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Speaker 1: This episode contains distressing themes, including suicide and disordered eating.

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Speaker 1: For twenty four to seven support, please contact Lifeline on

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Speaker 1: thirteen eleven fourteen. You'll find some links to more resources

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Speaker 1: in today's episode description.

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Speaker 2: Welcome to the eighty second Golden Gloves, o Zembich's Biggest Night.

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

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Speaker 3: What don't we think of this ozembic takeover in Hollywood?

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Speaker 3: Excuse me no beg.

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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 3: 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 say.

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

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Speaker 1: for young people?

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Speaker 6: Definitely a lot something new. I've never had disordered eating,

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Speaker 6: despite being a little bit bigger kind of growing up

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Speaker 6: my whole life, I was comfortable and like confident in

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Speaker 6: who I was and everything, and yeah, it could really

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Speaker 6: be further from that now.

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

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Speaker 1: new world of weight loss drugs GLP ones like ozeen, pic,

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Speaker 1: we go v, 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 we'll 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 2: It's tempting to say the solution is get rid of

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Speaker 2: these telehealth companies. That's not the solution. Our regular gps

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Speaker 2: need to do better about weight because so many people

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Speaker 2: are scared of going to the doctor because they're going

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Speaker 2: to get picked on about their weight from.

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Speaker 3: The daily os.

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

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

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

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

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Speaker 7: No reason whatsoever, and I hadn't felt like this for

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Speaker 7: a very long time, became suicidal unable to work.

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Speaker 1: Mackenzie told us she was prescribed Ozempick via an online

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Speaker 1: provider called Juniper.

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Speaker 2: When we think of weight loss, calorie counting, intensive exercise,

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Speaker 2: but science suggests they're not a sure way to achieving

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Speaker 2: long term weight loss? How can Juniper help.

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Speaker 4: Women following the Juniper program can lose over eleven percent

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Speaker 4: of their body weight in just seven months. Wow. Juniper's

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Speaker 4: medical weight loss program includes a treatment that works to

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

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Speaker 4: fuller 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 mosh, Instance,

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Speaker 1: Scripts and Yulie. But during our investigations for this series,

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Speaker 1: TDA conducted various callouts and audience polls, from which we

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Speaker 1: received a large volume of responses. A clear pattern emerged

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Speaker 1: amongst that feedback, which put Juniper in a category of

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Speaker 1: its own. For example, TDA didn't ask participants to name providers,

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Speaker 1: but in open prompts, Juniper accounted for an average of

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Speaker 1: seventy six percent of provider mentions. TDA does acknowledge though

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Speaker 1: some of the issues and prescribing practices were going to

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Speaker 1: discuss may be common to other platforms. The provider describes

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Speaker 1: itself as leading the way in medical weight loss, promising customers,

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Speaker 1: specifically women, a whole balistic approach for lasting results with

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Speaker 1: dietitian led health coaching, educational resources, health tracking, and unlimited follow.

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Speaker 3: Ups for patients with their Juniper doctor.

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Speaker 1: The platform is part of an Aussie 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 7: Chronic conditions are responsible for seventy five percent of all deaths.

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Speaker 7: The economic strain on the system is a breaking point.

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Speaker 8: We need to keep people out of hospital, intercepting them

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Speaker 8: upstream from the traditional healthcare system. Eucalyptus is building the

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Speaker 8: future of the preventative healthcare system to meet good health

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Speaker 8: 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 medication 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: The crust of the technology and a mission of Eucalyptus

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Speaker 5: is using technology to lower the cost of interaction with

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Speaker 5: the healthcare 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 7: So you complete this online questionnaire essentially asking your medical history, etc.

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Speaker 7: And then they get back to you whe whether or

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Speaker 7: not you are suitable for the medication. A doctor reviews

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Speaker 7: your information and then says, yeah, we're happy to prescribe

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Speaker 7: you this. They've got a pharmacy dispature that 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 June. Apart between the

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

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Speaker 1: process took only a couple of days.

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Speaker 7: And I never spoke to a doctor. They just reviewed

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Speaker 7: my information that I put in in a survey kind

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Speaker 7: of format. It did cover, you know, anything relevant to

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Speaker 7: my medical history, So, for example, any medications that I

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Speaker 7: was taking, history of mental health issues. Put that all

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Speaker 7: 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 7: I put very very clearly my exact medication, the dosage,

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Speaker 7: how long I've been diagnosed with major depressive disorder. I

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Speaker 7: was very very clear on all of that, and they

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Speaker 7: supposedly have a doctor reviewer and get back to you

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Speaker 7: and say, yeah, we're happy to authorize.

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Speaker 1: Within weeks, Mackenzie became suicidal.

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Speaker 7: It was largely really quite unexplained, and I was really

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Speaker 7: 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 OZEPIC. 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 7: It was incredibly scary because it was obviously depression, but

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Speaker 7: it was not depression I had felt before and the

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Speaker 7: doctor thinks that's because I was just so intensely coming

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Speaker 7: off in 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 ozempic immediately, go to hospital and contact Juniper.

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Speaker 7: I essentially sent a message through and said, my doctors

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Speaker 7: advised me to stop taking this. These were the side effects,

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Speaker 7: et cetera. And the response was, well, that's not on

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Speaker 7: the listed side effects. It actually shouldn't affect your absorption

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Speaker 7: at all.

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

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Speaker 1: her through resources.

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Speaker 7: No, I actually didn't say anything to do with mental health.

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Speaker 7: That wasn't mentioned on anything that consumers at least could

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Speaker 7: read that it would possibly reduce the absorption of medication

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Speaker 7: or anything like that. It did reduce the amount of

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Speaker 7: food noise, It did help me lose weight. But then

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Speaker 7: on the flip side, the side effects are so significant

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Speaker 7: that I would never do it again.

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Speaker 3: 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 Drugg

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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 semiglutyites, 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. Due to limitations in

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Speaker 1: the scope of reporting and research in this space, the

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

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

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Speaker 1: suicidal ideation associated with GLP ones may exist. It said

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Speaker 1: it's continuing to look into the issue and will communicate

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Speaker 1: final conclusions and recommendations after it completes its review. Juniper

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

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

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

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Speaker 1: loss medications it prescribes.

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Speaker 3: However, Vickers said we have.

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Speaker 9: One patients who have comorbid mental health conditions about the

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Speaker 9: possibility of low mood symptoms or deterioration, and to seek

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Speaker 9: 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 Munjarro

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Speaker 1: or we gow with antidepressants.

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Speaker 3: Juniper said it's unclear where that.

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Speaker 1: Leaves patients like McKenzie, who's lived experience with ozembic, contrasts

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

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Speaker 1: she argues are not airtight.

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Speaker 7: I think it would be very easy to be dishonest

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Speaker 7: on they ask you your height and your weight and

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Speaker 7: do no kind of verification. And I mean, in my case,

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Speaker 7: I was telling the truth, but I think it would

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Speaker 7: be very easy to omit certain things or change certain

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Speaker 7: 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 OS 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 6: I just kind of became really fixated on how much

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Speaker 6: weight I was losing. So I was weighing my stylef

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Speaker 6: like two or three times a day, and it really

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Speaker 6: 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 6: I work in marketing, so I was like, you know,

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Speaker 6: they're really really playing to your weaknesses here. I still

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Speaker 6: get targeted with their ads insanely. It's all very on

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Speaker 6: 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 10: One says, anyone actually saving money since starting medical weight loss?

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Speaker 10: I am spending so much less on food.

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Speaker 3: In reply, another commenter says my monthly takeaway bill was

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Speaker 3: more than 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: defended the ad, which it said, quote depicts an exchange

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Speaker 1: which was inspired by real conversations between members of the

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

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Speaker 1: it said, we did not use their actual words or names,

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Speaker 1: but instead reflected their expressed sentiments in a paraphrased manner.

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Speaker 1: The platform describes saving money on food as a quote

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Speaker 1: genuine benefit experienced by Juniper's patients and a legitimate angle

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Speaker 1: to canvas in Juniper's messaging. The provider's comments did not

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Speaker 1: clarify whether the Juniper's marketing strategy is in alignment with

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Speaker 1: the latest harm minimization advice from.

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Speaker 3: Eating disorder ex experts.

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Speaker 1: It raises questions about Juniper's overall marketing strategy, including how

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Speaker 1: it engages with prospective customers. For example, anyone can enter

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Speaker 1: their details in Juniper's initial online screening questionnaire, so to

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Speaker 1: find out more, I took the quiz myself. Now I'm

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Speaker 1: someone who is in a quote unquote healthy bear my range,

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Speaker 1: and after completing the questionnaire, I was told great news,

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Speaker 1: I could lose ten kilos in four months with Juniper's

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Speaker 1: weight reset program. With this news, I was shown a

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Speaker 1: personalized graph with my projected weight loss trajectory. To go

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Speaker 1: any further, I'd need to speak to a Juniper practitioner,

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Speaker 1: and that would involve paying a refundable deposit. I left

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Speaker 1: it there for a few weeks, but after several follow

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Speaker 1: up emails, text messages, promotional offers encouraging me to take

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Speaker 1: the next step, I eventually paid a deposit and booked

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Speaker 1: in a phone consult From there, a Juniper nurse told

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Speaker 1: me that I was below the provider's minimum BEMI threshold

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Speaker 1: and was never actually eligible for treatment from the graph,

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Speaker 1: I was shown to the promotional emails and texts that

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Speaker 1: I received afterwards. Eating disorder experts worn this type of

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Speaker 1: promotion can be highly triggering and exacerbate feelings of body dissatisfaction.

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Speaker 1: So why does Juniper continue to heavily market its weight

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Speaker 1: loss program to patients who are within a healthy BMI range,

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Speaker 1: who it knows it can't prescribe medication to.

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Speaker 3: We asked the provider about this directly.

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Speaker 9: It said, we accept tda's concerns in relation to this

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Speaker 9: specific graph and are in the process of amending it

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Speaker 9: so that it does not display an initial weight which

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Speaker 9: 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 10: A lot of folks was placed on meeting KPIs for

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Speaker 10: prescribing ozempic and eventually munjaro. One nurse practitioner was prescribing

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Speaker 10: one patient ozempic or munjaro every thirty seconds within their

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Speaker 10: designated shift, which is hardly enough time to ask the

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Speaker 10: required screening questions. It felt misaligned with providing quality patient

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Speaker 10: care in a safe way.

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Speaker 1: Kate says, as ozepic became more talked about in media

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Speaker 1: and pop culture, Juniper customers started coming forward with concerns

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Speaker 1: about side effects.

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Speaker 10: We had a lot of scared customers reaching out and

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Speaker 10: information fed back to them by staff that I feel

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Speaker 10: was deceptive or not the whole truth. We also had

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Speaker 10: 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 10: 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 inaccurate. It argues all clinicians

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Speaker 1: at Eucalyptus are well equipped 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 9: Said nurse practitioners are specialist nurses have typically practiced for

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Speaker 9: 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 at Eucalyptus, Kate also alleges that vulnerable patients

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Speaker 1: did not receive prompt follow up care.

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Speaker 10: We had one concerned mother email us about her son

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Speaker 10: as he had a history of suicidal ideation and he'd

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Speaker 10: been able to purchase multiple quantities of ozambics somehow through

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Speaker 10: our service. She was worried he would overdose on his medication.

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Speaker 10: I was told not to engage with the mother as

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Speaker 10: she was not a customer, and instead reach out to

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Speaker 10: 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 10: I was given very little a sistance or support to

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Speaker 10: deal 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 ozepic, a

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Speaker 1: medication originally developed for type two diabetes management. During that shortage,

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Speaker 1: Kate claims Junipus stockpiled ozepic supplies.

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Speaker 10: 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 new throughout twenty twenty five.

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

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Speaker 9: Did not stockpile semaglue Tarde, but worked with a network

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Speaker 9: of pharmacies to maintain continuity of care for its patients.

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Speaker 1: Kate's o Zeenpic stockpiling allegation relates to a time before

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Speaker 1: the advent of popular alternatives like WEGOVY and Munjaro. Australian

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

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

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Speaker 1: on supply chains and.

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Speaker 5: Doctors prescribers have felt a bit more comfortable using that

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

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

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Speaker 5: real blockbuster drug for diabetes.

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

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Speaker 1: treatment program now centers around wegov and Munjaro treatments. It

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Speaker 1: says its partner pharmacies currently have in stock and.

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Speaker 3: Available next time.

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Speaker 1: I'm on the final installment of Investigating Ozmpic. How has

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Speaker 1: the popularization of weight loss medication impacted the way young

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

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Speaker 10: A lot of people look up to these celebrities, especially

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Speaker 10: young women.

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Speaker 2: I think that means that a lot of young people

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Speaker 2: will think that when you're skinny, you're 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 2: If you take this drug, you are frowned on for

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Speaker 2: cheating and stealing it from diabetics. If you don't take

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Speaker 2: this drug, then you're frowned on for not taking the

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Speaker 2: options that are available. So I feel like it's a

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Speaker 2: 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 to sort of support, you

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Speaker 1: can contact the Butterfly Foundation on one eight hundred eedy hope,

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Speaker 1: that's one eight hundred double three four to six se.

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Speaker 3: My name is Lily Maddon and I'm a proud Arunda

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Speaker 3: Banjelung Calcuttin woman from Gadighl country.

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Speaker 8: The Daily oz acknowledges that this podcast is recorded on

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Speaker 8: the lands of the Gadighl people and pays respect to

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Speaker 8: all Aboriginal and torrest Rate island and nations.

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Speaker 3: We pay our respects to the first peoples of these countries,

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Speaker 3: both past and present.