Uncertainty and Accountability

Over the past year, I’ve written a lot about medical experimentation.

I’ve written about compounded GLP-1s sourced through regulatory loopholes. Peptides sold online with little more than a disclaimer and a prayer. Telehealth companies trying to see how close they can get to practicing medicine without accepting any of the responsibilities that come with it.

If you’ve been reading Drugstore Cowboy for a while, you probably know where I stand.

I like evidence.

I like clinical trials.

And I love FDA approval.

And generally speaking, I get angry when someone starts injecting substances into their body because a guy on a podcast told them it might improve recovery, optimize hormones, or help them live forever.

So when I opened the Wall Street Journal yesterday and saw a story about doctors prescribing Wegovy to elementary school children, I expected my blood to start boiling.

Instead, I found myself conflicted.

The article follows a family with nine-year-old twin boys who suffer from severe obesity. The kind of obesity that brings high blood pressure, liver dysfunction, insulin resistance, and growing concerns about what their health will look like twenty years from now. It also invites relentless bullying and incalculable damage to their developing psyche and self-esteem.

The children in the article are receiving GLP-1 medications despite the fact that these drugs are not approved for obesity in children their age.

That should make all of us uncomfortable.

It certainly makes me uncomfortable.

We don't know what happens when someone starts a GLP-1 at age nine and stays on it for decades.

We don't know what the long-term effects might be on growth, puberty, bone development, or nutrition. It’s never been studied. Which is the same thing I say when discussing peptides, supplements, compounded medications, and every other wellness craze currently flooding the internet.

But the longer I thought about this story, the more I realized something important.

I can’t dismiss what this family is doing the same way I can scold a friend who orders retatrutide from a Chinese website online. 

All experimentation is not the same.

One of the simplest mistakes people make when discussing medicine is pretending that doing nothing is somehow a neutral choice.

It isn't.

Every medical decision has risks.

Sometimes the risk comes from the treatment.

Sometimes the risk comes from refusing to treat.

A physician looking at a severely obese nine-year-old today is not choosing between certainty and uncertainty.

They're choosing between two different forms of uncertainty.

They don't know the long-term side effects if that child takes Wegovy for thirty years.

But they also don't know what happens if that child spends the next thirty years living with severe obesity.

One future contains unknown risks.

The other contains Type 2 diabetes, hypertension, cardiovascular disease, liver disease, cancer, and a dramatically reduced quality of life. Those risks are not theoretical. We see them every day.

Maybe that doctor ultimately decides the unknown is worth it.

Maybe they decide it isn't.

Reasonable people can disagree.

What struck me most is that this is still an experiment.

Just a very different kind.

When I write about peptides being sold online, what bothers me isn't merely the lack of evidence. It's the complete absence of accountability.

The seller bears no responsibility.

The influencer bears no responsibility.

The website bears no responsibility.

Everyone gets paid. Nobody owns the downside.

And if something goes wrong, the patient discovers they were the only participant in the experiment who actually had anything at stake.

That's not medicine.

That's marketing.

The situation described in this article feels fundamentally different.

The physicians involved aren't pretending they know everything.

Many openly acknowledge the lack of long-term data.

They're making difficult decisions in consultation with families because they believe the alternative may be worse.

That’s an important distinction.

Medicine has always involved calculated risk.

Every breakthrough treatment in history eventually reached a moment when someone had to move forward before every question was fully answered.

If we demanded perfect certainty before acting, we'd still be waiting for most of modern medicine to exist.

The challenge is deciding when uncertainty becomes acceptable and who gets to make that decision.

And who is accountable if they're wrong.

I've spent the last year criticizing a healthcare culture that increasingly treats every human problem as an opportunity for a new product.

A new peptide.

A new supplement.

A new subscription.

A new injection.

Most of those experiments deserve criticism.

Many deserve outright skepticism.

But this story reminded me that not all experimentation is reckless.

Sometimes experimentation is simply what medicine looks like when there are no good options left.

A doctor looking at a healthy thirty-five-year-old who wants an unapproved peptide to recover from workouts 4% faster is participating in a very different exercise than a doctor looking at a severely obese child whose health is deteriorating despite years of effort.

Both involve uncertainty.

Only one feels like medicine.

That's the line I've been trying to draw for the past year. This story is the first time I've found myself standing on the other side of it.

Giddy up.

Alec Wade Ginsberg, PharmD, RPh
4th-Gen Pharmacist | Owner & COO, C.O. Bigelow
Founder, Drugstore Cowboy