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Speaker 1: Happy Tuesday, and welcome back to the Daily OS Summer

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Speaker 1: podcast series. We are continuing with our Investigating ozen Pic

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Speaker 1: series today. If you missed part one yesterday, i'd recommend

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Speaker 1: you leave us here, go and check that out and

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Speaker 1: come back in about forty minutes. A lot of hard

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Speaker 1: work went into bringing this investigation to life, so I

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Speaker 1: just wanted to say thank you so much for commenting, supporting, listening,

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Speaker 1: sharing tda's journalism, our podcasts, all of our contents so

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Speaker 1: that we can continue to bring you stories like this one.

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Speaker 2: That's enough from me for now.

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Speaker 1: So here is Part two of Investigating Ozenpic. This episode

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Speaker 1: contains distressing themes, including suicide and disordered eating. For twenty

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Speaker 1: four to seven support, please contact Lifeline on thirteen eleven fourteen.

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Speaker 1: You'll find some links to more resources in today's episode description.

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Speaker 3: Welcome to the eighty second Golden Gloves Set the Figures Night.

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Speaker 1: From viral weight loss drug to Hollywood punchline.

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Speaker 2: What don't we think of this o zembic takeover in Hollywood?

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Speaker 4: Excuse me?

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Speaker 1: Once lauded as the silver bullet to the stars, Ozempic

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Speaker 1: and other similar medications have.

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Speaker 2: Slowly but surely crossed.

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Speaker 1: Into the mainstream, bringing with them new conversations about body image, ethics,

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Speaker 1: health and accessibility.

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Speaker 4: There is so much demand.

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Speaker 5: There is demand for this that outstrips anything we've ever seen.

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Speaker 1: But what does the exploding global popularity of ozempic mean

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Speaker 1: for young people?

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Speaker 6: Definitely, Polly oult something new.

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Speaker 7: I've never had disordered eating, despite being a little bit

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Speaker 7: bigger kind of growing up my whole life, I was

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Speaker 7: comfortable and like confident in who I was and everything,

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Speaker 7: and yeah, it could really be further from that now.

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Speaker 1: On the first episode of Investigating Ozeenpic, we explored the

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Speaker 1: new world of weight loss drugs glp ones like ozepic,

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Speaker 1: we go Vi, and Munjaro to understand how they work,

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Speaker 1: what they cost, and the many and varied side effects

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Speaker 1: associated with their use. This time will dive deeper into

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Speaker 1: how these medications are being prescribed, their accessibility, and the

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Speaker 1: world of online and telehealth providers.

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Speaker 8: It's tempting to say the solution is get rid of

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Speaker 8: these telehealth companies. That's not the solution. Our regular gps

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Speaker 8: need to do better about weight because so many people

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Speaker 8: are scared of going to the doctor because they're going

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Speaker 8: to get picked on about their weight.

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Speaker 2: From The Daily Os.

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Speaker 1: I'm Emma Gillespie and this is Investigating Ozempic Part two.

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Speaker 1: On episode one of Investigating Ozempic, we met McKenzie, the

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Speaker 1: twenty six year old woman who sought out Ozeenpic for

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Speaker 1: weight management, only to end up in hospital weeks later. I, for.

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Speaker 6: No reason whatsoever, and I hadn't felt like this for

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Speaker 6: a very long time, became suicidal unable to work.

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Speaker 1: McKenzie told us she was prescribed oz enpic via an

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Speaker 1: online provider called Juniper.

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Speaker 8: When we think of weight loss, calorie counting, intensive exercise,

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Speaker 8: but science suggests they're not a sure way to achieving

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Speaker 8: long term weight loss.

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Speaker 4: How can Juniper help? Women following the Juniper program can

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Speaker 4: lose over eleven percent of their body weight in just

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Speaker 4: seven months.

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Speaker 7: Wow.

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Speaker 4: Juniper's medical weight loss program includes a treatment that works

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Speaker 4: to suppress appetite, overhaul hunger signals, and ultimately help us

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Speaker 4: feel full for longer.

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Speaker 1: While Juniper is the focus of this episode, it's worth

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Speaker 1: noting that it's not the only virtual health provider that

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Speaker 1: prescribes weight loss medications in Australia. Other popular platforms include

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Speaker 1: mosh Instance Scripts and Yulie. But during our investigations. For

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Speaker 1: this series, TDA conducted various callouts and audience polls, from

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Speaker 1: which we received a large.

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Speaker 2: Volume of responses.

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Speaker 1: A clear pattern emerged amongst that feedback, which put Juniper

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Speaker 1: in a category of its own. For example, TDA didn't

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Speaker 1: ask participants to name providers, but in open prompts, Juniper

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Speaker 1: accounted for an average of seventy six percent of provider mentions.

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Speaker 1: TDA does acknowledge though some of the issues and prescribing

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Speaker 1: practices were going to discuss may be common to other platforms.

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Speaker 1: The provider describes itself as leading the way in medical

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Speaker 1: weight loss, promising customers, specifically women, a holistic approach for

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Speaker 1: lasting results with dietitian led health coaching, educational resources, health tracking,

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Speaker 1: and unlimited follow ups for patients with their Juniper doctor.

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Speaker 1: The platform is part of an ossie health startup called Eucalyptus.

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Speaker 1: The company, in which describes itself as a global telehealth provider,

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Speaker 1: also runs dermatology brand software, fertility health service kin, and

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Speaker 1: two men's health clinics, Pilot and Compound. Today it employs

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Speaker 1: hundreds of people around the world.

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Speaker 9: Chronic conditions are responsible for seventy five percent of all deaths.

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Speaker 8: The economic strain on the system is at breaking point.

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Speaker 9: We need to keep people out of hospital, intercepting them

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Speaker 9: upstream from the traditional healthcare system. Eucalyptus is building the

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Speaker 9: future of the preventative healthcare system to make good health

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Speaker 9: last a lifetime.

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Speaker 1: Patients across all five Eucalyptus brands can consult with registered

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Speaker 1: clinicians to access prescription medications and treatments. Scripts are issued

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Speaker 1: electronically and filled by Eucalyptus partner Pharmacies. The company says

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Speaker 1: harnessing the power of technology is at the center of

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Speaker 1: its mission. Here's Eucalyptus CEO Tim Doyle speaking about the

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Speaker 1: company in a twenty twenty three podcast interview.

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Speaker 5: Because of the technology and omission of Eucalyptus is using

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Speaker 5: technology to lower the cost of interaction with the healthcare

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Speaker 5: professional and then raising the quality of as introduction.

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Speaker 1: So is that what Eucalyptus has achieved with Juniper. To

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Speaker 1: understand more, we spoke to several Juniper patients. Many question

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Speaker 1: whether the platform is doing enough to prioritize patient care.

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Speaker 6: So you complete this online questionnaire essentially asking your medical history,

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Speaker 6: et cetera, and then they get back to you with

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Speaker 6: whether or not you are suitable for the medication. A

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Speaker 6: doctor reviews your information and then says, yeah, we're happy

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Speaker 6: to prescribe you this. They've got a pharmacy dispature that

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Speaker 6: they work with.

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Speaker 4: They sent it all that.

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Speaker 1: Mackenzie was prescribed as MPICK through Juniper. Between the questionnaire

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Speaker 1: and receiving her first script, she said, the whole process

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Speaker 1: took only a couple of days.

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Speaker 6: And I never spoke to a doctor. They just reviewed

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Speaker 6: my information that I put in in a survey kind

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Speaker 6: of format. It did cover, you know, anything relevant to

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Speaker 6: my medical history, so for example, any medications that I

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Speaker 6: was taking, history of mental health issues. Put that all

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Speaker 6: in there.

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Speaker 1: That included telling Juniper about an antidepressant she'd been taking

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Speaker 1: since her early teens.

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Speaker 6: I put very very clearly my exact medication, the dosage,

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Speaker 6: how long I've been diagnosed with major depressive disorder. I

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Speaker 6: was very very clear on all of that, and they

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Speaker 6: supposedly have a doctor reviewer and get back to you

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Speaker 6: and say yeah, we're happy to authorize.

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Speaker 2: Within weeks, Mackenzie became suicidal.

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Speaker 6: It was largely really quite unexplained, and I was really

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Speaker 6: really concerned.

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Speaker 1: She'd initially decided not to go through her regular GP

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Speaker 1: for ozmpic, but when her mood shifted, Mackenzie visited her

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Speaker 1: doctor in person. He told her there'd been a spike

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Speaker 1: in reports of suicidal ideation linked to ozempic. Mackenzie's GP

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Speaker 1: also explained that because the medication slows the digestive system,

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Speaker 1: it can negatively impact the way the body absorbs other medications,

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Speaker 1: reducing their effectiveness or in some cases, blocking them from

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Speaker 1: working at all.

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Speaker 6: It was incredibly scary because it was obviously depression, but

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Speaker 6: it was not depression I had felt before, and the

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Speaker 6: doctor thinks that's because I was just so intensely coming

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Speaker 6: off medication without being weaned off of it.

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Speaker 1: It was the first time the twenty six year old

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Speaker 1: had heard about the risk. Her doctor suggested she stopped

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Speaker 1: taking ozebic immediately, go to hospital and contact Juniper.

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Speaker 6: I essentially sent a message through and said, my doctors

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Speaker 6: advised me to stop taking this. These were the side effects,

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Speaker 6: et cetera. And the response was, well, that's not on

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Speaker 6: the listed side effects. It actually shouldn't affect your absorption

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Speaker 6: at all.

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Speaker 1: Mackenzie said that she thoroughly interrogated all the information available

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Speaker 1: to her through Juniper's resources.

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Speaker 6: Now, I actually didn't say anything to do with mental health.

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Speaker 6: That wasn't mentioned on anything that consumers at least could

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Speaker 6: read that it would possibly reduce the absorption of medication

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Speaker 6: or anything like that. It did reduce the amount of

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Speaker 6: food noise, it did help me lose weight, But then

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Speaker 6: on the flip side, the side effects are so significant

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Speaker 6: that I would never do it again.

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Speaker 1: We'll be back with more of today's episode right after this.

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Speaker 1: Juniper disputes any relationship between these medications and an increased

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Speaker 1: risk of mental health related side effects. Its clinical director,

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Speaker 1: doctor Matt Vickers, cited specific guidance from the UK Health

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Speaker 1: Regulator to TDA, which stated in September twenty twenty four

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Speaker 1: that the available data does not support a causal association

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Speaker 1: between GLP ones and suicide, suicidal ideation, self injury, and depression.

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Speaker 1: Vickers also pointed to similar findings detailed in a January

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Speaker 1: twenty twenty four update from the US Food and Drug

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Speaker 1: Administration the FDA, which quote did not find an association

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Speaker 1: or clearly demonstrated relationship between GLP ones and the occurrence

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Speaker 1: of suicidal thoughts or actions. However, an analysis of adverse

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Speaker 1: reactions within the World Health Organization's Global database paints a

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Speaker 1: different picture. Findings from an international study published in August

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Speaker 1: twenty twenty four identified a quote disproportionate link between suicidal

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Speaker 1: ideation and semaglutites, a type of GLP one. Considering this,

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Speaker 1: we took a closer look at the research cited by Juniper.

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Speaker 1: The data from the FDA it quoted comes from the

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Speaker 1: preliminary evaluation of an ongoing study. Dudal limitations in the

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Speaker 1: scope of reporting and research in this space. The FDA

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Speaker 1: conceded more clinical trials are needed and that a quote

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Speaker 1: cannot definitively rule out that a small risk of suicidal

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Speaker 1: ideation associated with GLP ones may exist. It said it's

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Speaker 1: continuing to look into the issue and will communicate final

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Speaker 1: conclusions and recommendations.

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Speaker 2: After it completes its review.

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Speaker 1: Juniper rejects claims it has failed in a duty of

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Speaker 1: care to patients and maintains there is no major known

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Speaker 1: risk of suicidal ideation as a side effect of the

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Speaker 1: weight loss medication it prescribes.

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Speaker 10: However, Vickers said, we have one patients who have comorbid

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Speaker 10: mental health conditions about the possibility of low mood, symptoms

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Speaker 10: or deterioration, and to seek support if they are concerned.

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Speaker 1: Juniper also says it has appointed several specialist staff with

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Speaker 1: mental health training and continues to screen patients extensively for

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Speaker 1: mental health conditions. Advice from the Therapeutic Goods Administration the

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Speaker 1: TGA for Munjarro notes the medication can impact the absorption

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Speaker 1: of certain other specific drugs, including the oral contraceptive pill,

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Speaker 1: but there is no advice cautioning the use of Munjaro

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Speaker 1: or we go Vi with antidepressants. Juniper said it's unclear

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Speaker 1: where that leaves patients like McKenzie, who's lived experience with ozebic,

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Speaker 1: contrasts the clinical evidence in forming Juniper's current processes, processes

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Speaker 1: which she argues are not airtight.

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Speaker 6: I think it would be very easy to be dishonest

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Speaker 6: on they are your height and your weight and do

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Speaker 6: no kind of verification. And I mean, in my case,

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Speaker 6: I was telling the truth, but I think it would

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Speaker 6: be very easy to omit certain things or change certain

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Speaker 6: numbers without any kind of formal verification of that.

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Speaker 1: Juniper now requires users to upload photos of themselves, and

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Speaker 1: the provider insists it verifies patient information through multiple methods,

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Speaker 1: but it did not explain to TDA how or if

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Speaker 1: it checks images for signs of manipulation or distortion. Juniper

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Speaker 1: says TGA regulations mandate a minimum BMI and health related

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Speaker 1: weight condition in order to prescribe someone weight loss medications.

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Speaker 1: Body mass index or BMI is a traditional diagnostic tool

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Speaker 1: used to measure obesity. While its relevance and accuracy have

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Speaker 1: been called into question, BMI is still widely used by

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Speaker 1: healthcare providers across the board today. Juniper also told us

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Speaker 1: if a practitioner is uncertain about a patient's true BMI,

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Speaker 1: they have several options available to them, including converting a

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Speaker 1: phone consult to a video call, requesting a patient to

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Speaker 1: have their weight verified at a local GP clinical pharmacy,

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Speaker 1: or they can decline to prescribe medication to a patient.

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Speaker 1: That being said, Juniper did not provide any further detail

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Speaker 1: to the Daily OZ on the frequency with which these

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Speaker 1: channels are or aren't being utilized. Sarah was prescribed weight

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Speaker 1: loss medication through Juniper when she was twenty four.

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Speaker 7: I just kind of became really fixated on how much

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Speaker 7: weight I was losing, so I was weighing my style

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Speaker 7: FLAK two or three times a day, and it really

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Speaker 7: turned into a bit more of probably an eating disorder.

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Speaker 1: When she wanted to cancel her subscription, she said Juniper's

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Speaker 1: follow up marketing made it really hard to walk away.

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Speaker 1: The provider sends regular emails and text messages to its

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Speaker 1: future and former patients with limited time offers and discount

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Speaker 1: codes to encourage them to either start using Juniper or

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Speaker 1: come back to it.

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Speaker 7: I work in marketing, so I was like, you know,

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Speaker 7: they're really really playing to your weaknesses here. I still

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Speaker 7: get targeted with their ads insanely. It's all very on

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Speaker 7: the nose for.

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Speaker 1: Me, if you're already in a vulnerable spot. Sarah thinks

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Speaker 1: Juniper's approach to marketing could be detrimental to some patients.

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Speaker 1: This includes a Juniper Facebook ad showing what looks like

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Speaker 1: a real conversation between two Facebook users.

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Speaker 3: One says, anyone actually saving money since starting medical weight loss?

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Speaker 3: I am spending so much less on food.

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Speaker 2: In reply, another commenter says my monthly takeaway bill was

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Speaker 2: more than Juniper. I'm saving money.

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Speaker 1: We asked Juniper about this Facebook ad, including whether it

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Speaker 1: was a real conversation between two users and why it

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Speaker 1: chose to promote saving money on food as a benefit

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Speaker 1: of weight loss medication. In a statement to TDA, Juniper

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Speaker 1: defends and did the ad, which it said, quote depicts

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Speaker 1: an exchange which was inspired by real conversations between members

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Speaker 1: of the Juniper online community. To protect the privacy of

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Speaker 1: those members, it said, we did not use their actual

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Speaker 1: words or names, but instead reflected their expressed sentiments in

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Speaker 1: a paraphrased manner. The platform describes saving money on food

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Speaker 1: as a quote genuine benefit experienced by Juniper's patients and

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Speaker 1: a legitimate angle to canvas in Juniper's messaging. The provider's

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Speaker 1: comments did not clarify where the Juniper's marketing strategy is

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Speaker 1: in alignment with the latest harm minimization advice from eating

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Speaker 1: disorder experts. It raises questions about Juniper's overall marketing strategy,

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Speaker 1: including how it engages with prospective customers. For example, anyone

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Speaker 1: can enter their details in Juniper's initial online screening questionnaire,

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Speaker 1: so to find out more, I took the quiz myself.

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Speaker 1: Now I'm someone who is in a quote unquote healthy

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Speaker 1: BEARI range, and after completing the questionnaire, I was told

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Speaker 1: great news. I could lose ten kilos in four months

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Speaker 1: with Juniper's weight Reset program. With this news, I was

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Speaker 1: shown a personalized graph with my projected weight loss trajectory.

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Speaker 1: To go any further, I'd need to speak to a

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Speaker 1: Juniper practitioner, and that would involve paying a refundable deposit.

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Speaker 1: I left it there for a few weeks, but after

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Speaker 1: several follow up emails, text messages, promotional offers encouraging me

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Speaker 1: to take the next step, I eventually paid a deposit

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Speaker 1: and booked in a phone consult From there, a Juniper

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Speaker 1: nurse told me that I was below the provider's minimum

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Speaker 1: BEARI threshold and was never actually eligible for treatment from

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Speaker 1: the graph I was shown to the promotional emails and

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Speaker 1: texts that I received afterwards. Eating disorder experts worn this

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Speaker 1: type of promotion can be highly triggering and exacerbate feelings

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Speaker 1: of body dissatisfaction. So why does Juniper continue to heavily

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Speaker 1: market its weight loss program to patients who are within

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Speaker 1: a healthy BMI range, who it knows it can't prescribe

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Speaker 1: medication to.

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Speaker 2: We asked the provider about this directly.

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Speaker 11: It said, we accept tda's concerns in relation to this

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Speaker 11: specific graph and are in the process of amending it

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Speaker 11: so that it does not display an initial weight which

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Speaker 11: falls within a healthy BMI range.

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Speaker 1: Kate is a healthcare professional and an ex Juniper employee

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Speaker 1: who shares the concerns raised by people like Sarah and McKenzie.

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Speaker 3: A lot of focus was placed on meeting KPIs for

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Speaker 3: prescribing ozempic and eventually munjaro. One nurse practitioner was prescribing

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Speaker 3: one patient ozempic or munjaro every thirty seconds within their

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Speaker 3: designated shift, which is hardly enough time to ask the

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Speaker 3: required screening questions. It felt misaligned with providing quality patient

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Speaker 3: care in a safe way.

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Speaker 2: Kate says.

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Speaker 1: As ozempic became more talked about in media and pop culture,

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Speaker 1: Juniper customers started coming forward with concerns about side effects.

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Speaker 3: We had a lot of scared customers reaching out and

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Speaker 3: information fed back to them by staff that I feel

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Speaker 3: was deceptive or not the whole truth. We also had

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Speaker 3: dietitians encouraging calorie counting, which concerned me greatly.

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Speaker 1: Staff concerns were dismissed, she claims. Kate also alleges workers

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Speaker 1: were discouraged from sharing information with community GPS about patients

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Speaker 1: they may have had long standing relationships with and says

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Speaker 1: the company cut ties with external health care providers who

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Speaker 1: voiced their concerns about patient care.

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Speaker 3: A plethora of issues that were coming through won't being addressed.

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Speaker 1: Kate claims staff were inundated with daily reports from patients

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Speaker 1: about mental health concerns and eating disorders, the scale of

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Speaker 1: which was downplayed by Eucalyptus, the company behind Juniper. She says, however,

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Speaker 1: Eucalyptus called this suggestion wildly in our accurate. It argues

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Speaker 1: all clinicians at Eucalyptus are well equipped.

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Speaker 2: To handle all patient concerns.

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Speaker 1: In many instances, Kate said high risk cases were being

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Speaker 1: handled by pharmacists and general nurse practitioners who didn't have

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Speaker 1: the training and qualifications to do so. The company has

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Speaker 1: defended the capabilities of its staff to TDA, although current

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Speaker 1: practices at Eucalyptus might not fully reflect the processes that

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Speaker 1: were in place when Kate worked there. Juniper's clinical director,

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Speaker 1: doctor Matt Vickers.

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Speaker 11: Said nurse practitioners are specialist nurses have typically practiced for

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Speaker 11: at least ten to fifteen years.

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Speaker 1: These providers are accredited by the Nursing Board of Australia

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Speaker 1: which permits them to prescribe any medications which fall within

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Speaker 1: their scope of practice. Doctor Vickers said Eucalyptus nurse practitioners

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Speaker 1: are required to undertake additional training when they're hired to

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Speaker 1: ensure they are adequately experienced in weight management prescribing. During

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Speaker 1: her time Eucalyptus, Kate also alleges that vulnerable patients did

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Speaker 1: not receive prompt follow up care.

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Speaker 3: We had one concerned mother email us about her son

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Speaker 3: as he had a history of suicidal ideation and he'd

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Speaker 3: been able to purchase multiple quantities of ozambics somehow through

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Speaker 3: our service. She was worried he would overdose on his medication.

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Speaker 3: I was told not to engage with the mother she

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Speaker 3: was not a customer, and instead reach out to the sun.

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Speaker 1: She described instances where staff were discouraged from escalating an

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Speaker 1: issue to emergency services, or an instance when staff reached

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Speaker 1: out to a patient on their personal phone to conduct

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Speaker 1: an after hours welfare check themselves.

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Speaker 3: I was given very little assistance or support to deal

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Speaker 3: with these situations in a safe way.

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Speaker 1: Doctor Matt Vickers strongly rejects these allegations and said the

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Speaker 1: company has clear internal benchmarks which are regularly audited to

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Speaker 1: ensure prompt follow up for all patient concerns, with the

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Speaker 1: most serious inquiries requiring the fastest response. On the last episode,

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Speaker 1: we spoke about glp ones Wegovi and Munjaro, which were

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Speaker 1: developed in response to a global shortage of ozempic, a

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Speaker 1: medication originally developed for type two diabetes management.

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Speaker 2: During that shortage, Kate.

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Speaker 1: Claims Juniper stockpiled ozepic supplies.

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Speaker 3: Kate says this was openly bragged about a company wide meetings.

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Speaker 1: At the time, The Therapeutic Goods Administration advised prescribers not

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Speaker 1: to start new patients on ozepic, with supplies to be

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Speaker 1: conserved for type two diabetes patients who have no other

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Speaker 1: treatment options. According to the latest TGA update, ozepic supply

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Speaker 1: issues are expected to continue throughout twenty twenty five. Juniper

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Speaker 1: rejects claims it hoarded ozepic supplies and said the company.

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Speaker 11: Did not stockpile semagluetard, but worked with a network of

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Speaker 11: pharmacies to maintain continuity of care for its patients.

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Speaker 1: Kate's ozepic stockpiling allegation relates to a time before the

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Speaker 1: advent of popular alternatives like Wegovy and Munjaro. Australian Medical

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Speaker 1: Association Chair of Public Health, doctor Michael Bonning says these

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Speaker 1: newer GLP ones have eased some of the pressure on

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Speaker 1: supply chains and doctors.

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Speaker 5: Prescribers have felt a bit more comfortable using that for

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Speaker 5: making sure that they're not ending up with people or

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Speaker 5: diabetics who are missing out on what is a real

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Speaker 5: blockbuster drug for diabetes.

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Speaker 1: While the ozempic shortage presented challenges for prescribers everywhere, Juniper's

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Speaker 1: treatment program now centers around we Goovy and Munjaro treatments.

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Speaker 1: It says it's partner pharmacies currently have in stock and

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Speaker 1: available next time on the final installment of Investigating Ozenpic.

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Speaker 1: How has the popularization of weight loss medication impacted the

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Speaker 1: way young people think about themselves, health and body image.

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Speaker 8: A lot of people look up to these celebrities, especially

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Speaker 8: young women. I think that means that a lot of

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Speaker 8: young people will think that when you're skinny or healthy.

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Speaker 1: How have these medications shifted conversations around obesity treatments and

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Speaker 1: diet culture.

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Speaker 8: If you take this drug, you are frowned on for

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Speaker 8: cheating and stealing it from diabetics. If you don't take

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Speaker 8: this drug, then you're frowned on for not taking the

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Speaker 8: options that are available. So I feel like it's a

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Speaker 8: situation where you can't win.

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Speaker 1: If this episode raised any issues or concerns for you,

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Speaker 1: help is available twenty four to seven through Lifeline on

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Speaker 1: thirteen eleven fourteen. For eating disort of support, you can

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Speaker 1: contact the Butterfly Foundation on one eight hundred Edy Hope.

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Speaker 1: That's one eight hundred double three four six seven three.

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Speaker 2: My name is Lily Madden and I'm a proud Arunda

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Speaker 2: Bungelung Calcotin woman from Gadigl Country.

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Speaker 10: The Daily oz acknowledges that this podcast is recorded on

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Speaker 10: the lands of the Gadighl people and pays respect to

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Speaker 10: all Aboriginal and torrest Rate island and nations.

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Speaker 7: We pay our respects to the first peoples of these countries,

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Speaker 7: both past and present,