♪ ♪ ZACH MOORE: Welcome to On Health with Houston Methodist. I'm Zach Moore. I'm a photographer and editor here, and I'm also a long-time podcaster.

SCOTT CRAWFORD: I'm Scott Crawford. I'm a videographer and editor here at Houston Methodist.

ZACH: And Scott, how much time do you spend online?

SCOTT: Way too much.

ZACH: Don't we all.

SCOTT: Yeah, it's -- it can get bad.

ZACH: And when you're online, you cannot help these days but to be inundated with online health claims. You see it all, right? Wanna lose weight? Wanna regrow your hair? Etcetera, etcetera. And the list goes on. And look, you and I obviously work for a health care organization here at Houston Methodist, so I feel like we have a good home base here that we can get a lot of those questions answered. What's tricky is, you know, you hear about something in the news, you hear about what some people are doing, you're like, "Oh, let me look that up," right? You look that up, and then what happens? The algorithms kick in, right? And every single source, no matter who, what, where, when, how, comes at you. And the layperson out there, how are they supposed to determine what they can trust and what they can't?

SCOTT: Right. There's a lot of stuff going around out there, and some sources seem credible, but maybe not. And there's influencers that people put their trust in, and they're spreading these claims, and they're just automatically thinking, "Well, this person wouldn't deceive me. They wouldn't steer me wrong."

ZACH: Well, people, they find what they wanna find too.

SCOTT: Mm-hmm.

ZACH: Like, "Well, this sounds great. Like, I can lose all this weight with no work," right? "I'm gonna drink this or take that," right?

SCOTT: Yeah, it's people trying to find an easy way out a lot of the time, and I think that gets preyed on by influencers.

ZACH: Yeah, and look, I love that we have the Internet and cell phones and air conditioning and space travel, and it's all wonderful, right? But, you know, when you give anybody a camera and a microphone, right? Like, anybody with a camera or microphone can share their opinions. And everyone's entitled to their opinion, but that's not necessarily fact.

SCOTT: Yeah, and there's good information out there too, but it can be really difficult to sort of filter through it and know what's fact and what's fiction. It pops up in a lot of places I wouldn't really expect. Like, YouTubers I like will sometimes bring in, like, "Oh, here's these supplements I've been taking," which is usually harmless, but there's some dangerous stuff out there too.

ZACH: And that's what we're talking about today. Online health claims, debunking them, how best to approach them, and who did we talk to today about that, Scott?

SCOTT: We talked to Dr. Joshua Septimus. He's a primary care physician here at Houston Methodist.

SCOTT: All right, Dr. Septimus, thanks so much for joining us today.

DR. JOSHUA SEPTIMUS: Thanks for having me back.

SCOTT: So, today we are gonna talk a little bit about online health claims and some of the fads sort of floating around out there. I'm thinking of things like supplements. I know peptides are a big thing. There's these -maxxing trends you always hear about, and all the different forms that it takes. What trends like that do you hear about from your patients or just out in your daily life?

DR. SEPTIMUS: So I would say the biggest trends right now in our clinical practice, our being myself and other members of the primary care group, really focus around peptides. And those peptides can really include all kinds of different compounds, going all the way from the true FDA-approved products like tirzepatide and semaglutide, which are branded as Zepbound and Wegovy for weight loss, all the way to the really, in my opinion, dangerous trends for peptides that are being pushed on social media and on a lot of really popular podcasts as anti-aging or for cosmetic reasons that are not FDA-approved and that have really caught on with these catchy names. The big one right now, there's two really big ones. One is the Wolverine cocktail, which is supposed to be like the comic book character Wolverine that keeps you ripped and muscular and young at all times and helps you heal, which there's no evidence it actually does that. And there's another peptide that's nicknamed the Barbie peptide that gives people this tanned-looking skin. But both of these are, or neither of these have been FDA-approved and have the potential to be very, very dangerous.

SCOTT: Right. So, how do these claims sort of spread? Because, as you said, a lot of them don't really have much credibility to them. And there are some that I should say may have credibility or plausible deniability for the dangers of them, but how do you think these things spread, and why do people sort of gravitate towards these trends?

DR. SEPTIMUS: Well, I think you have to go back to the COVID pandemic and see that there was a lot of mistrust with the public health establishment around the COVID epidemic because of true, I don't think it was misinformation. I think it was, we didn't know what was going on, and people were doing their best, and sometimes they were wrong. And so that helped a previously very underground kind of conspiracy theory underground blossom. And so you began to see people on really, really prominent podcasts and other very prominent social media influencers start talking about how the mainstream medical establishment either didn't know or was hiding the truth. And so that, now that, thank God, the pandemic is behind us, has really fostered this movement of individuals with huge platforms. I mean, we're talking about podcasts with millions and millions of listeners and other social media influencers with millions upon millions of followers who are putting on their podcasts, and even personally saying that they use these peptides. And anyone who questions the safety or validity of using these, they are either told, or they tell their audiences, that, "Oh, they're just ignorant" or "They're hiding things from you," or, they're using these personal experiences. "Well, I took the Wolverine peptide, and look how good I look." And as anyone who knows anything about medicine knows, you can't use singular examples of success to prove safety and what's called efficacy, meaning that products actually work. You also now see that there's even people who are prominent in government who are pushing things like peptides. So I think all of that combined has created this atmosphere of, really, confusion. And so our struggle and our challenge in primary care is to try and redirect our patients to things that we know are safe and that we know work, and avoiding ordering these really potentially dangerous cocktails off the Internet. The other thing I think is really important is that you can get a lot of these things on the Internet through kind of the gray market or the black market, and you really have no idea what you're getting when that's the case. And you alluded to in your question, there's some of these that maybe there is some safety data. A really good example of that is retatrutide. So, retatrutide is a next generation GLP. So the second generation, or the most recent generation, I don't know what generation we're on, but the most recent generation of these GLPs is tirzepatide, which is branded as Mounjaro for diabetics and Zepbound for weight loss. Retatrutide is made by the same company that makes tirzepatide, and it is in phase three clinical trials right now. Assuming that things look good, which they look good on preliminary data, it will probably be FDA approved in 2027 for weight loss, but you can get it on the gray market now. And so now you have no idea what you're getting when you order these compounds, even the ones that may be potentially approved in the near future.

SCOTT: And I think that also kind of muddies the waters in general. Just if you -- if there's trustworthy, or I guess things that have data behind them that seem trustworthy, I guess that could also lead you to believe that these other things that are adjacent to it may also be trustworthy. And so it kind of, it works both ways, where you're trusting things that shouldn't be trusted, and then you're mistrusting the things that are actually valid because they're sort of bundled together like that.

DR. SEPTIMUS: Well, I think, I think what happens is that people look at singular examples of people on social media who, you know, if you've ever watched behind the scenes, you know that these people, the way that they look in their social media feeds is not the way that they look in real life. And you're assuming because of that example that using these cocktails, or using reta or BP-157 or any of these cocktails, is gonna make you look ripped. If you're a guy, you mentioned looks-maxxing in the introduction, or for women, there's now a really dangerous trend towards extreme thinness again. And so people are assuming that they can do that safely because they're seeing it on social media. The flip side of what you're saying, though, there's also this very, very dangerous trend for mistrust of vaccines. You mentioned, you know, there's a mistrust for things that you should be trusting and a trust for things you shouldn't. Well, you know, we had in this country, even before the COVID pandemic, a small but very noisy anti-vaccine movement. Nationally, this movement is really, really growing, similar to the social media landscape and even government official landscape. When it comes to these peptides, you see the exact same thing happening with vaccines, where people use really dangerous language. "Oh, I'm just asking questions." And they put out really, truly misinformation that's extremely hard to counter because science is really complicated. And the language of science is very different than the language of social media. And so, you know, those are the two, you know, the peptides and the vaccines are the two sides of this social media landscape that's so dangerous. You see that, you know, we're on the verge of losing our measles exempt status. Canada has already lost it because they have a large anti-vaccine movement in Canada as well. And we see people dying from diseases that should be preventable. Even most recently, just last week, the U.S. military reinstituted their requirement for the flu vaccine because you see what happens when you eliminate vaccine mandates. Diseases spread. Viruses love when people are not vaccinated. And so it really scares me that young children could be exposed to measles now that they never should have been exposed to.

SCOTT: When I was doing my research for this, there was a study I saw that showed that trust in the health care industry was around 70-plus percent based on the metric that they had calculated. And then by 2024, it had been reduced to about 40% trust. So, they determined that the majority of people don't trust the health care system at large. The flip side of that was one of their conclusions was that people do tend to trust their own personal doctor. So, I think when we talk about recovering from this downturn in trust, that could play a big part, just that sort of grassroots one-on-one involvement with people and sort of de-influencing them. And have you had any experience with that in your office of just talking to people and sort of clearing up these misconceptions?

DR. SEPTIMUS: Every single day. I will tell you that this consumes an inordinate amount of my time and my practice partners' time. If you read anything about physicians right now, you'll see a lot about burnout. Physicians are experiencing increasing burnout. And you would think that that was from the stress of caring for patients during the pandemic and the fears of the pandemic. And I think in 2020, that was certainly the case. But now it's actually the stress of combating all of this misinformation and the amount of time that that's taking up. In the real world, you know, physicians have a limited amount of time, and patients have infinite time to scroll on social media. So you may spend, you know, a really long period of time with a patient these days is 10 or 15 minutes. It doesn't sound like a lot of time, but our appointment slots are generally 15 minutes long, including all of our time to do documentation. So, if I spend 10 minutes trying to explain to a patient why the new mRNA vaccine that was FDA approved for influenza is safe and effective, but that patient spends hours upon hours per week, which most people do, scrolling through social media and seeing how mRNA vaccines are going to change your DNA, which, by the way, is physically impossible, does not happen, it's really hard to combat that in a 10-minute conversation. So even though I have, you know, I've been in practice 23 years, most of my patients have been with me for over a decade. And I will tell you that the patients who believe what I just kind of jokingly said about mRNA vaccines, they will not take the COVID vaccine. These are people I have known for a decade. These are people that know that I take the COVID vaccine every year. These are people that know I worked on the COVID ward at Houston Methodist during the end of 2020. They still don't trust me.

SCOTT: Wow.

DR. SEPTIMUS: And so it's created an enormous problem. And then the flip side of that is that for peptides, for example, and I see this as the biggest problem, actually, not in men who are trying to looksmaxx, the Wolverine cocktail, that type of thing. That's actually an enormous problem in young men who are probably not going to the doctor. These are people who, they're done with their pediatrician. They're probably in college or, you know, in their 20s. Well, they don't really go to the physician. And so you don't get the chance to really go over it. And because they are just getting it off the gray market, there's no controls on them. Where I see it more is in women who are under increasing pressure to look thinner and thinner and where I can spend -- I just had this happen last week. Last year, I spent almost the entire time at a woman in her 40s physical counseling her on why she should not take a peptide, a GLP, an FDA-approved GLP, to lose five or 10 pounds. She was already thin and healthy. She was already exercising. And I worried that the risks of these drugs outweighed the benefits. So she came in last week for her physical. She's lost 10 pounds, and she's on a compounded form of tirzepatide that she was getting off the Internet. And I'm not saying this to say anything negative about her. She's a victim in this case of all of the influencers and social media landscape and the availability of these drugs on the market. She didn't even get it off the gray market. She got it off of one of these websites that are now everywhere where people can get online care, not just for weight loss, but for hair loss and erectile dysfunction and everything else. It's just exploded in the last few years.

SCOTT: So, it seems like even with the direct one-on-one physician-patient relationship, there's still an overwhelming flood of information, misinformation, and influencing going on. So, assuming people are not gonna just delete Instagram and TikTok off their phone, which I think is just, that's just not gonna happen, how can people sort of vet the information that they are getting? So, is there such a thing as an influencer that is trustworthy and reputable?

DR. SEPTIMUS: Absolutely. So, I now include in my after-visit summary. So, for anyone who hasn't been to the doctor in a while, generally at the end of your visit, you'll get an after-visit summary. It used to be printed out. Now we just get it on our MyChart because we're on Epic, the electronic health record. And I now include a list of people that I trust on X, formerly known as Twitter, and on Instagram. I'm not on TikTok, so I don't know who's available on TikTok, but I'm trying to give my patients people to follow that they can trust. And I also, I mean, I'm on X, and so I will sometimes give my X handle out to people as well, although I post about things other than just medicine. So, I tend to be a little reluctant to do that. But I have a number of people that I really think people should trust when it comes to knowing how to review medical literature and who provide reliable and timely rebuttals to the nonsense that's out there. These physicians have actually published content expressing their own frustration with how much time it takes them to do this. These men and women are really doing a service. The other thing that I also provide to patients is links to podcasts, including this one. And so I've again, I said, thank you for having me back. I've been on this podcast a couple of times, so I tend to give them links to episodes where I've been interviewed. And there's a couple of other episodes that I really recommend to folks. For example, the one where you interviewed Dr. Wooldridge, who's one of our sports medicine doctors. I really try to focus people on healthy aging. And so I'm trying to provide them with alternative places to look, but it's fighting an uphill battle.

SCOTT: Well, first of all, thank you for spreading our podcast around. We greatly appreciate that. And on the topic of vetting information, this is a hot topic now, AI. So, a lot of people are now getting information from AI chatbots or, like, the Google AI search functionality. How do you think that plays a role in this information war that we're in? Are people getting reliable information from that, or can it be erroneous in some ways?

DR. SEPTIMUS: So I will tell you, I am extremely bullish on AI. I think that it is an incredible tool for us to use. But just like any tool, it can be used incorrectly. So I think with AI, number one, you have to understand the limits of AI and train your AI in how you want it to behave. So you have to literally, and I'm most familiar with ChatGPT, you have to literally tell ChatGPT, "Do not give me theories. Only give me medical information that has been," and you can pick your phrase. A doctor would probably say that's been peer-reviewed or something like that. You wanna make sure that you're training your AI chatbot. The other thing is that I think it's important to, number one, find a physician with whom you can partner. So, I tell my patients that the doctor-patient relationship, at least for primary care, is like a marriage. It has to be a two-way street. It can't be one person telling the other person how it is. If it was like that, I would have no patients in my practice who refused the COVID vaccine or who refused a statin, right? I have recommendations. The patients have their feelings, their emotions, their backgrounds. So we have to be able to agree to disagree. So, what I ask my patients is to please come to me with your questions. I am thinking about 1,500 or 1,800, however many patients that are in my patient panel. The average primary care doctor has around between 1,500 and 2,500 patients in their patient panel. We can't be thinking about you all the time. You are thinking about yourself all the time. And so if you put a bunch of symptoms into an AI chatbot and it comes up with something that your physician has not thought of, what I would encourage you is don't go fire your doctor. Make an appointment with your physician to have a conversation about it. And that's where your physician should be engaged and willing to do so. Now, I will not answer 50 MyChart messages about a particular question. What I will do is, if it's anything other than a simple yes, no, I'll set up a video visit with that patient. One of the really great things that came out of COVID, we now offer telemedicine visits to our patients so they don't have to take a half a day off work and drive across town and pay for parking. They can just set up a video visit, and we can have a conversation about their question. I will tell you that often my patients are thinking about things that I just haven't considered. And I'll give you one example where I even used it. I had a patient that, Houston Methodist has a lot of patients who come to the United States for their care. And I work with our Houston Methodist Global group and see a lot of patients from Latin America. One of my patients from Latin America came in with a constellation of symptoms I had never encountered. Again, I've been in practice over 20 years, but I put it into one of the AI algorithms, and it came up with a diagnosis I had never heard of, never seen. But then I went and looked it up in the medical literature, and I'll be darned, it was right.

SCOTT: Wow.

DR. SEPTIMUS: And I was able to put that patient on a very, very simple treatment regimen with over-the-counter medications that cost pennies. And he's now completely asymptomatic. So, I think AI is great when used the right way and when your physician is willing to partner with you.

SCOTT: It's like the favorite term that we have on the podcast is, "It depends." So everything has a place and a way it can be used correctly, but you can also use it incorrectly and end up in a bad situation. But I think if you, with AI, use it as sort of a guidance rather than the hard truth and use it as a way to advocate for yourself and bring questions to a real physician who actually has the experience rather than just collecting the information online, that's a good way of still getting a benefit from it.

DR. SEPTIMUS: Well, and I'll add, this AI may end up being the solution to this problem of misinformation, right? So you have influencers, podcasters, even some government officials who go in and say things that are outlandish. So you as a patient, just like you don't trust, you know, some patients don't trust the medical establishment anymore. Well, I would encourage them, don't trust all those people either then.

SCOTT: Right.

DR. SEPTIMUS: Put these questions into a reliable AI algorithm and then go to your physician with the question that you have. If you put the hard questions into ChatGPT, Gemini, Claude, any of these, if you put in something really simple like, "Should I take the Wolverine cocktail?" which is the big peptide cocktail, and then you keep pushing it with questions, it's eventually gonna tell you, "No, this is not, you know, an FDA-approved medication." But you have to go that step. But if you put the question in there and you get some basic answers that you can then bring to your physician, and you have an open relationship with your physician, you guys can go back and forth and discuss this. And it can help you as a consumer fact-check not only what your doctor is telling you, not only what, you know, what guidelines are telling you, you can even help fact-check what social media influencers and podcasters are saying as well. So, I look at it as being potentially not an equalizer, but a really useful tool.

SCOTT: So overall, in terms of online health trends, what sort of statement would you give as a wrap-up to somebody who is being exposed to these things or is maybe listening to these topics online? What sort of takeaways can they get?

DR. SEPTIMUS: I think that we have to acknowledge that we are living in a different landscape than we were a generation ago. Information is no longer only available to specialists. You no longer have to, you know, be a medical student or a physician to have access to the same information that previously was really kept behind a gatekeeper. You had to have medical textbooks and all of those kinds of things. So that information is everywhere. So my take-home message would be, even though that information is out there, it doesn't mean that you know how to interpret it. And so I would encourage people who are listening to this to find a physician, like a physician at the Houston Methodist Primary Care Group, with whom you can partner and work your way through what I would consider really critical health care decisions related to health span, related to longevity, related to vaccines, related to risk factor modification. So that instead of just taking unnecessary risks and potentially taking dangerous compounds, you're ensuring that you are interpreting what you're seeing correctly and living what truly is your best life.

SCOTT: All right. Well, thank you so much, Dr. Septimus. I think that was a lot of good information and great insight from you.

DR. SEPTIMUS: Pleasure being here.

SCOTT: It really stood out to me how much time Dr. Septimus says this takes up out of his day, dealing with misinformation and trying to sort of re-educate people about these things that they're reading online.

ZACH: Yeah.

SCOTT: It seems like it's a staggering amount of misinformation.

ZACH: When he put it in the terms of, look, I see a patient 15 to 20 minutes in an appointment. Who knows how frequent or infrequent those appointments are? I mean, that's such a minuscule amount of time compared to the endless hours someone can spend self-diagnosing or researching stuff online, right?

SCOTT: I thought it was good that he mentioned that he tries to share influencers that do have a good reputation and credentials that are actually giving you good information that's peer-reviewed or based on studies.

ZACH: Such as our podcast.

SCOTT: Yes, very, very important. I appreciate that callout from him. But yeah, that's a really good way of fighting that misinformation without taking up his whole day. Yeah. So I thought it was good advice that he gave to just sort of spend that same amount of time doing their own research on it rather than just taking this advice at face value from people who don't have any credentials.

ZACH: Yeah, absolutely. Because look, it's healthy to question things, right? But if you're gonna question people with credentials, you should certainly question people without credentials.

SCOTT: Absolutely.

ZACH: And I think that's where the big disconnect is.

SCOTT: Yeah, the distrust in health care, I don't think should mean that people need to just suddenly trust random people on Instagram. [Laughing]

ZACH: Yeah, like I said off the top, we work for a health care organization, obviously, right? So, I don't get sucked into any of these claims as quickly as someone else might. But I can't blame them if, look, if people equate the nightly news with a YouTube video with something they saw on Instagram, that's where we are right now, right?

SCOTT: Yeah, it can be, I guess, difficult to distinguish a lot for just a layperson who doesn't have a lot of experience with these topics. And it can be difficult to know who to trust. So it's an uphill battle, for sure.

ZACH: Yeah, but it was encouraging to know that, I mean, you mentioned this in your conversation with Dr. Septimus, that people still trust their doctor. So that should be your first source, right? Because they know you. The people online, they don't know you, right? Now, even if you only go once a year, your doctor at least has a baseline for your health, your health needs, right? And that's the person you should go to first when you have these, like, "Look, trying to lose some weight" or, "Hey, what do you think about my hair loss?" or etcetera, etcetera. I go to those two because I feel like those are like A and B out there, right?

SCOTT: Right, those are really common.

ZACH: Yeah.

SCOTT: It's definitely always important to be an advocate for yourself and to bring these questions to your doctor rather than just acting on the information that you see. You need to take those extra steps and do the research and ask questions.

ZACH: Absolutely. All right, that's gonna do it for us this time on On Health with Houston Methodist. Be sure to share, like, and subscribe wherever you get your podcasts. We drop episodes Tuesday mornings. So until next time, stay tuned and stay healthy. ♪ ♪