May 19, 2025 • 23 mins
Correction: In a previous version of this podcast, TDA incorrectly stated that Juniper receives an average of 41 mental health-related patient interactions per week. This should have said Juniper receives an average of 41 mental health-related per month.
In a new three-part series, TDA is investigating the complex world of medicated weight-loss. In part two, we explore Ozempic's telehealth boom to understand how virtual clinics are reshaping prescribing practices. We'll hear first-hand accounts from patients and practitioners as we take a closer look at the country's most popular online provider in this space. Just a heads up, this is the second episode of a three-part series. Listen to the first episode, 'The young Aussies using Ozempic', here.
Note: We've changed the names of some of the people you'll hear from in this episode. These sources are known to TDA, but we've kept some of their personal details private to protect their identity.
Support resources: For 24/7 crisis support, please call Lifeline on 13 11 14. For eating disorder support, help is available through the Butterfly Foundation online or over the phone on 1800 ED HOPE.
Host and producer: Emma Gillespie
Guests: Dr Michael Bonning, Dr Emma Beckett, and Varsha Yajman
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
This episode contains distressing themes, including suicide and disordered eating.
For twenty four to seven support, please contact Lifeline on
thirteen eleven fourteen. You'll find some links to more resources
in today's episode description.
Speaker 2 (00:16):
Welcome to the eighty second Golden Gloves, o Zembich's Biggest Night.
Speaker 1 (00:21):
From viral weight loss drug to Hollywood punchline.
Speaker 3 (00:24):
What don't we think of this ozembic takeover in Hollywood?
Excuse me no beg.
Speaker 1 (00:31):
Once lauded as the silver bullet to the stars, Ozempic
and other similar medications have.
Speaker 3 (00:37):
Slowly but surely crossed.
Speaker 1 (00:38):
Into the mainstream, bringing with them new conversations about body image, ethics,
health and accessibility.
Speaker 4 (00:46):
There is so much demand.
Speaker 5 (00:48):
There is demand for this that outstrips anything we've ever say.
Speaker 1 (00:53):
But what does the exploding global popularity of ozepic mean
for young people?
Speaker 6 (00:58):
Definitely a lot something new. I've never had disordered eating,
despite being a little bit bigger kind of growing up
my whole life, I was comfortable and like confident in
who I was and everything, and yeah, it could really
be further from that now.
Speaker 1 (01:13):
On the first episode of Investigating Ozenpic, we explored the
new world of weight loss drugs GLP ones like ozeen, pic,
we go v, and Munjaro to understand how they work,
what they cost, and the many and varied side effects
associated with their use. This time we'll dive deeper into
(01:33):
how these medications are being prescribed, their accessibility, and the
world of online and telehealth providers.
Speaker 2 (01:41):
It's tempting to say the solution is get rid of
these telehealth companies. That's not the solution. Our regular gps
need to do better about weight because so many people
are scared of going to the doctor because they're going
to get picked on about their weight from.
Speaker 3 (01:57):
The daily os.
Speaker 1 (01:58):
I'm Emma Gillespie and this is Investigating Ozmpic, Part two.
On episode one of Investigating Ozempick, we met McKenzie, the
twenty six year old woman who sought out Ozenpick for
(02:18):
weight management, only to end up in hospital weeks later. I, for.
Speaker 7 (02:23):
No reason whatsoever, and I hadn't felt like this for
a very long time, became suicidal unable to work.
Speaker 1 (02:29):
Mackenzie told us she was prescribed Ozempick via an online
provider called Juniper.
Speaker 2 (02:35):
When we think of weight loss, calorie counting, intensive exercise,
but science suggests they're not a sure way to achieving
long term weight loss? How can Juniper help.
Speaker 4 (02:44):
Women following the Juniper program can lose over eleven percent
of their body weight in just seven months. Wow. Juniper's
medical weight loss program includes a treatment that works to
suppress appetite, overhaul hunger signals, and ultimately help us feel
fuller for longer.
Speaker 1 (03:00):
While Juniper is the focus of this episode, it's worth
noting that it's not the only virtual health provider that
prescribes weight loss medications in Australia. Other popular platforms include mosh, Instance,
Scripts and Yulie. But during our investigations for this series,
TDA conducted various callouts and audience polls, from which we
(03:22):
received a large volume of responses. A clear pattern emerged
amongst that feedback, which put Juniper in a category of
its own. For example, TDA didn't ask participants to name providers,
but in open prompts, Juniper accounted for an average of
seventy six percent of provider mentions. TDA does acknowledge though
(03:44):
some of the issues and prescribing practices were going to
discuss may be common to other platforms. The provider describes
itself as leading the way in medical weight loss, promising customers,
specifically women, a whole balistic approach for lasting results with
dietitian led health coaching, educational resources, health tracking, and unlimited follow.
Speaker 3 (04:08):
Ups for patients with their Juniper doctor.
Speaker 1 (04:11):
The platform is part of an Aussie health startup called Eucalyptus.
The company, in which describes itself as a global telehealth provider,
also runs Dermatology brand Software, Fertility Health Service Kin and
two men's health clinics, Pilot and Compound. Today it employs
hundreds of people around the world.
Speaker 7 (04:32):
Chronic conditions are responsible for seventy five percent of all deaths.
The economic strain on the system is a breaking point.
Speaker 8 (04:40):
We need to keep people out of hospital, intercepting them
upstream from the traditional healthcare system. Eucalyptus is building the
future of the preventative healthcare system to meet good health
last a lifetime.
Speaker 1 (04:53):
Patients across all five Eucalyptus brands can consult with registered
clinicians to access prescription medication and treatments. Scripts are issued
electronically and filled by Eucalyptus partner Pharmacies. The company says
harnessing the power of technology is at the center of
its mission. Here's Eucalyptus CEO Tim Doyle speaking about the
(05:15):
company in a twenty twenty three podcast interview.
Speaker 5 (05:19):
The crust of the technology and a mission of Eucalyptus
is using technology to lower the cost of interaction with
the healthcare professional and then raising the quality of as introduction.
Speaker 1 (05:26):
So is that what Eucalyptus has achieved with Juniper. To
understand more, we spoke to several Juniper patients. Many question
whether the platform is doing enough to prioritize patient care.
Speaker 7 (05:40):
So you complete this online questionnaire essentially asking your medical history, etc.
And then they get back to you whe whether or
not you are suitable for the medication. A doctor reviews
your information and then says, yeah, we're happy to prescribe
you this. They've got a pharmacy dispature that they work with.
Speaker 4 (05:56):
They sent it all that.
Speaker 1 (05:57):
Mackenzie was prescribed as MPICK through June. Apart between the
questionnaire and receiving her first script, she said, the whole
process took only a couple of days.
Speaker 7 (06:07):
And I never spoke to a doctor. They just reviewed
my information that I put in in a survey kind
of format. It did cover, you know, anything relevant to
my medical history, So, for example, any medications that I
was taking, history of mental health issues. Put that all
in there.
Speaker 1 (06:22):
That included telling Juniper about an antidepressant she'd been taking
since her early teens.
Speaker 7 (06:27):
I put very very clearly my exact medication, the dosage,
how long I've been diagnosed with major depressive disorder. I
was very very clear on all of that, and they
supposedly have a doctor reviewer and get back to you
and say, yeah, we're happy to authorize.
Speaker 1 (06:43):
Within weeks, Mackenzie became suicidal.
Speaker 7 (06:47):
It was largely really quite unexplained, and I was really
really concerned.
Speaker 1 (06:51):
She'd initially decided not to go through her regular GP
for OZMPIC, but when her mood shifted, Mackenzie visited her
doctor in person. He told her there'd been a spike
in reports of suicidal ideation linked to OZEPIC. Mackenzie's GP
also explained that because the medication slows the digestive system,
(07:12):
it can negatively impact the way the body absorbs other medications,
reducing their effectiveness or in some cases, blocking them from
working at all.
Speaker 7 (07:21):
It was incredibly scary because it was obviously depression, but
it was not depression I had felt before and the
doctor thinks that's because I was just so intensely coming
off in medication without being weaned off of it.
Speaker 1 (07:33):
It was the first time the twenty six year old
had heard about the risk. Her doctor suggested she stopped
taking ozempic immediately, go to hospital and contact Juniper.
Speaker 7 (07:43):
I essentially sent a message through and said, my doctors
advised me to stop taking this. These were the side effects,
et cetera. And the response was, well, that's not on
the listed side effects. It actually shouldn't affect your absorption
at all.
Speaker 1 (07:55):
Mackenzie said she thoroughly interrogated all the information available to
her through resources.
Speaker 7 (08:01):
No, I actually didn't say anything to do with mental health.
That wasn't mentioned on anything that consumers at least could
read that it would possibly reduce the absorption of medication
or anything like that. It did reduce the amount of
food noise, It did help me lose weight. But then
on the flip side, the side effects are so significant
that I would never do it again.
Speaker 3 (08:22):
We'll be back with more of today's episode right after this.
Speaker 1 (08:26):
Juniper disputes any relationship between these medications and an increased
risk of mental health related side effects. Its clinical director,
doctor Matt Vickers cited specific guidance from the UK Health
Regulator to TDA, which stated in September twenty twenty four
that the available data does not support a causal association
(08:47):
between GLP ones and suicide, suicidal ideation, self injury, and depression.
Vickers also pointed to similar findings detailed in a January
twenty twenty four update from the US Food and Drugg
Administration the FDA, which quote did not find an association
or clearly demonstrated relationship between GLP ones and the occurrence
(09:08):
of suicidal thoughts or actions. However, an analysis of adverse
reactions within the World Health Organization's Global database paints a
different picture. Findings from an international study published in August
twenty twenty four identified a quote disproportionate link between suicidal
(09:28):
ideation and semiglutyites, a type of GLP one. Considering this,
we took a closer look at the research cited by Juniper.
The data from the FDA, it quoted comes from the
preliminary evaluation of an ongoing study. Due to limitations in
the scope of reporting and research in this space, the
FDA conceded more clinical trials are needed and that a
(09:52):
quote cannot definitively rule out that a small risk of
suicidal ideation associated with GLP ones may exist. It said
it's continuing to look into the issue and will communicate
final conclusions and recommendations after it completes its review. Juniper
rejects claims it has failed in a duty of care
to patients and maintains there is no major known risk
(10:16):
of suicidal ideation as a side effect of the weight
loss medications it prescribes.
Speaker 3 (10:21):
However, Vickers said we have.
Speaker 9 (10:23):
One patients who have comorbid mental health conditions about the
possibility of low mood symptoms or deterioration, and to seek
support if they are concerned.
Speaker 1 (10:32):
Juniper also says it has appointed several specialist staff with
mental health training and continues to screen patients extensively for
mental health conditions. Advice from the Therapeutic Goods Administration the
TGA for Munjarro notes the medication can impact the absorption
of certain other specific drugs, including the oral contraceptive pill,
(10:56):
but there is no advice cautioning the use of Munjarro
or we gow with antidepressants.
Speaker 3 (11:01):
Juniper said it's unclear where that.
Speaker 1 (11:04):
Leaves patients like McKenzie, who's lived experience with ozembic, contrasts
the clinical evidence in forming Juniper's current processes, processes which
she argues are not airtight.
Speaker 7 (11:17):
I think it would be very easy to be dishonest
on they ask you your height and your weight and
do no kind of verification. And I mean, in my case,
I was telling the truth, but I think it would
be very easy to omit certain things or change certain
numbers without any kind of formal verification of that.
Speaker 1 (11:33):
Juniper now requires users to upload photos of themselves, and
the provider insists it verifies patient information through multiple methods,
but it did not explain to TDA how or if
it checks images for signs of manipulation or distortion. Juniper
says TGA regulations mandate a minimum BMI and health related
(11:54):
weight condition in order to prescribe someone weight loss medications.
Body mass index or BMI is a traditional diagnostic tool
used to measure obesity. While its relevance and accuracy have
been called into question, BMI is still widely used by
healthcare providers across the board today. Juniper also told us
(12:14):
if a practitioner is uncertain about a patient's true BMI,
they have several options available to them, including converting a
phone consult to a video call, requesting a patient to
have their weight verified at a local GP clinical pharmacy,
or they can decline to prescribe medication to a patient.
That being said, Juniper did not provide any further detail
(12:35):
to the Daily OS on the frequency with which these
channels are or aren't being utilized. Sarah was prescribed weight
loss medication through Juniper when she was twenty four.
Speaker 6 (12:47):
I just kind of became really fixated on how much
weight I was losing. So I was weighing my stylef
like two or three times a day, and it really
turned into a bit more of probably an eating disorder.
Speaker 1 (13:02):
When she wanted to cancel her subscription, she said, Juniper's
follow up marketing made it really hard to walk away.
The provider sends regular emails and text messages to its
future and former patients with limited time offers and discount
codes to encourage them to either start using Juniper or
come back to it.
Speaker 6 (13:21):
I work in marketing, so I was like, you know,
they're really really playing to your weaknesses here. I still
get targeted with their ads insanely. It's all very on
the nose for.
Speaker 1 (13:31):
Me if you're already in a vulnerable spot. Sarah thinks
Juniper's approach to marketing could be detrimental to some patients.
This includes a Juniper Facebook ad showing what looks like
a real conversation between two Facebook users.
Speaker 10 (13:47):
One says, anyone actually saving money since starting medical weight loss?
I am spending so much less on food.
Speaker 3 (13:55):
In reply, another commenter says my monthly takeaway bill was
more than I'm saving money.
Speaker 1 (14:02):
We asked Juniper about this Facebook ad, including whether it
was a real conversation between two users and why it
chose to promote saving money on food as a benefit
of weight loss medication. In a statement to TDA, Juniper
defended the ad, which it said, quote depicts an exchange
(14:23):
which was inspired by real conversations between members of the
Juniper online community. To protect the privacy of those members,
it said, we did not use their actual words or names,
but instead reflected their expressed sentiments in a paraphrased manner.
The platform describes saving money on food as a quote
genuine benefit experienced by Juniper's patients and a legitimate angle
(14:48):
to canvas in Juniper's messaging. The provider's comments did not
clarify whether the Juniper's marketing strategy is in alignment with
the latest harm minimization advice from.
Speaker 3 (14:59):
Eating disorder ex experts.
Speaker 1 (15:01):
It raises questions about Juniper's overall marketing strategy, including how
it engages with prospective customers. For example, anyone can enter
their details in Juniper's initial online screening questionnaire, so to
find out more, I took the quiz myself. Now I'm
someone who is in a quote unquote healthy bear my range,
(15:23):
and after completing the questionnaire, I was told great news,
I could lose ten kilos in four months with Juniper's
weight reset program. With this news, I was shown a
personalized graph with my projected weight loss trajectory. To go
any further, I'd need to speak to a Juniper practitioner,
and that would involve paying a refundable deposit. I left
(15:47):
it there for a few weeks, but after several follow
up emails, text messages, promotional offers encouraging me to take
the next step, I eventually paid a deposit and booked
in a phone consult From there, a Juniper nurse told
me that I was below the provider's minimum BEMI threshold
and was never actually eligible for treatment from the graph,
(16:09):
I was shown to the promotional emails and texts that
I received afterwards. Eating disorder experts worn this type of
promotion can be highly triggering and exacerbate feelings of body dissatisfaction.
So why does Juniper continue to heavily market its weight
loss program to patients who are within a healthy BMI range,
(16:32):
who it knows it can't prescribe medication to.
Speaker 3 (16:36):
We asked the provider about this directly.
Speaker 9 (16:39):
It said, we accept tda's concerns in relation to this
specific graph and are in the process of amending it
so that it does not display an initial weight which
falls within a healthy BMI range.
Speaker 1 (16:51):
Kate is a healthcare professional and an ex Juniper employee
who shares the concerns raised by people like Sarah and McKenzie.
Speaker 10 (16:59):
A lot of folks was placed on meeting KPIs for
prescribing ozempic and eventually munjaro. One nurse practitioner was prescribing
one patient ozempic or munjaro every thirty seconds within their
designated shift, which is hardly enough time to ask the
required screening questions. It felt misaligned with providing quality patient
care in a safe way.
Speaker 1 (17:20):
Kate says, as ozepic became more talked about in media
and pop culture, Juniper customers started coming forward with concerns
about side effects.
Speaker 10 (17:28):
We had a lot of scared customers reaching out and
information fed back to them by staff that I feel
was deceptive or not the whole truth. We also had
dietitians encouraging calorie counting, which concerned me greatly.
Speaker 1 (17:40):
Staff concerns were dismissed, she claims. Kate also alleges workers
were discouraged from sharing information with community gps about patients
they may have had long standing relationships with, and says
the company cut ties with external health care providers who
voiced their concerns about patient care.
Speaker 10 (18:00):
Plethora of issues that were coming through won't being addressed.
Speaker 1 (18:02):
Kate claims staff were inundated with daily reports from patients
about mental health concerns and eating disorders, the scale of
which was downplayed by Eucalyptus, the company behind Juniper. She says, However,
Eucalyptus called this suggestion wildly inaccurate. It argues all clinicians
at Eucalyptus are well equipped to handle all patient concerns
(18:27):
in many instances, Kate said high risk cases were being
handled by pharmacists and general nurse practitioners who didn't have
the training and qualifications to do so. The company has
defended the capabilities of its staff to TDA, Although current
practices at Eucalyptus might not fully reflect the processes that
were in place when Kate worked there, Juniper's clinical director,
(18:51):
Doctor Matt Vickers.
Speaker 9 (18:52):
Said nurse practitioners are specialist nurses have typically practiced for
at least ten to fifteen years.
Speaker 1 (18:59):
These providers are accredited by the Nursing Board of Australia,
which permits them to prescribe any medications which fall within
their scope of practice. Doctor Vickers said Eucalyptus nurse practitioners
are required to undertake additional training when they're hired to
ensure they are adequately experienced in weight management prescribing. During
(19:19):
her time at Eucalyptus, Kate also alleges that vulnerable patients
did not receive prompt follow up care.
Speaker 10 (19:26):
We had one concerned mother email us about her son
as he had a history of suicidal ideation and he'd
been able to purchase multiple quantities of ozambics somehow through
our service. She was worried he would overdose on his medication.
I was told not to engage with the mother as
she was not a customer, and instead reach out to
the sun.
Speaker 1 (19:45):
She described instances where staff were discouraged from escalating an
issue to emergency services, or an instance when staff reached
out to a patient on their personal phone to conduct
an after hours welfare check themselves.
Speaker 10 (19:58):
I was given very little a sistance or support to
deal with these situations in a safe way.
Speaker 1 (20:03):
Doctor Matt Vickers strongly rejects these allegations and said the
company has clear internal benchmarks which are regularly audited to
ensure prompt follow up for all patient concerns, with the
most serious inquiries requiring the fastest response. On the last episode,
we spoke about GLP ones Wegovi and Munjaro, which were
(20:25):
developed in response to a global shortage of ozepic, a
medication originally developed for type two diabetes management. During that shortage,
Kate claims Junipus stockpiled ozepic supplies.
Speaker 10 (20:38):
Kate says this was openly bragged about a company wide meetings.
Speaker 1 (20:42):
At the time, the Therapeutic Goods Administration advised prescribers not
to start new patients on ozepic, with supplies to be
conserved for type two diabetes patients who have no other
treatment options. According to the latest TGA update, ozepic supply
issues are expected to continue new throughout twenty twenty five.
(21:02):
Juniper rejects claims it hoarded ozempic supplies and said the company.
Speaker 9 (21:07):
Did not stockpile semaglue Tarde, but worked with a network
of pharmacies to maintain continuity of care for its patients.
Speaker 1 (21:13):
Kate's o Zeenpic stockpiling allegation relates to a time before
the advent of popular alternatives like WEGOVY and Munjaro. Australian
Medical Association Chair of Public Health, doctor Michael Bonning says
these newer GLP ones have eased some of the pressure
on supply chains and.
Speaker 5 (21:30):
Doctors prescribers have felt a bit more comfortable using that
for making sure that they're not ending up with people
or diabetics who are missing out on what is a
real blockbuster drug for diabetes.
Speaker 1 (21:42):
While the ozepic shortage presented challenges for prescribers everywhere, Juniper's
treatment program now centers around wegov and Munjaro treatments. It
says its partner pharmacies currently have in stock and.
Speaker 3 (21:56):
Available next time.
Speaker 1 (22:00):
I'm on the final installment of Investigating Ozmpic. How has
the popularization of weight loss medication impacted the way young
people think about themselves health and body image.
Speaker 10 (22:11):
A lot of people look up to these celebrities, especially
young women.
Speaker 2 (22:15):
I think that means that a lot of young people
will think that when you're skinny, you're healthy.
Speaker 1 (22:20):
How have these medications shifted conversations around obesity treatments and
diet culture.
Speaker 2 (22:26):
If you take this drug, you are frowned on for
cheating and stealing it from diabetics. If you don't take
this drug, then you're frowned on for not taking the
options that are available. So I feel like it's a
situation where you can't win.
Speaker 1 (22:42):
If this episode raised any issues or concerns for you,
help is available twenty four to seven through Lifeline on
thirteen eleven fourteen. For eating to sort of support, you
can contact the Butterfly Foundation on one eight hundred eedy hope,
that's one eight hundred double three four to six se.
Speaker 3 (23:07):
My name is Lily Maddon and I'm a proud Arunda
Banjelung Calcuttin woman from Gadighl country.
Speaker 8 (23:13):
The Daily oz acknowledges that this podcast is recorded on
the lands of the Gadighl people and pays respect to
all Aboriginal and torrest Rate island and nations.
Speaker 3 (23:22):
We pay our respects to the first peoples of these countries,
both past and present.
This episode contains distressing themes, including suicide and disordered eating.
For twenty four to seven support, please contact Lifeline on
thirteen eleven fourteen. You'll find some links to more resources
in today's episode description.
Speaker 2 (00:16):
Welcome to the eighty second Golden Gloves, o Zembich's Biggest Night.
Speaker 1 (00:21):
From viral weight loss drug to Hollywood punchline.
Speaker 3 (00:24):
What don't we think of this ozembic takeover in Hollywood?
Excuse me no beg.
Speaker 1 (00:31):
Once lauded as the silver bullet to the stars, Ozempic
and other similar medications have.
Speaker 3 (00:37):
Slowly but surely crossed.
Speaker 1 (00:38):
Into the mainstream, bringing with them new conversations about body image, ethics,
health and accessibility.
Speaker 4 (00:46):
There is so much demand.
Speaker 5 (00:48):
There is demand for this that outstrips anything we've ever say.
Speaker 1 (00:53):
But what does the exploding global popularity of ozepic mean
for young people?
Speaker 6 (00:58):
Definitely a lot something new. I've never had disordered eating,
despite being a little bit bigger kind of growing up
my whole life, I was comfortable and like confident in
who I was and everything, and yeah, it could really
be further from that now.
Speaker 1 (01:13):
On the first episode of Investigating Ozenpic, we explored the
new world of weight loss drugs GLP ones like ozeen, pic,
we go v, and Munjaro to understand how they work,
what they cost, and the many and varied side effects
associated with their use. This time we'll dive deeper into
(01:33):
how these medications are being prescribed, their accessibility, and the
world of online and telehealth providers.
Speaker 2 (01:41):
It's tempting to say the solution is get rid of
these telehealth companies. That's not the solution. Our regular gps
need to do better about weight because so many people
are scared of going to the doctor because they're going
to get picked on about their weight from.
Speaker 3 (01:57):
The daily os.
Speaker 1 (01:58):
I'm Emma Gillespie and this is Investigating Ozmpic, Part two.
On episode one of Investigating Ozempick, we met McKenzie, the
twenty six year old woman who sought out Ozenpick for
(02:18):
weight management, only to end up in hospital weeks later. I, for.
Speaker 7 (02:23):
No reason whatsoever, and I hadn't felt like this for
a very long time, became suicidal unable to work.
Speaker 1 (02:29):
Mackenzie told us she was prescribed Ozempick via an online
provider called Juniper.
Speaker 2 (02:35):
When we think of weight loss, calorie counting, intensive exercise,
but science suggests they're not a sure way to achieving
long term weight loss? How can Juniper help.
Speaker 4 (02:44):
Women following the Juniper program can lose over eleven percent
of their body weight in just seven months. Wow. Juniper's
medical weight loss program includes a treatment that works to
suppress appetite, overhaul hunger signals, and ultimately help us feel
fuller for longer.
Speaker 1 (03:00):
While Juniper is the focus of this episode, it's worth
noting that it's not the only virtual health provider that
prescribes weight loss medications in Australia. Other popular platforms include mosh, Instance,
Scripts and Yulie. But during our investigations for this series,
TDA conducted various callouts and audience polls, from which we
(03:22):
received a large volume of responses. A clear pattern emerged
amongst that feedback, which put Juniper in a category of
its own. For example, TDA didn't ask participants to name providers,
but in open prompts, Juniper accounted for an average of
seventy six percent of provider mentions. TDA does acknowledge though
(03:44):
some of the issues and prescribing practices were going to
discuss may be common to other platforms. The provider describes
itself as leading the way in medical weight loss, promising customers,
specifically women, a whole balistic approach for lasting results with
dietitian led health coaching, educational resources, health tracking, and unlimited follow.
Speaker 3 (04:08):
Ups for patients with their Juniper doctor.
Speaker 1 (04:11):
The platform is part of an Aussie health startup called Eucalyptus.
The company, in which describes itself as a global telehealth provider,
also runs Dermatology brand Software, Fertility Health Service Kin and
two men's health clinics, Pilot and Compound. Today it employs
hundreds of people around the world.
Speaker 7 (04:32):
Chronic conditions are responsible for seventy five percent of all deaths.
The economic strain on the system is a breaking point.
Speaker 8 (04:40):
We need to keep people out of hospital, intercepting them
upstream from the traditional healthcare system. Eucalyptus is building the
future of the preventative healthcare system to meet good health
last a lifetime.
Speaker 1 (04:53):
Patients across all five Eucalyptus brands can consult with registered
clinicians to access prescription medication and treatments. Scripts are issued
electronically and filled by Eucalyptus partner Pharmacies. The company says
harnessing the power of technology is at the center of
its mission. Here's Eucalyptus CEO Tim Doyle speaking about the
(05:15):
company in a twenty twenty three podcast interview.
Speaker 5 (05:19):
The crust of the technology and a mission of Eucalyptus
is using technology to lower the cost of interaction with
the healthcare professional and then raising the quality of as introduction.
Speaker 1 (05:26):
So is that what Eucalyptus has achieved with Juniper. To
understand more, we spoke to several Juniper patients. Many question
whether the platform is doing enough to prioritize patient care.
Speaker 7 (05:40):
So you complete this online questionnaire essentially asking your medical history, etc.
And then they get back to you whe whether or
not you are suitable for the medication. A doctor reviews
your information and then says, yeah, we're happy to prescribe
you this. They've got a pharmacy dispature that they work with.
Speaker 4 (05:56):
They sent it all that.
Speaker 1 (05:57):
Mackenzie was prescribed as MPICK through June. Apart between the
questionnaire and receiving her first script, she said, the whole
process took only a couple of days.
Speaker 7 (06:07):
And I never spoke to a doctor. They just reviewed
my information that I put in in a survey kind
of format. It did cover, you know, anything relevant to
my medical history, So, for example, any medications that I
was taking, history of mental health issues. Put that all
in there.
Speaker 1 (06:22):
That included telling Juniper about an antidepressant she'd been taking
since her early teens.
Speaker 7 (06:27):
I put very very clearly my exact medication, the dosage,
how long I've been diagnosed with major depressive disorder. I
was very very clear on all of that, and they
supposedly have a doctor reviewer and get back to you
and say, yeah, we're happy to authorize.
Speaker 1 (06:43):
Within weeks, Mackenzie became suicidal.
Speaker 7 (06:47):
It was largely really quite unexplained, and I was really
really concerned.
Speaker 1 (06:51):
She'd initially decided not to go through her regular GP
for OZMPIC, but when her mood shifted, Mackenzie visited her
doctor in person. He told her there'd been a spike
in reports of suicidal ideation linked to OZEPIC. Mackenzie's GP
also explained that because the medication slows the digestive system,
(07:12):
it can negatively impact the way the body absorbs other medications,
reducing their effectiveness or in some cases, blocking them from
working at all.
Speaker 7 (07:21):
It was incredibly scary because it was obviously depression, but
it was not depression I had felt before and the
doctor thinks that's because I was just so intensely coming
off in medication without being weaned off of it.
Speaker 1 (07:33):
It was the first time the twenty six year old
had heard about the risk. Her doctor suggested she stopped
taking ozempic immediately, go to hospital and contact Juniper.
Speaker 7 (07:43):
I essentially sent a message through and said, my doctors
advised me to stop taking this. These were the side effects,
et cetera. And the response was, well, that's not on
the listed side effects. It actually shouldn't affect your absorption
at all.
Speaker 1 (07:55):
Mackenzie said she thoroughly interrogated all the information available to
her through resources.
Speaker 7 (08:01):
No, I actually didn't say anything to do with mental health.
That wasn't mentioned on anything that consumers at least could
read that it would possibly reduce the absorption of medication
or anything like that. It did reduce the amount of
food noise, It did help me lose weight. But then
on the flip side, the side effects are so significant
that I would never do it again.
Speaker 3 (08:22):
We'll be back with more of today's episode right after this.
Speaker 1 (08:26):
Juniper disputes any relationship between these medications and an increased
risk of mental health related side effects. Its clinical director,
doctor Matt Vickers cited specific guidance from the UK Health
Regulator to TDA, which stated in September twenty twenty four
that the available data does not support a causal association
(08:47):
between GLP ones and suicide, suicidal ideation, self injury, and depression.
Vickers also pointed to similar findings detailed in a January
twenty twenty four update from the US Food and Drugg
Administration the FDA, which quote did not find an association
or clearly demonstrated relationship between GLP ones and the occurrence
(09:08):
of suicidal thoughts or actions. However, an analysis of adverse
reactions within the World Health Organization's Global database paints a
different picture. Findings from an international study published in August
twenty twenty four identified a quote disproportionate link between suicidal
(09:28):
ideation and semiglutyites, a type of GLP one. Considering this,
we took a closer look at the research cited by Juniper.
The data from the FDA, it quoted comes from the
preliminary evaluation of an ongoing study. Due to limitations in
the scope of reporting and research in this space, the
FDA conceded more clinical trials are needed and that a
(09:52):
quote cannot definitively rule out that a small risk of
suicidal ideation associated with GLP ones may exist. It said
it's continuing to look into the issue and will communicate
final conclusions and recommendations after it completes its review. Juniper
rejects claims it has failed in a duty of care
to patients and maintains there is no major known risk
(10:16):
of suicidal ideation as a side effect of the weight
loss medications it prescribes.
Speaker 3 (10:21):
However, Vickers said we have.
Speaker 9 (10:23):
One patients who have comorbid mental health conditions about the
possibility of low mood symptoms or deterioration, and to seek
support if they are concerned.
Speaker 1 (10:32):
Juniper also says it has appointed several specialist staff with
mental health training and continues to screen patients extensively for
mental health conditions. Advice from the Therapeutic Goods Administration the
TGA for Munjarro notes the medication can impact the absorption
of certain other specific drugs, including the oral contraceptive pill,
(10:56):
but there is no advice cautioning the use of Munjarro
or we gow with antidepressants.
Speaker 3 (11:01):
Juniper said it's unclear where that.
Speaker 1 (11:04):
Leaves patients like McKenzie, who's lived experience with ozembic, contrasts
the clinical evidence in forming Juniper's current processes, processes which
she argues are not airtight.
Speaker 7 (11:17):
I think it would be very easy to be dishonest
on they ask you your height and your weight and
do no kind of verification. And I mean, in my case,
I was telling the truth, but I think it would
be very easy to omit certain things or change certain
numbers without any kind of formal verification of that.
Speaker 1 (11:33):
Juniper now requires users to upload photos of themselves, and
the provider insists it verifies patient information through multiple methods,
but it did not explain to TDA how or if
it checks images for signs of manipulation or distortion. Juniper
says TGA regulations mandate a minimum BMI and health related
(11:54):
weight condition in order to prescribe someone weight loss medications.
Body mass index or BMI is a traditional diagnostic tool
used to measure obesity. While its relevance and accuracy have
been called into question, BMI is still widely used by
healthcare providers across the board today. Juniper also told us
(12:14):
if a practitioner is uncertain about a patient's true BMI,
they have several options available to them, including converting a
phone consult to a video call, requesting a patient to
have their weight verified at a local GP clinical pharmacy,
or they can decline to prescribe medication to a patient.
That being said, Juniper did not provide any further detail
(12:35):
to the Daily OS on the frequency with which these
channels are or aren't being utilized. Sarah was prescribed weight
loss medication through Juniper when she was twenty four.
Speaker 6 (12:47):
I just kind of became really fixated on how much
weight I was losing. So I was weighing my stylef
like two or three times a day, and it really
turned into a bit more of probably an eating disorder.
Speaker 1 (13:02):
When she wanted to cancel her subscription, she said, Juniper's
follow up marketing made it really hard to walk away.
The provider sends regular emails and text messages to its
future and former patients with limited time offers and discount
codes to encourage them to either start using Juniper or
come back to it.
Speaker 6 (13:21):
I work in marketing, so I was like, you know,
they're really really playing to your weaknesses here. I still
get targeted with their ads insanely. It's all very on
the nose for.
Speaker 1 (13:31):
Me if you're already in a vulnerable spot. Sarah thinks
Juniper's approach to marketing could be detrimental to some patients.
This includes a Juniper Facebook ad showing what looks like
a real conversation between two Facebook users.
Speaker 10 (13:47):
One says, anyone actually saving money since starting medical weight loss?
I am spending so much less on food.
Speaker 3 (13:55):
In reply, another commenter says my monthly takeaway bill was
more than I'm saving money.
Speaker 1 (14:02):
We asked Juniper about this Facebook ad, including whether it
was a real conversation between two users and why it
chose to promote saving money on food as a benefit
of weight loss medication. In a statement to TDA, Juniper
defended the ad, which it said, quote depicts an exchange
(14:23):
which was inspired by real conversations between members of the
Juniper online community. To protect the privacy of those members,
it said, we did not use their actual words or names,
but instead reflected their expressed sentiments in a paraphrased manner.
The platform describes saving money on food as a quote
genuine benefit experienced by Juniper's patients and a legitimate angle
(14:48):
to canvas in Juniper's messaging. The provider's comments did not
clarify whether the Juniper's marketing strategy is in alignment with
the latest harm minimization advice from.
Speaker 3 (14:59):
Eating disorder ex experts.
Speaker 1 (15:01):
It raises questions about Juniper's overall marketing strategy, including how
it engages with prospective customers. For example, anyone can enter
their details in Juniper's initial online screening questionnaire, so to
find out more, I took the quiz myself. Now I'm
someone who is in a quote unquote healthy bear my range,
(15:23):
and after completing the questionnaire, I was told great news,
I could lose ten kilos in four months with Juniper's
weight reset program. With this news, I was shown a
personalized graph with my projected weight loss trajectory. To go
any further, I'd need to speak to a Juniper practitioner,
and that would involve paying a refundable deposit. I left
(15:47):
it there for a few weeks, but after several follow
up emails, text messages, promotional offers encouraging me to take
the next step, I eventually paid a deposit and booked
in a phone consult From there, a Juniper nurse told
me that I was below the provider's minimum BEMI threshold
and was never actually eligible for treatment from the graph,
(16:09):
I was shown to the promotional emails and texts that
I received afterwards. Eating disorder experts worn this type of
promotion can be highly triggering and exacerbate feelings of body dissatisfaction.
So why does Juniper continue to heavily market its weight
loss program to patients who are within a healthy BMI range,
(16:32):
who it knows it can't prescribe medication to.
Speaker 3 (16:36):
We asked the provider about this directly.
Speaker 9 (16:39):
It said, we accept tda's concerns in relation to this
specific graph and are in the process of amending it
so that it does not display an initial weight which
falls within a healthy BMI range.
Speaker 1 (16:51):
Kate is a healthcare professional and an ex Juniper employee
who shares the concerns raised by people like Sarah and McKenzie.
Speaker 10 (16:59):
A lot of folks was placed on meeting KPIs for
prescribing ozempic and eventually munjaro. One nurse practitioner was prescribing
one patient ozempic or munjaro every thirty seconds within their
designated shift, which is hardly enough time to ask the
required screening questions. It felt misaligned with providing quality patient
care in a safe way.
Speaker 1 (17:20):
Kate says, as ozepic became more talked about in media
and pop culture, Juniper customers started coming forward with concerns
about side effects.
Speaker 10 (17:28):
We had a lot of scared customers reaching out and
information fed back to them by staff that I feel
was deceptive or not the whole truth. We also had
dietitians encouraging calorie counting, which concerned me greatly.
Speaker 1 (17:40):
Staff concerns were dismissed, she claims. Kate also alleges workers
were discouraged from sharing information with community gps about patients
they may have had long standing relationships with, and says
the company cut ties with external health care providers who
voiced their concerns about patient care.
Speaker 10 (18:00):
Plethora of issues that were coming through won't being addressed.
Speaker 1 (18:02):
Kate claims staff were inundated with daily reports from patients
about mental health concerns and eating disorders, the scale of
which was downplayed by Eucalyptus, the company behind Juniper. She says, However,
Eucalyptus called this suggestion wildly inaccurate. It argues all clinicians
at Eucalyptus are well equipped to handle all patient concerns
(18:27):
in many instances, Kate said high risk cases were being
handled by pharmacists and general nurse practitioners who didn't have
the training and qualifications to do so. The company has
defended the capabilities of its staff to TDA, Although current
practices at Eucalyptus might not fully reflect the processes that
were in place when Kate worked there, Juniper's clinical director,
(18:51):
Doctor Matt Vickers.
Speaker 9 (18:52):
Said nurse practitioners are specialist nurses have typically practiced for
at least ten to fifteen years.
Speaker 1 (18:59):
These providers are accredited by the Nursing Board of Australia,
which permits them to prescribe any medications which fall within
their scope of practice. Doctor Vickers said Eucalyptus nurse practitioners
are required to undertake additional training when they're hired to
ensure they are adequately experienced in weight management prescribing. During
(19:19):
her time at Eucalyptus, Kate also alleges that vulnerable patients
did not receive prompt follow up care.
Speaker 10 (19:26):
We had one concerned mother email us about her son
as he had a history of suicidal ideation and he'd
been able to purchase multiple quantities of ozambics somehow through
our service. She was worried he would overdose on his medication.
I was told not to engage with the mother as
she was not a customer, and instead reach out to
the sun.
Speaker 1 (19:45):
She described instances where staff were discouraged from escalating an
issue to emergency services, or an instance when staff reached
out to a patient on their personal phone to conduct
an after hours welfare check themselves.
Speaker 10 (19:58):
I was given very little a sistance or support to
deal with these situations in a safe way.
Speaker 1 (20:03):
Doctor Matt Vickers strongly rejects these allegations and said the
company has clear internal benchmarks which are regularly audited to
ensure prompt follow up for all patient concerns, with the
most serious inquiries requiring the fastest response. On the last episode,
we spoke about GLP ones Wegovi and Munjaro, which were
(20:25):
developed in response to a global shortage of ozepic, a
medication originally developed for type two diabetes management. During that shortage,
Kate claims Junipus stockpiled ozepic supplies.
Speaker 10 (20:38):
Kate says this was openly bragged about a company wide meetings.
Speaker 1 (20:42):
At the time, the Therapeutic Goods Administration advised prescribers not
to start new patients on ozepic, with supplies to be
conserved for type two diabetes patients who have no other
treatment options. According to the latest TGA update, ozepic supply
issues are expected to continue new throughout twenty twenty five.
(21:02):
Juniper rejects claims it hoarded ozempic supplies and said the company.
Speaker 9 (21:07):
Did not stockpile semaglue Tarde, but worked with a network
of pharmacies to maintain continuity of care for its patients.
Speaker 1 (21:13):
Kate's o Zeenpic stockpiling allegation relates to a time before
the advent of popular alternatives like WEGOVY and Munjaro. Australian
Medical Association Chair of Public Health, doctor Michael Bonning says
these newer GLP ones have eased some of the pressure
on supply chains and.
Speaker 5 (21:30):
Doctors prescribers have felt a bit more comfortable using that
for making sure that they're not ending up with people
or diabetics who are missing out on what is a
real blockbuster drug for diabetes.
Speaker 1 (21:42):
While the ozepic shortage presented challenges for prescribers everywhere, Juniper's
treatment program now centers around wegov and Munjaro treatments. It
says its partner pharmacies currently have in stock and.
Speaker 3 (21:56):
Available next time.
Speaker 1 (22:00):
I'm on the final installment of Investigating Ozmpic. How has
the popularization of weight loss medication impacted the way young
people think about themselves health and body image.
Speaker 10 (22:11):
A lot of people look up to these celebrities, especially
young women.
Speaker 2 (22:15):
I think that means that a lot of young people
will think that when you're skinny, you're healthy.
Speaker 1 (22:20):
How have these medications shifted conversations around obesity treatments and
diet culture.
Speaker 2 (22:26):
If you take this drug, you are frowned on for
cheating and stealing it from diabetics. If you don't take
this drug, then you're frowned on for not taking the
options that are available. So I feel like it's a
situation where you can't win.
Speaker 1 (22:42):
If this episode raised any issues or concerns for you,
help is available twenty four to seven through Lifeline on
thirteen eleven fourteen. For eating to sort of support, you
can contact the Butterfly Foundation on one eight hundred eedy hope,
that's one eight hundred double three four to six se.
Speaker 3 (23:07):
My name is Lily Maddon and I'm a proud Arunda
Banjelung Calcuttin woman from Gadighl country.
Speaker 8 (23:13):
The Daily oz acknowledges that this podcast is recorded on
the lands of the Gadighl people and pays respect to
all Aboriginal and torrest Rate island and nations.
Speaker 3 (23:22):
We pay our respects to the first peoples of these countries,
both past and present.
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