Growth Hormone Secretagogues and the Longevity Trade-Off
Longevity medicine is a field in the process of inventing itself — assembling, from the raw material of geroscience, a ...
Testosterone, HGH, and the Industrial Logic of Male Optimization
Testosterone replacement therapy has been practiced in some form since the 1940s, and the clinical indications for it — classical ...
The Peptide Underground: Clinical Evidence, Compounding Markets, and the Optimization Economy
The peptide optimization market exists in a regulatory and evidentiary gap that is unusual even by the standards of the ...
GLP-1 Agonists Beyond Obesity: The Expanding Therapeutic and Optimization Frontier
The SELECT trial's results, published in 2023, established something that the GLP-1 agonist's mechanistic profile had long suggested but clinical ...
Carve-Outs, Coalitions, and the New Architecture of Employer Pharmacy
The traditional employer pharmacy benefit structure — select a PBM, sign a contract, delegate formulary management — has not disappeared. ...
Mark Cuban, Cost Plus Drugs, and the Limits of Disruption in a Managed Market
Mark Cuban's Cost Plus Drugs launched in January 2022 with a proposition simple enough to be disruptive: sell generic drugs ...
ERISA Preemption: The Legal Architecture That Protects Employers From States — and Sometimes From Accountability
ERISA preemption is the legal concept that the health policy community loves to cite and rarely examines with sufficient care. ...
The Fiduciary Blind Spot: Why Employer Health Plans Are Not Actually Managed Like Retirement Plans
The legal framework for ERISA fiduciary duty does not distinguish between retirement plans and health plans. Both are employee benefit ...
Self-Funded and Exposed: How Employers Lost Control of Their Own Pharmacy Spend
The self-insured employer is, in theory, the most sophisticated buyer in American healthcare. It bears the full financial risk of ...
Rebate Aggregators and the New Intermediary Problem in Drug Pricing
Every system generates the consultants it deserves. The pharmaceutical rebate system — opaque, bilateral, and structured to reward information asymmetry ...
The IRA’s Drug Negotiation Mechanism Meets the Rebate Industrial Complex
The Inflation Reduction Act's drug negotiation provision represents the federal government's most direct intervention into pharmaceutical pricing since the creation ...
Medicaid’s Best Price Rule and the Perverse Geometry of Drug Discounts
The Medicaid best price rule is an elegant policy mechanism with an unintended consequence that has become inseparable from its ...
FDA Evaluation of Certain Bulk Drug Substances in Compounding: Clinical Interpretation
Clinicians increasingly encounter patients using or requesting peptide-based therapies sourced through compounding pharmacies. The U.S. Food and Drug Administration has identified a subset of bulk drug substances, including certain peptides, that may present significant safety risks when used in compounded formulations. The clinical question is whether these regulatory signals reflect meaningful patient-level risk and how they should influence prescribing behavior. This matters because compounded peptides often sit outside traditional approval pathways, creating uncertainty around quality, dosing consistency, and safety. Understanding...
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