Two Women, Two Ambulances, and a Peptide Nobody Could Test

This one is a news story instead of a reader story, because we think it matters for anyone in this space. None of this is medical or legal advice. Talk to a real doctor before you inject anything, and be careful who you buy from.

We spend a lot of time here talking about what peptides can do when things go right. This issue is about what happens when they go wrong, and who ends up paying for it.

Last summer, two women collapsed after getting peptide injections at an anti-aging festival in Las Vegas. Both left the building in ambulances. Both were sick enough that they had to be intubated to help them breathe. They have since recovered, which is the good news, but the story did not end there. Nevada regulators just handed out fines to the people they say were behind those injections, and the details are worth slowing down for.

What actually happened

The event was RAADFest, short for Revolution Against Aging and Death. It is run by an Arizona group that openly sells the idea of an "unlimited lifespan." Inside, a doctor named Kent Holtorf, whose practice is based in California, ran a booth offering alternative therapies, peptide injections among them.

Two women got injected at that booth. Then they got critically ill. The Nevada Pharmacy Board investigated, and last month it issued the penalties.

Here is who got fined:

• Dr. Kent Holtorf, fined $10,000 for practicing in Nevada without a state license. He is licensed in California, not Nevada.
• Han Bao Nguyen, a pharmacist who works at Holtorf's practice, also fined $10,000. The board says he mixed the peptides for both women and gave the injection to one of them.
• Michael McNeal, who calls himself an "integrative health coach" and works for a peptide company Holtorf founded, fined $5,000. The board says he recommended a peptide cocktail to one of the women, and that he does not appear to hold any health care license at all.
• Forgotten Formula, a Texas private membership association, fined $10,000. The board says it mailed the peptides to the casino resort, addressed to Holtorf, which counts as unlicensed wholesaling of drugs.

The part that should make you pause

Investigators could not figure out exactly why the women got so sick. They could not tell whether the injections were contaminated or whether the women simply reacted badly to the peptides themselves. The reason is almost worse than either answer. They could not get their hands on the actual product to test it. As the board's executive secretary put it, "We were not able to obtain the product, although attempts were made."

Think about that for a second. Someone gets injected, ends up in an ambulance, and the people whose job it is to investigate cannot even get a sample of what went into their body. That is the gray market in a sentence.

It gets a little sharper. The board says at least one of the peptides given to the women is on the FDA's list of substances that pose a "significant safety risk." There are 19 popular peptides on that list right now, and compounding pharmacies are not allowed to dispense them. That has not stopped them from being sold, which is the whole problem.

Why this keeps happening

Plenty of peptide medications are FDA approved and used to treat serious illness, things like diabetes and certain cancers. That is real medicine. The trouble is the anti-aging and "regenerative" corner, which is barely regulated at all. When the legal supply is restricted, a booming gray market fills the gap, selling directly to consumers and skirting the rules. Some of it ships from inside the US, some from overseas.

The regulatory picture is also shifting under everyone's feet. RFK Jr., now running Health and Human Services, has been a vocal fan of peptides, and he recently said the FDA plans to reclassify 14 of the peptides currently flagged as unsafe, which could let compounding pharmacies start dispensing them again. Whether that makes things safer or messier is anyone's guess right now.

The legal wrinkle

The most interesting defense came from Forgotten Formula. Its co-founder argues that pharmacy regulations simply do not apply to his group, because it only deals with members who sign a contract, and he says that kind of private, member-to-member activity is protected by the First and 14th Amendments. He also says Holtorf was operating at the festival under his public medical practice, not as a member, and that the two women who got sick were not members either.

The board's lawyer was not impressed. She said this is the first time the board has seen a private membership association make that kind of argument, but she was blunt about the bottom line: mailing drugs into the state without a Nevada license breaks state law, full stop. Everyone fined can appeal.

What we take from it

We are not here to dunk on anyone, and we are not anti-peptide. Obviously. But this story lines up with the same advice we give in every issue, just with higher stakes attached.

Know who is actually holding the needle, and whether they are licensed to do it where you are. "Health coach" is not a medical license. Know what is in the vial, which means buying from suppliers that publish real third party lab testing, the same thing Mara looked for in our last issue. And be very wary of anything sold through a setup that seems designed mostly to dodge oversight, because the moment something goes wrong, that same setup makes it nearly impossible to find out what happened.

Two women got on the floor of a convention center and ended up on ventilators, and to this day nobody can say for certain what was in the syringe. Let that be the thing you remember.

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Stay curious, and be careful out there.