One telehealth consult and a doctor prescribed unapproved peptides

The booming industry selling Australians on the promise of living longer and turning back the clock on aging is exploiting significant gaps in health regulation, exposing consumers to risk.Four Corners has identified around 100 operators that have opened in Australia, offering services they say will keep you young, beautiful, strong and full of energy. They advertise IV drips, red light therapy, cryotherapy and hyperbaric chambers.Clinics are offering NAD+ infusions to fire up your mitochondria, boost your energy and keep you younger for longer.These treatments may look and sound medical. But for many of the anti-aging claims, the sales pitch has raced ahead of the evidence. For example, with NAD+, despite little evidence of benefit in humans, there are laboratory research findings that it has a role in cancer.Some clinics sell customers red light therapy. (Four Corners: Ryan Sheridan)And then there are peptides — short chains of protein building blocks called amino acids. While peptides such as insulin and GLP-1 agonists like Ozempic are part of mainstream medicine, the peptides in the anti-aging industry are unproven and unapproved.Social media is awash with people unlawfully spruiking these injectables for everything from a hot body, glowing skin and shiny hair to an instant tan.While many get them from overseas black-market manufacturers, some are turning to Australian doctors at wellness or longevity clinics.To test how easy or hard it is to get a prescription, ABC health reporter Rachel Carbonell booked a "peptide therapy" consultation of her own.Rachel's 'peptide therapy'The website for the Queensland wellness clinic I booked with said peptide treatments were available to suitable patients, prescribed by the clinic doctor.When I clicked on the link to book the appointment, I was directed to a long questionnaire about my health, then referred for a panel of blood tests, and I had to send through a health summary including any past scans or results.Rachel Carbonell was given a telehealth appointment for a clinic's "peptide therapy". (Four Corners)Once I had jumped through these hoops, which took a couple of weeks, I was offered a telephone consult. To secure an appointment, I first had to sign an informed consent form.It said that I had been advised of alternatives, including lifestyle changes, approved treatments or no treatment at all. I wasn't sure where this advice was supposed to have come from given I hadn't yet seen a doctor.By this time, I was about $400 down for the blood tests, a GP appointment for the health summary and the telehealth appointment fee.I asked if we could do the consultation by video but was told the doctor only did them by telephone. She called me and started with a thorough run-through of my blood tests, previous scans and medical history.When the doctor asked me what I booked the appointment for, I gave an honest description of what I assume is typical for many 50-something women. I'm feeling a bit old and fatigued; I often wake early in the morning and can't get back to sleep; building muscle at the gym is harder than it used to be; I have a sore lower back, and I've got a niggling hamstring injury. I did say that I was looking for something anti-aging in nature and beyond the kinds of offerings I was receiving from my own GP.Rachel was not asked what other options she had tried. (Four Corners)At this point, the doctor acknowledged that "in Australia peptides are very controversial" and that they "should be a last resort" and must only be prescribed for a legitimate medical condition.I had already mentioned my diet and exercise routine, my peri-menopause treatment and my home physio routine. We did not discuss what other options I had tried or not, or if I had seen other doctors and exhausted all other options. Instead, she said my legitimate medical conditions were my "degenerative issues" and potentially, insomnia.The doctor then recommended one peptide to heal my hamstring and my "degeneration", another peptide for overall improvement in my skin and "aesthetics", and then another two for sleep and muscle repair.A "stack", as they say, of four different unapproved peptides with little or no scientific evidence in people that they do the jobs they are promoted to do.The doctor was forthright about the lack of data on the long-term safety of the peptides and mentioned that it was important that I had no pre-existing cancer risks.Given that I live in Victoria and she was based in Queensland, I asked what to do if something went wrong. She said I should stop taking them and go to a doctor.Rachel's treatment plan offered an option that would cost $1,181 for a four-to-six-week supply. (Four Corners)I was sent a treatment proposal, which had only my first name on it, no doctor's name or signature. It appeared to be a generic form, outlining the risks and benefits of each product. It included options to have them compounded and packaged into an injection pen, costing $1,181 for a four-to-six-week supply.The invoice note said once I had paid, the clinic would issue the prescription to the pharmacy and arrange dispensing and shipping.A reality checkFour Corners gave Rachel's treatment plan to endocrinologist Katherine Samaras to review."To me it reads like a legal document that has been written to protect the company that is prescribing and dispensing [the peptides]," Professor Samaras said."Most of what I see in that report is really to protect the company rather than inform, guide and treat Rachel."Katherine Samaras says the peptide prescription could have serious health risks. (Four Corners)Professor Samaras said the recommendation for a follow-up blood test a month after starting the peptide treatment was a red flag because "anyone who knows their endocrinology knows that it takes three months to reach peak" levels induced by the growth hormone stimulating peptides.She warned that some of the peptides prescribed come with known health risks because they stimulate growth factors."It'll have the muscle-boosting, muscle-building effects, but it will promote fluid retention, it will promote osteoarthritis, inflammation, deranged glucose metabolism and increased diabetes risk if she's a susceptible person,"But Professor Samaras said the biggest potential risk was stimulating or promoting cancer."The big question for me is cancer; we know that they act on cancer pathways."'Profits ahead of patients'It may seem surprising that doctors can prescribe these unapproved peptides.Unapproved does not necessarily mean unlawful, but it does mean they have not been assessed for safety, quality and effectiveness by the Therapeutic Goods Administration (TGA).There are regulations that allow for this in Australia, but they were designed for people with compelling clinical needs, not to provide routine access to products without an established therapeutic role.Responsibility is divided between product and practitioner regulation. The TGA regulates therapeutic goods, while the Australian Health Practitioner Regulation Agency (AHPRA) and the relevant national boards oversee the doctors and pharmacists who prescribe and dispense them.But wellness and longevity clinics appear to be taking advantage of the gaps in enforcement and regulations."There are allowances for doctors to make their own decisions backed up by robust evidence … to prescribe unapproved products to their patients," the TGA's chief medical advisor Professor Robyn Langham said."We don't regulate clinicians, that job is for AHPRA," Professor Langham said.Health and longevity clinics appear to be taking advantage of the gaps in enforcement and regulations. (ABC News: Keana Naughton)AHPRA chief executive Justin Untersteiner said the regulator was "concerned that some practitioners may be seeking to exploit the latest health trends by putting profits ahead of patients"."This is unacceptable. The onus is on practitioners to do the right thing and follow good practice, regardless of the business model," he said in a statement."AHPRA is limited in what it can say about individual matters but can confirm that we have open notifications regarding prescribing and supply of peptides."He said good practice includes "only recommending treatments when there is an identified therapeutic need and a reasonable expectation of clinical efficacy and benefit for the patient."AHPRA said it was being proactive, "not just responding to complaints", and had made clear the expectations around prescribing, compounding and telehealth.There is no shortage of sites selling black market peptides. (Four Corners)The TGA does regulate, and strictly forbids, advertising prescription or unapproved products.When Four Corners asked the clinic that provided Rachel Carbonell with a prescription if its online offering of "peptide therapy" was legal, the clinic said it was because the website "did not advertise any specific prescription" and that "booking a consultation did not guarantee that any medicine would be prescribed".It has since removed and renamed that particular service.Professor Langham said the majority of the supply of unapproved peptides was happening via the black market, which the TGA is attempting to crack down on.Four Corners had samples of three black market peptides sent to a Melbourne Lab for analysis.Vials of GHK-CU, a copper peptide often promoted for skin and hair. (Four Corners: Patrick Stone)It found the concentrations of the peptides varied widely. One sample contained none of the advertised peptide at all.Grace Hamann, an analytical chemist, said the lab also found heavy metals in some peptide samples, including significant amounts of potentially toxic free copper."Generally, it's there as a marketing gimmick … to make the peptide in the vial appear blue," she said.Professor Samaras said the longevity industry was capitalising on people's desire for better health."People are vulnerable. They're trying to do the right thing by their health, and they think that there is something more that they can add to it, but they have been utterly misled."Watch Four Corners' full investigation The Race to Reverse Aging tonight from 8:30 on ABC TV and ABC iview.