Peptide-Seeking Patients and Clinical Responsibility
What should medical providers be asking themselves about the peptide boom?
Picture this: you are a family practice physician performing a routine health exam for a patient. Let’s say you’ve known this patient for something like twenty years, serving as the primary care doctor for both her and her husband. When they’ve required specialized care, you’ve referred both of them both out to specialists within your professional networks. Their children’s pediatrician is a colleague of yours who works in the same building.
Suffice to say, you know this patient well. Even have an easygoing rapport with her. You also know that she has a history of disordered eating. She has a DSM diagnosis of anorexia nervosa, for which she received once as an adolescent and again in her early thirties. These flare-ups were both occasioned by periods of high stress (going to college in the first case, and giving birth to her first child in the second) and accompanied by worsening symptoms of Generalized Anxiety Disorder and Major Depressive Disorder. Fortunately, your patient was able to navigate these difficult periods with the help of a psychotherapist and psychiatrist. Now she’s in her early forties, and her anorexia appears to be in complete remission, along with her other psychiatric symptoms.
But when this patient enters your office, you know something’s amiss. Her expression bears the hallmarks of her old generalized anxiety: her eyes dart, and she has trouble holding eye contact with you. Most tellingly, you notice a significant decrease in body mass. The weigh in confirms it: she’s lost twenty-five pounds since you last saw her six months ago.
Given the patient’s history of disordered eating and other psychiatric comorbidities, you become concerned that she’s experiencing a resurgence of behavioral health issues, possibly related to a new stress in your life. And sure enough, it comes up in conversation as the two of you review her recent health history. There’s been a death in her extended family, a high-stress event that resulted in feelings of despondency, fear, and inadequacy. As a result, she’d gained weight in excess of what constitutes a healthy BMI — a development that has only redoubled her behavioral health symptoms, and reintroduced the possibility of “control” via food restriction.
“Things were feeling hard, and I knew I didn’t want to fall back into my old restriction patterns,” she tells you. “I knew I needed to make a real change. And then I saw an ad online.”
The ad she saw was for a local med spa, offering “revolutionary fat-burning protocols.” The protocol? Non-FDA approved retatrutide, injected at 2mg/weekly over the course of six weeks. Your patient was initially thrilled with her weight loss progress, but now she’s worried: she couldn’t afford the $100/week injections indefinitely, and doesn’t want to finagle herself a prescription from a compounding pharmacy online. She’s wondering if you’d be willing to resume this protocol with her?
“It’s really changed my life,” she says hopefully.
As this patient’s long-term provider, you are now presented with a choice:
Find a way to move forward with this peptide-based weight-loss protocol (albeit in a way that’s better suited to your patient’s needs and approved by the FDA and her insurance)
Deny your patient’s requests on the grounds that she obtained the retatrutide from a medical spa, and that it could interfere with the treatment plan for her behavioral health.
Both options have their benefits and risks. The first choice allows you to maintain the patient’s trust by listening to her (“It’s really changed my life”) and offering her personalized care that will be safer and more scientifically rigorous than the injections she was receiving at the med spa. The patient has always struggled with her weight — a major contributing factor to the emergence of her adolescent anorexia — and has at a few points in her recovery exhibited bloodwork that indicated pre-diabetes. Given that certain peptides like semaglutide and tirzepatide have proven to be incredibly effective in the realm of weight management for Type II diabetes, there’s a compelling case to be made for a continuation of this protocol. Provided her insurance approves of the treatment, you might have found a way to regulate her health and curtail a major trigger of her eating disorder.
The second choice feels riskier in that you’re jeopardizing your patient’s trust by appearing to dismiss her testimony. But it has the major clinical advantage of slowing down the process to gather more information before initiating an intervention that may or may not be necessary: i.e. doing no harm, a central tenet of your Hippocratic oath. You may say, “I’m not going to prescribe you this today, because I want to get more information from you,” and then interview the patient about the protocol. She may have benefited from an initial burst of weight loss, but what else has she been doing to sustain her physical and mental health? Has she experienced any other symptoms from the retatrutide, physical or mental? Because you have a long history with her, you might even dip into that well of accumulated trust and let her know that you noticed she seemed anxious when she walked into her appointment with you.
These choices are difficult ones, and the answers are never completely clear. As a clinician, you are contending with an oversaturated alternative health marketplace, the limitations of both your practice and your patients’ insurance, and the very real time limitations of your patients’ appointments. Given the way our healthcare system is structured, it can feel more like you’re providing revolving-door consumer service than the personalized medical treatment you trained for. Even so, finding ways to provide your patients with that well-considered, personalized treatment — wherever you can, and however you can — should always be the goal.
In this upcoming series on peptides in clinical settings, we’ll discuss the realities of being a medical provider during the peptide boom and how to balance exciting advancements in longevity research with your clinical responsibilities and your patients’ needs. In the coming weeks, you’ll hear from actual patients who’ve benefited from peptide therapies as well as those who haven’t. And if you’d like to comment with your own thoughts on peptide therapeutics in a clinical setting, we’d love to hear what you have to say!
Peptides are here to stay in the medical field, and that’s not at all a bad thing. But as with any scientific advancement in the healthcare realm, we have to ensure that persuasion doesn’t outstrip the science. Ask yourself: What does the medical research need? What do medical patients need? And proceed from there.
Peptide Research, Done Cleanly — Peptide Partners. Independent HPLC/MS, batch COAs, and endotoxin screening to USP <85> validate identity and purity of peptides for research. Browse inventory and view certificates at Peptide Partners.
