Dr. Jonathan Slotkin breaks down MedVee: fake doctors, oral GLP-1s with zero evidence, and regulatory gaps enabling bad actors

one person startup. We're getting to the bottom of it. Uh let's see if he's here. I think he is. John, how are you doing?

Good. How are you guys doing? And first of all, congratulations on everything. Great to see you again.

Thank you. Yeah, great to see you again. So, uh I mean, how did you process this story? Uh where where do you think is good to start? uh do you want to maybe set the table with sort of your a little bit of your background and then some of the uh understanding of uh what the claims were made and then we can kind of go through them one at a time.

Yeah, sure. Sounds good. So, I'm a neurosurgeon. I practice I'm also an investor over at Scrub Capital and

I invest in digital health um quite a bit and I look when I saw this story

Yeah.

just like I think a lot of us I wanted this story to be true.

Yeah. Um, so we have an extraordinary reporter and a great venue and I think what happened is we ended up with a tech story when what we needed was a health story. Yep.

So we needed different questions asked of different people.

Sure.

To really go a layer deeper before we anointed this as this great example of where we should go. And

look, I think part of it is we're all guilty of having wanted this to be exactly what it seemed to be. I think investors were guilty of it, writers, founders,

and honestly guys, probably patients too because tech stories, they feel consumable, they feel easy,

but look, revenue when it's absent probably some of the needed regulatory context, that's where we need to go deeper. So that's that's where I came from at this.

So yeah, unpack that idea. Revenue uh you know, free of the context or it needs more context because there are like several different pieces to that. the marketing claims, but also the margins, all these different things. Like what what popped out to you first where you were like, h, this this seems maybe too good to be true.

Yeah. So, for me, the the biggest thing about the article, and it's this is a great reporter, a decorated reporter, was

what what wasn't in the article. So, six weeks before the article came out, um FDA sent a warning letter to this this company. Now, to be clear, they sent them to many. Yeah. And that that that's fair, but those weren't featured um and anointed in the New York Times. Yeah. Those other companies that that received those letters.

They are also um some of their supply chain partners named in the article are subject of a RICO lawsuit right now.

Oh,

there are multiple um class action lawsuits. And look, some of those look like they're coming from these volume firms to be fair. But to me, it's that con one of those things alone may be one thing. And look, Maggie uh Maggie Harrison reported over a year ago fake patients, fake testimonials, and AI generated photos. She actually put out a piece this morning that was a great piece. But that's so that's a year old. So to me

that conting pattern in tele medicine of people saying like, well, real patients don't want their face on a website. Oh yeah, I'll use AI name or a fake picture. But but then it just keeps coming up as again an issue.

There were also though as you saw there were fake doctors. So there was Dr. Albus Dongor. There was

there was Dr. Tucker Carl Zinn spelled with a D.

Like that that's that's another layer. And it's just that I'm saying when that constellation comes together, I think there's now almost like a burden of why are we telling this story in this way? And and that's where, you know, I think we needed a lot more of well, wait a second, is work that we're talking about. And I I I want to make a point here. The day before this article ran, the day before Lily's oral got approved, it was not Tzepide. In fact, it wasn't even a peptide.

So, it's often been said the last thing that that weatherman needs to do before going on any air is look out the window.

Yeah.

Well, so we have this company selling and others too selling an oral version of the medication that has no biological plausibility of working. And to me, the best witness of that is that the the day before Lily announced an entirely different medication despite the fact that it would cause market confusion potentially. So, you think there'll be you're expecting there to be sort of issues with the actual product assortment that the company has been selling as well?

Well, some of what they sell and others are products that work. And let's be clear, a lot of these work really well, okay? But the problem when we sell ones that don't work is it sets those people back. it it sets back their metabolic time. But also, if this administration, and I love that they're doing this, is being so pro- ininoation in this regard, then they we need to be particularly harsh when people are bringing things that are completely irrational and have zero evidence base. And when I say that oral tzepetide has zero evidence base, somebody email me if they find otherwise, but Lily is quoted as saying it's true. There are zero no published studies on oral terspatide in humans. None. Okay. And so when when that's that's the subject of the RICO lawsuit. So what we can get into there is in order for there to be innovation, we have to punish snake oil.

Yeah. and and we do want innovation in peptides.

How do you think about the um uh like just the broader boom in peptide prescription tellaalth because I I like I'm familiar with the warning letter process. It's usually violation of like marketing languages but it can also be used for uh a variety of other uh sort of regulatory actions. Um, do you think that there needs to be like more clarification from the FDA or is it pretty easy for the companies that you've talked to and interacted with to steer clear of uh FDA warning letters in this particular category?

You you've really nailed it um there. And let me be clear, I not only am I pro-development in this area, I myself am have have had peptides as part of my own health journey. That that's been great for me over the last couple of years. Yeah.

And let's start here. The demand is real.

Yeah.

And part of what leads to this is the supply constraints are also real.

So that that that's that's true. And these drugs when done right, they're some of the most powerful agents we've ever seen. Look, I don't want to put too fine a point on it, but this is true. In a subset of people, and before everybody messages me, I said a subset.

Yeah. Yeah.

We have cured obesity in a subset of people. And yes, they need to continue on the medications, but we I all three of us live long enough to see that happen in some people, and that's real.

Yeah.

And so I'm thrilled that this administration is encouraging development here, but that's why we need to police better. So what do I what you you had pointed an important space, a gap that's allowing this to occur and it's a little bit inside baseball, but it's important.

Yeah.

FDA regulates substances and devices largely. And as you know, they cannot regulate the practice of medicine. That's key. Only the states can.

So that's that's one of the spreads here that's leading to this daylight for operators like this to come in, which is FDA approves I you know, subcut great zepound mjaro formulations that gets into the practice of medicine and compounding. FDA is statutoily forbidden from getting involved in the practice of medicine. So I I'm looking to and over in HHS between Abe and some of these other guys and and Marty, there are some extremely smart people that I think we need to now think about. This is an issue of reg yes regulatory lag but also regulatory gap between federal we get to control the substances but states we control the practice of medicine. It's allowing too much daylight.

That's interesting. What about the gap within the pharma companies themselves around e-commerce? It feels crazy to say, but like the pharma companies uh Novo, Eli, they uh Eli Liy, they market a lot. They run Super Bowl ads and they uh somehow are getting beat on e-commerce or something or they just don't it's not like it's not like the average customer's journey starts at elilly.com, right? And it could I would imagine of course there's this uh you know compounding loophole because of the supply constraints but is there something else going on where they don't feel like because of their business relationships with other distributors and doctors and other networks that they can just be their own Amazon.com and and just put their own website up and say hey look no one else can say can buy it because

Apple did this right they were distributor

right yeah there's plenty of there's plenty of other companies that have said like we want to be the sole supplier of our product online. There's going to be fake sites that pop up, but our URL is the only destination where you can go to get the real thing. Everything else is fake. Instead, we've lived in this hybrid where there I mean even just among the two venturebacked uh telealth companies, one's doing compounding, one appears to have a partnership, very different regulatory structures. That's a lot for consumers to wrap their minds around. I'm wondering like do you think that the the actual uh formulators, the drug companies with the intellectual property should just be going deeper into e-commerce?

Well, I think we we caught them where um there was their own internal friction and inertia, right? Where

these these venturebacked entities that can stand up and move quickly on on on mobile and they that was that was

lead time here that that they had.

But I will tell you and I I hear this from a bunch of my patients,

they have gotten better. So right now, for example, Lily, if you want to go cash pay, you get an order from your doctor. They send the prescription, and I I'm not associated with Lily. I'm sure we go has the same exact thing, so I'm not picking sides here,

but your doctor goes in and sends the prescription just like it's to a pharmacy.

You receive a text message the next day. You click it, you pay, easy, it shows up the next day at your house in a cooler. So that is where they are now. Now, they were way behind in getting there.

Yeah.

But we also made a point, and I'm sure you've heard friends,

where the Lily price for Zbound

is getting pretty darn close to what the compoundings can charge. And the compoundings are starting to not be able to charge, you know, even less. But what what we really need here in my view to make this work right where we want to reward innovation and punish snake oil is come up with a structural way and it may need to be regulated because of this regulation gap where the right thing to do is the easiest thing to do and the right thing to do is the profitable thing to do. Right now I don't think we're structured that way and it gets to this federal and state gap.

Yeah.

Amongst other reasons. Uh last question from my experience uh with the FDA in the tobacco industry, they would send warning letters, but a big problem was that uh there were distributors abroad usually that would manufacture uh illegal unapproved vape devices, basically ecigarettes, bring them in and then uh push them through a whole bunch of corner stores and and uh gas stations. And the FDA just didn't really have the enforcement team to go store by store. uh do you think that they will face a similar challenge in regulating peptides online? It feels like it can be done a little bit more behind a computer. You don't need as many people going doortodoor. So maybe they're more equipped for it. But I'm wondering if you have any thoughts on like what it actually takes to play the game of whack-a-ole here. I think Marty and team are are the the right team to think this through because there's there's this permissive lens above them that wasn't there in prior groups on as to these medicines. So once there's a permissive lens now you can get positively innovative instead of thinking like this all needs to happen in shadow where Jordy walks up to me with it below a jacket and kind of like hands it to me. This needs to be

done right. Yeah. And and look, FTC teaming up with FDA,

that's going to be, I think, some of the power here because some of the enforcement we're seeing is already coming from FTC as to the way these things are marketed.

But let's let's get clarity and start collecting evidence, folks. So, if you say, "I'm giving this thing orally, and I know it works," well, write that up and share that news with the rest of us because right now, we think we have no evidence that it does. Let let's get there

and let's let's realize these are extraordinarily powerful medications and let's not let a couple of of bad actors ruin what could be great progress for us.

No, I think it's a great message. Uh well, thank you so much for taking the time to come chat with us.

Well said.

Have a great rest of your day and great week.

Great to see you. Talk to you soon.

Have a good one.

Up next, we have Liz Hoffman. She is Semaphore's business and finance editor and host of compound interest, a podcast from Semaphore Business.

Powerful name.

We will welcome Liz in the TV.

Yet scoops in just a minute.

Some hope for everyone.

They say the world's oldest known tortoise is still alive.

Reports of death revealed.

I heard about the death of the tortoise. I didn't realize.

That was an April Fool's Day post.

Oh, it was real. Yeah.

I thought it was real, too. Uh, very very sad. But that's that that that's amazing news. How old is the world's oldest tortoise? Over a hundred. Correct. Let's see. Okay. 193. Wow. That is amazing. So, there's a chance. Fantastic. There's a chance. We