is why Bryan Johnson is more of a human test subject than a clinical patient, trying out radical new longevity therapies on an experimental group of one, with a control group of zero. Try turning that into a meaningful data set!)
As I’ve written before, this sort of wellness-optimization comes with a great deal of risk. Some optimizers feel they’ve been apprised of this risk, and accept what they’re getting themselves into. But in many cases, what they’re getting themselves into is a null data set – a complete unknown.
This situation is especially true for those of us who want to optimize our health, but lack the vast resources of biohacking tech entrepreneurs to do so. Maybe we’ve grown skeptical of regulatory agencies like the FDA – perhaps rightfully so, given the lengthy and bloated-with-expense regulatory process, and the agency’s affiliation with corporate interests and notorious characters like “pharma bro” Martin Shkreli. So we decide to seek affordable, extra-regulatory outlets for our longevity medicine from specialists who claim to have our back. But this is where we abandon nuance at our own risk, because Dr. Kent Holtorf is one such specialist. And he’s just one of scores of private physicians, direct-to-consumer pharmaceutical companies, and cash-pay healthcare sites in the business of making dubious claims.
Mazin expounds on the threats of snake oil salesmanship to longevity science:
“A legitimate concern exists that the longevity movement might be overshadowed, compromised, and ultimately impeded by the murky wave of overblown claims, unfounded promises, unproven therapies, and flat-out ‘snake oil’ cures.”
This calls to mind extraordinary false advertising claims, like that of Brooklyn-based entrepreneur Andrew Martin Sinclair, who claimed that his $60, 16-ounce bottles of Earth Tea could cure COVID. Or the widespread use of “magnetic healing bracelets” to improve circulation and reduce joint pain: studies have found limited benefits, though their effect seems to be more placebo than anything. And then there’s Holtorf himself, whose website’s scientifically unfounded claims about peptide therapies that “may even support prevention and treatment of COVID-19” and colloidal silver, which “may ease symptoms and encourage the resolution of COVID-19,” landed him a warning letter from the Federal Trade Commission. Both Sinclair and Holtorf have received warning letters from the FDA, though Holtorf’s are no longer listed in the agency’s database as of this writing.
One doesn’t want to die suddenly in the process of trying to live forever, and there’s nothing quite like snake oil salesmanship to invoke the specter of fatal malpractice. At this point you might be thinking, “How can I realistically expect to tell which regulators and healthcare providers have my back, and which don’t?”
It’s a simple question with a deceptively simple answer: you just need to look where the science is.
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Reader, are you feeling distrustful of the federal government, multibillion-dollar pharmaceutical corporations, and medical consumerism? Want to take control of your health without becoming ensnared by bureaucratic red tape or the machinations of the pharmaceutical-industrial complex? Then let’s dive deeper into a couple commonly held beliefs about all these things, and see what holds up:
The FDA is an ideologically captured federal agency that withholds valuable medical treatments in pursuit of profit.
Verdict: Yes…and no.
This is a tricky one, and requires a bit of nuance to tease out – perhaps that’s why I’ve chosen to start with it. As some of you have pointed out in my subscriber chat – and I’ve pointed out myself in previous installments of this series – FDA approval cannot be reasonably regarded as the be-all end-all of safe clinical treatment. For instance: I will often drink a cup of mullein tea for a sore throat, and brew a mixture of ginger and dandelion root to drink when I have a stomach ache. These are generations-old family remedies, and as far as I’m concerned, they’re quite effective ones. They’re also not FDA-approved, nor are they clinically indicated for the illnesses I take them for. Thinking bigger: vast swaths of the healthcare and wellness industries (naturopathic health, cutting-edge longevity science, diet interventions) are not FDA-approved. It would be unreasonable to expect an individual consumer to go his or her whole life consuming only FDA-approved goods – indeed, I imagine you’d be hard-pressed to find anyone living their life this way, whether by accident or design.
The entanglement-with-Big-Pharma point is well taken here, too. Peptides – in particular GLP-1s – are not the only popular medications whose patents and manufacture are siloed at pharmaceutical giants like Eli Lilly, Pfizer, Moderna and Novo Nordisk because of lengthy clinical trials and FDA approval. The case has also been the same for both COVID vaccines, as well as for certain non-generic diabetes medications – the list goes on,
And while all that may be true, here’s something else that’s true as well: the FDA is an ideologically heterogeneous institution that continues to count a number of well-trained and scientifically minded personnel on its staff. And it’s these food and pharmaceutical scientists who can credibly debunk snake oil cures like Earth Tea, or issue a consumer warning when the Holtorf Medical Group claims it can cure your COVID with an injection of colloidal silver. These warnings are not nothing – neither are any of the warnings in this database. Even a cursory scan will reveal that they were issued in the interest of preserving consumer safety. (And yes, Novo Nordisk and Eli Lilly got slapped with warning letters, too – both for false advertising and misbranding.)
Next, you may recall the constant refrain we hear emerging from the longevity sphere: Interest in longevity treatments moves faster than our ability to generate meaningful data about these treatments. We may hear rumors that the drug rapamycin works to decelerate aging, or that stem cell injections could keep us from experiencing brain fog; we may even see the ultra-wealthy seeking these treatments out, and giving interviews about their untold benefits to legacy media outlets. But are these treatments actually effective, or could we be witnessing placebo effects from afar? (Or in extreme cases like Kanye West’s, what appears to be bona fide medical malpractice.) Will these treatments ever be available to the general public? And how can their safety and effectiveness across a diverse consumer base be ensured?
The answers to these questions will lie for better or worse with a regulatory body that has the resources to conduct scientifically rigorous randomized controlled trials – a regulatory body like the FDA. It’s the FDA – not a direct-to-consumer pharmaceutical company, not a centimillionaire, not a group buy organizer on Facebook, and not the influencer who’s excited to share her “pepper stack to stay petite and youthful” – that can recruit a large cross-section of average Americans to participate in a multi-phase study that will generate actual scientific data about a given medical treatment. Data that can then be used to make the treatment available to wider varieties of medical patients – and covered by their insurance no less! Data that could someday grant you access to your favorite peptides for cheap or even for free, and with no worries about purity, potency or quality control.
There’s the not-so-easily-summarized truth about the FDA for you, reader.
If a healthcare provider is an “outsider” who rejects the systems that have jeopardized my health, I can trust them.
Verdict: Not always.
While it’s certainly true that there are all variety of doctors – allopathic, osteopathic, naturopathic, etc. – who’ve challenged prevailing medical trends and reinvested themselves in actually helping their patients heal, I’m going to be realistic, reader: “I’m a maverick doctor” is also a highly convincing sales pitch.
Not all mavericks are scammers, but you’ll be hard pressed to find a scammer who doesn’t bill themselves as some form of maverick. Sometimes, this means you get hit with a story of personal triumph over tragedy: Dr. X lost his mother to Y heritable disease and nearly lost his own life to it as well; after experimenting with Radical New Treatment, he was able to pull himself out of his tailspin. And now you can be pulled out of a tailspin of your own, all for the low, low price of $2,999* (*paid in full in advance of treatment; not covered by any form of insurance).
Sometimes, the doctor will have a general sense of an effective protocol – weekly semaglutide coupled with a certain number of lifestyle changes – but will attempt to cash in on market trends by applying that protocol sloppily and indiscriminately across his entire patient population. Are you a 65 year old man with a history of emphysema and heart disease? Are you a 23 year old woman with a known history of disordered eating? Are you a 43 year old distance runner coming off a recent knee surgery? Try weekly semaglutide, a low carb diet, and high-intensity cardio three times a week!
Here as always, it’s up to you as the consumer to exercise discernment. Maybe you’ll recall Jordan, the trans man from the second installment of this series [LINK]: his desperation for a testosterone prescription landed him in a prescribing dynamic with a medical professional who was not well-equipped to handle his concerns about the medication, and who applied a protocol that was mentally and physically strenuous for him. This doesn’t mean that Jordan should not have sought a testosterone prescription at all. What it means is that he needed a doctor committed to working with him instead of hurriedly selling him a product.
As is the case with anything you choose to put in your body – whether that be a philly cheesesteak or a vial of reconstituted proteins – your discernment is what matters most. That discernment can (and probably should) be informed by judicious research and the guidance of a trusted expert. But you’re the one who decides what to research and how, and which experts are actually trustworthy. It’s a delicate balance for us to maintain, that of openness and skepticism. But when it comes to our health and wellbeing, it’s more than worth it.
Suffice to say you won’t see me getting any on-the-spot peptide injections at a convention expo anytime soon.