Looksmaxxing and Peptides

Among the recent wave of online looksmaxxing culture, peptides have become the latest obsession. "Looksmaxxing" is a catch-all term for behaviors meant to improve physical appearance, ranging from everyday habits like hygiene, diet, and exercise to extreme measures such as steroids or experimental drugs pushed online as quick fixes [1][2].

What Are Peptides?

In looksmaxxing spaces, peptides are often talked about like a single thing that will magically transform your body, this however is far from accurate. In science and medicine, a peptide is simply a short chain of amino acids [3]. There are many kinds and they have different biological effects [4].

For example, Sermorelin is a growth hormone-releasing hormone analog that was FDA-approved in 1997 for treating children with growth hormone deficiency. The manufacturer discontinued it in 2008 for commercial reasons. Today it's pushed for it’s use as a way of boosting growth hormone which is believed to improve muscle recovery, and maybe allow you to grow taller [5].

Retatrutide is an experimental weight loss medication which is still under trial. There are preliminary results to suggest that it may be effective and it’s these results that looksmaxxers have latched on to [6].

Melanotan II is pushed for its uses in tanning your skin, aside from the litany of implications associated with that, it has never been approved for human use and has been linked to serious complications including kidney failure, rhabdomyolysis, and renal infarction [7][8][9].

These substances differ in purpose, evidence, and regulatory status but ultimately none are intended for and some actively dangerous for the use-cases laid out by the online community.

Medical and Safety Risks

Most of these compounds interact with hormonal systems or body regulation. Outside of a supervised medical context, the risks multiply because dosing becomes guesswork, side effects may go unrecognized, and there is no screening for underlying conditions [4][12]. Peptides sold outside regulated channels often lack verification of purity or strength and may trigger immune reactions, contamination issues, or unpredictable side effects [7][13].

Beyond hormonal disruption, using non-approved peptides poses other medical risks. Healthcare professionals have documented serious complications including permanent facial scarring from contaminated products, kidney dysfunction, and other severe adverse events [9][10][14]. Because many unregulated peptides have limited or no safety data in humans, claims of benefits often rest on speculation rather than evidence [4][12].

The Psychological and Cultural Context

Looksmaxxing culture overlaps with body image issues and unhealthy fixation on appearance, which can resemble disordered eating and body dysmorphia, it’s also quite a young community on average [1][2]. As a result, those who are both giving and receiving advice are probably young people suffering from mental illnesses, a true recipe for disaster.

Experimenting with hormones and metabolic pathways during that period carries unknown long-term consequences, especially when these drugs were developed for adults with specific diseases [2][13].

Some looksmaxxing communities also promote racialized beauty hierarchies that frame lighter skin and European features as ideal while presenting non-white features as flaws requiring correction [1]. These narratives are rooted in racial stereotyping and pseudoscience.

Conclusion

Grouping all peptides together is scientifically inaccurate [3][4]. Treating them as harmless aesthetic tools is worse.  For individuals considering peptide use, safer alternatives exist: proper nutrition, regular exercise, adequate sleep, and evidence-based skincare. When medical concerns arise, consultation with qualified healthcare providers offers access to FDA-approved treatments with established safety profiles [14].

Reviewed by: Vedant Patel

References:

[1] https://www.medscape.com/viewarticle/extremely-risky-trend-should-be-family-doctors-radar-2026a10004tc

[2] https://wrdnews.org/looksmaxxing-drugs-young-men-risk-health-for-appearance/

[3] https://www.fda.gov/regulatory-information/search-fda-guidance-documents/clinical-pharmacology-considerations-peptide-drug-products

[4] https://pmc.ncbi.nlm.nih.gov/articles/PMC10968328/

[5] https://www.healthline.com/health/sermorelin

[6] https://vitalizemedical.com/the-ultimate-guide-to-peptides-2025-types-benefits-and-fda-regulations/

[7] https://pmc.ncbi.nlm.nih.gov/articles/PMC7148395/

[8] https://pubmed.ncbi.nlm.nih.gov/23121206/

[9] https://health.clevelandclinic.org/nasal-tanning-spray

[10] https://www.frierlevitt.com/articles/regulatory-status-of-peptide-compounding-in-2025/

[11] https://floridahealthcarelawfirm.com/are-peptides-legal/

[12] https://www.healthline.com/health/tanning-injections

[13] https://pmc.ncbi.nlm.nih.gov/articles/PMC11806371/

[14] https://djholtlaw.com/what-peptides-are-legal-in-the-u-s-understanding-fda-approval-compounding-and-the-legal-gray-areas/

Harm Reduction in a Zero-Tolerance Culture

When Americans talk about drugs, the language is often absolute, with phrases such as “zero tolerance,” “drug-free communities,” and “getting tough.” The moral clarity feels reassuring, but the data tells a different story. In 2023, the United States recorded over 100,000 drug overdose deaths for the third consecutive year, driven largely by synthetic opioids such as fentanyl [1]. Despite decades of criminalization, drug use persists and the consequences have grown deadlier.

With Americans beginning to realize the ineffectiveness of current measures, harm reduction policies have begun to gain attention. These include syringe service programs, naloxone distribution, fentanyl test strips, and supervised consumption sites. Rather than demanding abstinence as a prerequisite for care, harm reduction policies accept that some individuals will continue to use drugs and seek to minimize associated risks. The approach is pragmatic, evidence-based, and above all, controversial.

Syringe service programs (SSPs) provide sterile injection equipment to reduce the transmission of infectious diseases, such as HIV or hepatitis C. A substantial amount of research has demonstrated that SSPs are linked with reduced HIV transmission without increasing drug use [2]. The Centers for Disease Control and Prevention (CDC) reports that comprehensive syringe service programs can reduce HIV incidence among people who inject drugs by as much as 50 percent, and when combined with medication-assisted treatment, reductions are even greater [2]. Yet these programs have historically faced political resistance, often rooted in the belief that providing clean needles condones illegal behavior.

The distribution of naloxone, a medication that reverses opioid overdoses by displacing opioids from receptors in the brain, has sparked debate similar to that surrounding SSPs. Community-based naloxone programs have been shown to significantly reduce overdose mortality [3]. In 2023, the U.S. Food and Drug Administration approved the first over-the-counter naloxone product, expanding access nationwide [4]. Still, critics argue that widespread naloxone availability may create “moral hazard,” encouraging riskier drug use. Empirical studies, however, have not found evidence that naloxone access increases opioid consumption; instead, they demonstrate reductions in fatal overdoses [3].

Perhaps the most debated harm reduction policy is the supervised consumption site (SCS), sometimes called a safe injection site. These facilities allow individuals to use drugs they have previously obtained, but under medical supervision, with sterile equipment and immediate access to overdose response. While federal law in the United States complicates implementation, internationally the evidence is clearer. Evaluations of Vancouver’s Insite, North America’s first legally sanctioned supervised injection facility, found reductions in overdose deaths in the surrounding area and increased uptake of addiction treatment services [5]. Research has not demonstrated increases in crime or drug use attributable to the facility [5].

If the science behind many harm reduction strategies is robust, why does resistance remain so strong? Part of the answer lies in stigma. Addiction has long been framed as a moral failing rather than a chronic medical condition. Although major medical organizations, including the American Medical Association, recognize substance use disorder as a disease, public discourse often reverts to blame [6]. Harm reduction challenges that instinct. It shifts the question from “How do we stop this behavior entirely?” to “How do we prevent deaths while people are still struggling?”

There is also a cultural component; U.S. drug policy has historically favored prohibitionist approaches. The War on Drugs, launched in the 1970s and intensified in the 1980s, expanded criminal penalties for drug possession and distribution. Decades later, the United States has one of the highest incarceration rates in the world, with drug offenses accounting for a significant portion of federal prison populations [7]. Yet incarceration has not eliminated substance use, and people leaving prison face heightened overdose risk due to reduced tolerance [8].

Harm reduction policies do not reject abstinence or treatment. Instead, they recognize that recovery is often nonlinear. Medication-assisted treatment (MAT) with methadone or buprenorphine reduces mortality and improves retention in care [9]. However, barriers to treatment, including stigma, cost, and regulatory restrictions, remain widespread. Harm reduction initiatives frequently serve as entry points into broader care systems, building trust where abstinence-only models may alienate.

Critics argue that harm reduction policies send the wrong message, signaling surrender. But public health has long embraced pragmatic strategies. Seatbelts do not encourage reckless driving—they reduce injury when accidents occur. Condom distribution does not promote sexual activity—it reduces the rate of unwanted pregnancies and the transmission of sexually transmitted infections. In each case, policymakers accepted that risky behaviors persist and focused on minimizing harm.

The ethical tension at the heart of harm reduction is not trivial. It asks whether society is willing to prioritize survival over symbolic condemnation. It challenges the idea that compassion must wait for compliance and forces a reconsideration of what success looks like. If a person survives an overdose today because naloxone was available, that survival is not an endorsement of addiction; it is the preservation of a life that might otherwise have been lost.

As overdose deaths remain historically high, the limitations of zero-tolerance rhetoric become increasingly clear. Harm reduction does not promise a world without drugs. It offers something more modest and more immediate: fewer funerals, fewer infections, and more opportunities for recovery. In a culture that often prefers moral certainty, embracing pragmatism may be uncomfortable—but the evidence suggests it is necessary.

Designed by: Leah Kim

Reviewed by: Abby Winslow

References

[1] Centers for Disease Control and Prevention. (2024). Drug overdose deaths in the United States, 2003–2023. National Center for Health Statistics. https://www.cdc.gov/nchs/state-stats/deaths/drug-overdose.html?CDC_AAref_Val=https://www.cdc.gov/nchs/pressroom/sosmap/drug_poisoning_mortality/drug_poisoning.htm.

[2] Centers for Disease Control and Prevention. (2023). Strengthening syringe services programs (SSPs). https://www.cdc.gov/hepatitis-syringe-services/php/about/index.html.

[3] Walley, A. Y., Xuan, Z., Hackman, H. H., et al. (2013). Opioid overdose rates and implementation of overdose education and nasal naloxone distribution in Massachusetts. BMJ, 346, f174. https://doi.org/10.1136/bmj.f174.

[4] U.S. Food and Drug Administration. (2023). FDA approves first over-the-counter naloxone nasal spray. https://www.fda.gov/news-events/press-announcements/fda-approves-first-over-counter-naloxone-nasal-spray.

[5] Marshall, B. D. L., Milloy, M. J., Wood, E., et al. (2011). Reduction in overdose mortality after the opening of North America’s first supervised injection facility. The Lancet, 377(9775), 1429-1437. https://doi.org/10.1016/S0140-6736(10)62353-7.

[6] American Medical Association. (2021). Issue brief: Nation’s drug-related overdose and death epidemic continues to worsen. https://www.ama-assn.org.

[7] Federal Bureau of Prisons. (2023). Offenses. https://www.bop.gov/about/statistics/statistics_inmate_offenses.jsp.

[8] Binswanger, I. A., Stern, M. F., Deyo, R. A., et al. (2007). Release from prison - A high risk of death for former inmates. New England Journal of Medicine, 356(2), 157-165. https://doi.org/10.1056/NEJMsa064115.

[9] National Academies of Sciences, Engineering, and Medicine. (2019). Medications for opioid use disorder save lives. National Academies Press. https://doi.org/10.17226/25310.

Markup Medicine: How Hospitals Inflate the Cost of Care

Most Americans assume a hospital bill reflects the cost of care. Yet a new wave of reports reveals an unsettling truth: hospital prices are not only opaque but inflated to extremes. Recent findings show that the same knee replacement surgery can cost $12,870 in one hospital and $101,527 in another [1]. Without change, Americans will keep paying significantly more for the same care, and the vulnerable will continue to suffer.

What are price markups?

Hospitals do not all set prices the same way. A 2025 report from Trilliant Health analyzed data from nearly 2,700 hospitals and 3,500 surgery centers, uncovering ninefold price differences for identical procedures [1]. Even within a single state, hospitals often charge up to three times as much as their competitors. For consumers, the consequences are real: higher premiums, larger deductibles, and growing debt. Over the past quarter-century, health insurance premiums have risen nearly three times as fast as wages, driven in part by hospital pricing [1].

What’s most striking is the lack of correlation between price and quality. Trilliant found that hospitals ranked among the nation’s “best” often charged more but did not deliver better outcomes. Allison Oakes, the company’s chief research officer, explained that the industry has long treated pricing as “a well-protected secret.” Even as federal transparency laws require hospitals to publish negotiated rates, many still either obscure or withhold them. Without transparent pricing, patients remain powerless to choose affordable care.[1]

A system built on markups

Unfortunately, the practice of overcharging is hardly new. A Johns Hopkins Bloomberg School of Public Health study found that the 50 hospitals with the highest markups billed patients more than 1,000% above Medicare-allowed costs [2]. In one Florida hospital, that meant charging $1,260 for every $100 of actual cost. The researchers, Gerard Anderson and Ge Bai, called it a form of legalized price gouging. “They charge these prices simply because they can,” Anderson said [2].

In North Carolina, a state analysis of 140 hospitals found similar variance across 16 common “shoppable” services: an automated urinalysis that carried a median commercial price of $28.80 versus Medicare’s $2.36, a 1,120 percent median markup [5]. A CT scan of the brain averaged $1,167 commercially compared to $108 for Medicare, and an MRI of a leg joint cost $1,897 versus $229 for Medicare [5].

Of the top 50 hospitals with the steepest markups, 49 were for-profit institutions, and nearly half were owned by just two corporate chains: Community Health Systems and Hospital Corporation of America [2]. The victims of these inflated rates are not limited to the uninsured, though they are most affected. 

Around 30 million Americans without insurance are charged the full sticker price, leading to bankruptcies, damaged credit, and avoidance of care. Privately insured patients are not spared either. Hospitals use inflated rates to negotiate higher reimbursements from insurance companies, which then pass the cost on to employers and workers through higher premiums.

Why markups persist

Several factors keep hospital prices high. When a few large hospital systems control most of the market, competition is reduced. These large hospitals can thus charge more. Rules like North Carolina’s Certificate of Need laws, which govern how many facilities can operate, often make it difficult for new hospitals to open. Additionally, weak enforcement of price-transparency rules allows hospitals to hide important numbers, such as negotiated commercial rates and realistic cash prices. The North Carolina report found that only about half of hospitals disclosed commercial rates for the selected services and less than half disclosed cash prices, making shopping for care effectively impossible for many patients. [4]

Who pays and who suffers

The burden of hospital prices isn’t shared equally. Insurance may protect some patients, but high hospital costs still lead to higher premiums and lower wages. Employers who pay for coverage pass those costs back to workers through higher deductibles. Patients without insurance or who go out of network are affected most—they can be charged the full sticker price, face debt collection agencies, or even be sued. In North Carolina alone, hospitals filed more than 7,500 lawsuits over medical debt in recent years, substantiating how pricing opacity can quickly lead to financial and legal harm [4,5].

Transparency is necessary but not enough

Price transparency rules adopted at the federal level aimed to force hospitals to publish machine-readable files of standard charges and consumer-friendly price lists. In practice, compliance has been inconsistent, and enforcement has been weak. Even when price files exist, they can be hard to interpret, incomplete, or formatted in ways that make direct comparison difficult. Furthermore, research shows that simply revealing prices will not fix the problem. People who are sick cannot shop around, and in areas where a few hospitals dominate, insurers have little power to push prices down [2,4].

A practical takeaway 

Efforts to address hospital markups are in motion. States like Colorado and Texas have enforced stronger price transparency laws, preventing hospitals from collecting medical debt if they fail to disclose prices [4]. In North Carolina, lawmakers are considering the Medical Debt De-Weaponization Act, which would give the state attorney general authority to enforce transparency rules and penalize hospitals that refuse to comply. The bill passed unanimously in the Senate, but remains stalled in the House [4].

Treasurer Folwell argues that these reforms are essential to protect the solvency of the State Health Plan, which faces a $24 billion unfunded liability. Without price relief, its federal reserves could fall below required thresholds within two years [4]. The state’s proposed budget would require hospitals to cut $125 million in costs for the plan—roughly 8% of its projected hospital spending. Hospitals have resisted, lobbying against reforms that would expose their prices to public scrutiny.

Patients can rarely solve these structural problems, but others can make a difference. Employers who buy coverage should demand price transparency and incorporate price data into network design. State governments should demand hospitals earn their tax breaks and access to public programs by proving they help their communities and share clear prices. Regulators can also enforce the rules more strictly, so hospitals that hide their prices do not continue to benefit from it.

Designed by: Esha Kalikiri

Reviewed by: Ashley Gutierrez-Torres

References

[1] Alltucker, K. (August 19, 2025). A $101,000 knee replacement? Why some hospitals charge far more than others. USA TODAY. https://www.usatoday.com/story/money/2025/08/18/why-hospital-charges-prices-vary-cost/85656566007/.

[2] Bai, G., & Anderson, G. F. (June 8, 2015). Some hospitals marking up prices more than 1,000 percent. Johns Hopkins Bloomberg School of Public Health. https://publichealth.jhu.edu/2015/some-hospitals-marking-up-prices-more-than-1000-percent.

[3] Brinder, B. (May 8, 2024). State Treasurer Folwell Releases Report Finding North Carolina 340B Hospitals Overcharged State Employees for Cancer Drugs, Reaped Thousands of Dollars in Profits Per Claim. North Carolina Department of State Treasurer. https://www.nctreasurer.gov/news/press-releases/2024/05/08/state-treasurer-folwell-releases-report-finding-north-carolina-340b-hospitals-overcharged-state.

[4] North Carolina State Health Plan for Teachers and State Employees. (August 16, 2023). North Carolina Hospitals: Extreme Price Markups, Failures in Transparency for Shoppable Hospital Services.  North Carolina Department of State Treasurer. https://www.shpnc.gov/what-the-health/nc-hospital-price-transparency-report.

[5] North Carolina State Health Plan for Teachers and State Employees. (August 16, 2023). Hospital Price Transparency Report.  North Carolina Department of State Treasurer. 

https://www.shpnc.gov/documents/north-carolina-hospitals-extreme-price-markups-failures-transparency-shoppable-hospital-services/download?attachment.