Nancy Glick

The Dangerous Market for Unapproved GLP-1 Medications and Research-Grade Peptides: It’s Time for Social Media Platforms to Step Up

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By Nancy Glick, NCL Director of Food and Nutrition Policy

The American frontier between 1865 and 1890 was called the “Wild West” —a vast, untamed region lacking government control, formal infrastructure, and reliable law enforcement. It flourished during the gold rush when outlaws and vigilantes roamed freely.

Now a modern-day Wild West has emerged, fueled by a new gold rush and weak government controls. But instead of sparking gunfights between settlers and cattle herders, this Wild West puts public health at risk by feeding an unregulated online marketplace selling unapproved GLP-1 drugs and other substances that can cause serious harm, even death.

One of the most visible parts of this market is a large exploitative online trade in unapproved compounded GLP-1 weight-loss drugs. It emerged in 2022, when shortages of semaglutide and tirzepatide triggered FDA rules allowing compounding pharmacies to produce “non-identical” versions that were not FDA-approved. Seeing the profit potential, compounders turned inexpensive raw active pharmaceutical ingredients (APIs) into monthly injectable products, while telehealth companies and other sellers marketed them aggressively as cheaper alternatives with the same safety and efficacy as FDA-approved branded medicines.

By 2024, nearly one in three consumers taking a GLP-1 weight loss drug said they were getting the medicine from a compounding pharmacy. This prompted the National Consumers League to issue a national alert relaying FDA’s warning that compounded GLP-1s are not tested, reviewed, or approved by the FDA and may cause dosing errors or exposure to the wrong ingredients.

A year later, the national shortage of semaglutide and tirzepatide ended, and the FDA gave compounders until May 22, 2025, to stop selling their mass-produced compounded versions. Instead, compounders created a workaround to stay on the market, selling new formulations as “personalized” compounded GLP-1 drugs as microdoses and GLP-1s with added ingredients, like Vitamin B-12. However, these formulations were never tested in large clinical trials and have caused side effects, prompting NCL to issue a second alert summarizing the serious safety risks, including substandard drug potency, bacterial contamination, potentially harmful impurities, patient harm, and even death.

Yet, the exploitative market for unapproved compounded GLP-1 drugs is thriving, which is why the FDA has issued dozens of warning letters to online vendors making misleading equivalency or safety claims about these products. In April 2026, the FDA issued a proposed rule to exclude three GLP-1 drugs – semaglutide, tirzepatide, and liraglutide – from what is called the 503B bulks list. This development is significant because the rule makes clear that compounding is intended for limited purposes, not the permanent sale of mass-produced alternatives to FDA-approved medicines.

However, even with these developments, a new danger has emerged. The same regulatory loopholes that enabled the mass marketing of compounded GLP-1’s are now fueling the Wild West – a lucrative underground marketplace where “gray market vendors” sell consumers the active ingredients for semaglutide and tirzepatide and “research-grade” experimental peptides that are banned in Canada, Australia, the European Union, and by the World Anti-Doping Agency.

Gray markets refer to approved drugs being sold outside of legal channels, but this Wild West is also a black market selling unapproved drugs illegally. This is what has occurred with retatrutide, a potent weight loss drug currently undergoing clinical trials and not approved anywhere in the world, where cheap, illegal counterfeit versions sourced primarily from Chinese manufacturers are sold to consumers online in powdered form with dosing instructions.

Because black market drugs come with no guarantee of quality, purity, or dosing accuracy, global health bodies warn that knockoff retatrutide may contain substituted chemicals, toxic impurities, or completely different active compounds, resulting in serious adverse effects. This was confirmed recently when CBS News found that health problems reported to America’s Poison Centers about retatrutide surged to an average of 95 cases per month in early 2026, a 265% increase from late 2025.

Moreover, in June 2026, health authorities in Australia issued an urgent alert after multiple users of black-market retatrutide suffered from acute liver failure, major kidney injuries, and life-threatening changes in heart rate, with investigators raising the possibility that contaminants were responsible. This prompted NCL to issue a third safety alert, relaying the warnings from the FDA, the American Medical Association, and global health bodies that self-injecting research-grade peptides and experimental retatrutide is dangerous.

But warnings are insufficient to address this serious situation. While deceptive advertising of compounded GLP-1 drugs is rampant and out in the open, raw compounds and unregulated peptides are marketed through informal online channels, such as chat rooms and social media platforms, and users rely on social media tutorials and influencers for advice on where to buy the peptides and how to self-administer them. Thus, it is time to focus on social media platforms as a conduit fueling the gray and black markets for unapproved GLP-1 drugs and research peptides sold outside regulated medical channels.

Already, a November 2025 Reuters report brought to light how Meta generated roughly
$7 billion in annualized sales from so-called “higher risk” scam ads and allowed AI-generated misleading marketing of weight loss products on Facebook, Instagram, and other Meta platforms that violated Meta’s policies for fraudulent content. But Meta is the tip of the iceberg. Across platforms such as TikTok, Instagram, YouTube, Telegram, and Discord, unapproved and potentially harmful peptides are being promoted as shortcuts to weight loss, body enhancement, and longevity.

Demonstrating the extent of the problem, a study published in JAMA found more than 130,000 Instagram posts and over 230 million TikTok views of content promoting illicit injectable peptides as of May 2026. This is significant in light of a May 2026 study conducted by Sunlight, a telehealth company, which found that nearly half (45 percent) of peptide users purchasing these compounds via social media required treatment at a hospital emergency room due to experiencing severe reactions.

Of equal concern, Eli Lilly and Company, the company conducting clinical trials to bring retatrutide to market, has reported to regulatory authorities more than 14,000 websites, advertisements, social media posts and product listings that unlawfully market retatrutide in over 100 countries via internet service providers, social media platforms, and e-commerce companies. The company’s warning – that the so-called retatrutide now being sold on the black market is not a medicine but an unverified, risky substance – is playing out in reports of people being seriously harmed. For example, in mid-September, Australia’s Therapeutic Goods Administration revealed that a patient suffered a torn esophagus after using an unapproved weight loss peptide labeled as retatrutide.

The good news is that the FDA is acting against online sellers of illicit weight-loss drugs, including retatrutide. But the scale of the problem requires a coordinated response from the FDA, Federal Trade Commission, customs agencies, and state and federal law enforcement, as well as action by social media platforms to stop facilitating gray- and black-market sales of potentially unsafe, unapproved drugs.

To that end, NCL joins the patient safety community in urging social media platforms to be part of the solution. This means working with agencies like the FDA and state attorneys general to share intelligence and to take proactive steps, such as using proactive AI detection, banning coded terms used to promote illicit products, blocking searches for unapproved compounds, and permanently banning sellers who advertise gray- or black-market drugs and redirect buyers to encrypted messaging apps to complete illegal sales.

LIV Golf Schadenfreude

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By NCL CEO, Sally Greenberg

I read a headline today that I found very satisfying – and I felt bad that it made me happy.

“LIV Golf has filed for Chapter 11 bankruptcy protection. It is $500 million in debt, part of its goal to revive the league without Saudi funding.”

What I was experiencing was classic schadenfreude, or “feeling pleasure or joy or satisfaction when something bad happens to someone else.” But I believe that in this case, it’s deserved.

I took the Saudi invasion of US golf personally. I love the game:  I love to play, watch, and I love going to tournaments – seeing golfers’ perfect shots up close is thrilling.

Some context. In June 2022, the Saudi government announced they would launch a men’s golf league to compete with the PGA. LIV promised to pay nine-figure signing bonuses to lure away top names from the men’s tour. I was disgusted that so many pro golfers let greed lure them, including top player Phil Mickelson, who acknowledged that the Saudis threw gay men off buildings and murdered a Washington Post journalist. Still, he was signing with them anyway. “used words I sincerely regret” in a recently published interview in which the six-time major winner described the Saudi regime as “scary motherf******” and brushed aside known human rights violations, including the murder of journalist Jamal Khashoggi.

What does LIV pulling the plug have to do with US consumers? Well, power and money are corrupting influences – it showed up in LIV golf, and it shows up in US elections and with the explosion of billionaires in the US – which now has a record 989 billionaires according to the Forbes Billionaires List. Many of the super-rich are using their money to try to buy elections – Elon Musk poured $291 million into Republican candidates, political action committees, and other outside spending organizations in the 2024 election cycle. And Musk was not alone, according to analysis by OpenSecrets.

The other top six political donors gave $100 million or more, and all supported Republican candidates and causes.

The big money far more often goes to candidates who support weakening safety, environmental, and financial regulations, none of which is good for consumers. And controlling content on their tech platforms and resisting regulation for privacy, allowing blatant fraud, violent and hateful messaging, and because it attracts more eyeballs, resisting the call to take it down.

Back to LIV golf collapsing. When in 2022 the Saudis poured billions into US golf and tried to steal the sport with their riches, it seemed like a reiteration of what we are seeing across America –and that is not good. But now LIV has collapsed, and the players who fell for the promise of many millions are now “creditors”. Ie., they will never see the millions they were promised and now have to crawl back to the PGA and hope they can get back on the tour.

Unlimited riches – like what the Saudis have and so too almost a million US billionaires – are dangerous for democracy. But sometimes the bottom falls out even for them. Call it gloating, call it schadenfreude. Either way, it feels like justice.

This Labor Day, Remember the Women Who Fought for the 40-Hour Workweek

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By NCL CEO Sally Greenberg

Labor Day 2026 is around the corner, and fittingly, I was asked this week to join an important discussion about “Responsible Purchasing Practices,” hosted by the Fair Labor Association (FLA), on whose board I serve. It may sound like a niche topic, but the issue is anything but: for generations, workers have been pushed into exploitative conditions to meet relentless demand for goods.

Unrealistic deadlines, last-minute changes, low prices, and production demands can put enormous pressure on the factories and workers who make our products. Children too are often exploited in the supply chain, with low wages, forced labor, hazardous work conditions, and human trafficking.

Florence Kelley, NCL’s esteemed first General Secretary appointed in 1899, made responsible purchasing practices an issue early on. One example is her work with Edward Filene of Filene’s Department Store to encourage shoppers to buy not 2 days before the holidays but weeks before. They launched the campaign because workers – often shopgirls as young as 10 and 11 – could typically be required to work 12 hours a day or more behind counters until late in the evenings, especially during holiday crunch season.

The Filene’s campaign was launched decades before the adoption of the U.S. Fair Labor Standards Act of 1938, which Frances Perkins, who was an acolyte of Florence Kelley and in 1932 became the Department of Labor Secretary under FDR, brought to fruition. The FLSA gave us maximum-hours laws, minimum wages, banned child labor, and required overtime pay beyond a 40-hour week. Ten and 12 hour days were not unusual, and often people worked 6-7 days a week. I talked about this fact on the panel this week – for 88 years, American workers – with a few categories unfortunately carved out and still lacking protections – have enjoyed the benefits of a 40-hour workweek. Workers around the world deserve the same.

The FLA’s program on Responsible Purchasing Practices shows that good RPPs remain a critical concern for workers around the globe – especially those who don’t enjoy broad labor law protections. Without limits on the demands manufacturers and retailers can make on workers to produce around the clock, suffering, exploitation, and misery will surely result.

The FLA is distinctive as a multistakeholder 501(c)(3) organization, bringing together universities, manufacturers, civil society organizations, and other stakeholders to advance laws, policies, and practices that promote safe and ethical working conditions. Responsible Purchasing Practices are central to that mission.

Florence Kelley understood that consumers also have a role to play in demanding decent working conditions for the people who make the goods they buy. When Filene’s and the National Consumers’ League launched their campaign, a central goal was to build that consumer awareness.

As significant as the Fair Labor Standards Act was for workers, NCL has spent decades working to close a major gap in its protections: the exemption affecting children who work on farms alongside their parents. In some states, that exemption can result in children working seven days a week without a guaranteed day of rest.

Poverty was—and remains—a major driver of child labor around the world. Early reformers understood that simply removing children from the workplace was not enough; families often depended on their earnings. Philanthropists therefore stepped in to help replace that lost income, making it possible for children to remain in school rather than at work.

That history helps explain why responsible purchasing practices matter today.

Consumers may see only the finished product on a store shelf or delivered to their homes. But behind every product are workers whose time and labor made it possible. Companies therefore have a responsibility to ensure that their purchasing practices do not encourage excessive overtime, unsafe conditions, or the erosion of basic labor standards.

More than 125 years after NCL was founded, the principle that guided Florence Kelley and Frances Perkins remains central to our work: consumers, companies, and policymakers all have a role to play in building an economy that respects workers and their rights.

We should also remember that the protections many workers enjoy today were hard-won. The eight-hour day, the 40-hour workweek, overtime protections, and restrictions on child labor did not simply appear. Generations of workers and reformers fought for them, often in the face of powerful opposition.

That struggle continues around the world. We are encouraged by recent progress in Mexico and Chile. Mexico recently enacted a constitutional amendment reducing the maximum workweek from 48 to 40 hours, with the reduction to be phased in between 2027 and 2030. Chile, meanwhile, is already implementing its own 40-hour workweek law. The maximum ordinary workweek fell from 44 to 42 hours on April 26, 2026, and will decline to 40 hours in 2028.

Labor Day reminds us not only of what workers have achieved, but also of how much work remains. Hundreds of millions of workers around the globe still lack meaningful protections, and Responsible Purchasing Practices are one important tool for addressing persistent labor abuses.

This Labor Day, let us celebrate American workers while remembering Florence Kelley, Frances Perkins, and the modern-day organizations—including NCL and the Fair Labor Association—that continue the fight for decent work, fair treatment, and meaningful protections for workers everywhere.

It’s Time to Regulate Big Data: An Argument for Privacy in the Information Age

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By Margaret Peterman, NCL Summer Communications Intern

How comfortable are you with someone seeing your purchase history? What about who you voted for? Your health data? Browsing history? Location?
If any of those questions made you anxious, it may be disturbing to realize that just about anyone can access your personal information—including minimally regulated data brokers who sell your information to private corporations and government agencies.
Data brokers are organizations that collect and sell consumers’ personal information to third-party groups—major brokers include LexisNexis, Experian, Acxiom, and Oracle—for use in marketing, political campaigns, and even government investigations. These organizations gather all kinds of data, from contact and demographic information to precise geolocation data and browsing history.
As a result of mass data collection, data brokers and online platforms have unprecedented levels of control over what consumers see and purchase online. Thousands of the online ads Americans see daily are shaped by complex data profiles built from consumers’ social media pages, browsing and click history, location data, and demographics. Even consumers’ most personal and private behaviors are being shaped by data collection. In 2022, Pray.com came under fire for sharing users’ personal prayers with third-party sources and advertising agencies, ensuring that even prayer is not excluded from a consumer’s data profile.
Consumers’ data is even used to shape access to certain programs or even price health insurance policies. In 2019, the Department of Housing and Urban Development sued Facebook for violating the Fair Housing Act by determining which users could see housing-related ads based on their race, religion, and nationality. In 2013, the Federal Trade Commission sued Equifax for selling consumer credit scores and mortgage information to companies advertising potentially predatory and fraudulent loan services. Insurance and actuarial companies use consumer data to create health risk profiles—inferred from what consumers wear, when they pay their bills, and what they post on social media, not actual health data.
AI has further complicated data privacy concerns. A growing number of Americans are relying on AI for daily use, and nearly three-quarters of businesses have adopted some form of AI technology in the workplace. But AI has not been a champion of data privacy. Users’ chats are funneled into models to train chatbots further. Countless musicians, programmers, authors, and news outlets have sued AI companies for using copyrighted work without consent. Generative AI chatbots like Anthropic’s Claude, OpenAI’s ChatGPT, and X’s Grok have all published user chats including personally identifiable information (PII) like phone numbers, emails, and healthcare data.
So why should we care about data privacy? After all, in an increasingly digitized society, it’s hard to fathom a world where we have control over our own data.
Data privacy is closely tied to protecting consumers’ rights. Advertising agencies represent a significant portion of data brokers’ clients, making up nearly 40% of the market share. When consumers see ads tailored to their personal preferences, they are far more likely to buy the advertised products or services. As targeted ads grow more specific to a consumer’s data profile, consumers are slowly deprived of their right to make independent choices in the marketplace.
Data privacy is also part of the larger debate over individual privacy in a post-9/11 world. Even with guarantees against domestic surveillance outlined in the Foreign Intelligence Surveillance Act and the Electronic Communications Privacy Act, “data broker loopholes” allow federal and state government agencies to purchase bulk data from brokers and social media sites for immigration enforcement, criminal investigations, and surveillance of protestors.
In the past few years, several state governments have passed laws attempting to rein in consumer data collection. Regulations like California’s Delete Act are promising on paper, but it remains to be seen how effective these laws will be in practice. A recent Stanford study found that only 9% of eligible data brokers were in compliance with California’s data privacy legislation nearly three years after its adoption. Hundreds of brokers have failed to register with state consumer protection agencies, violating multiple state laws and making it difficult to understand the role data brokers play in consumers’ lives.
It is now clear that the U.S. needs a national privacy guarantee. For too long, government, healthcare, and advertising organizations have utilized Americans’ data to build personalized, error-prone, and invasive data profiles at the expense of consumers. Without meaningful federal oversight, data brokers run roughshod over consumers’ rights. Congress and state governments need to prioritize consumers’ privacy rights and pass legislation that protects consumers from, and makes them aware of, predatory data-collection practices.

Fill it Up and Scale it Back: Consumer Spending in the Post-Hormuz Economy 

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By Claire Leadman, NCL Summer Communications Intern
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On February 28th, when Iran closed the Strait of Hormuz, the average cost of gas was $2.98 a gallon. Six months later, in August, that rate increased nearly 34.5% to an average of $4.01 a gallon nationwide. Without President Trump having reached a deal that guarantees price decreases anytime soon, consumers are searching for any and all ways to alleviate the impact of rising costs.

As a college student with friends who live all over the country, I try my best every summer to plan a trip to see at least one of them. This summer, that came with an extra challenge. When I first started looking at flights, I knew off the bat that seeing my friends in Europe or on the West Coast was out of the question. After turning on my Google Flights price tracker notifications and comparing all my options, I settled on visiting a friend outside of Boston. From DCA to BOS, I was used to a round-trip ticket costing around $180. Compared to the $325 ticket I ended up purchasing, it was clear that I hadn’t adjusted my expectations to the current cost of travel.

For most Americans, gas is not an optional expense. With the stark increase in fuel prices, alongside relatively static incomes, households have been forced to adjust their habits at the pump to stick to pre-existing budgets.

According to a report by the Associated Press, members-only retailers such as Costco, Walmart’s Sam’s Club, and BJ’s Wholesale Club have seen an increase in traffic at their gas pumps, where fuel prices are typically lower than at independent gas stations. Not only has the price of gas influenced where consumers are filling their tanks, but also how they are doing so. Costco Chief Financial Officer Gary Millerchip noted a pattern of customers coming in to “top up in between what would have normally been a gap between getting the tank to empty,” reflecting the anticipation of price increases.

When looking at the Consumer Price Index (CPI) for July 2026, I was surprised to see that prices were relatively stable. Although the CPI rose .1% over the prior month, I had anticipated seeing prices of groceries, healthcare, housing, and other categories skyrocket – which was simply not the case. Instead, those categories showed far more modest changes than I anticipated. One notable exception that has been most heavily impacted by the surge in gas prices is the cost of air travel. Over the past twelve months, the CPI increased 3.4% across all items, while airline fares rose sharply, increasing 25.5% from July 2025.

Consumers who save all year for their summer vacations have been forced to adapt their plans as airfare prices surge, particularly for international travel. Since the Strait of Hormuz was closed, jet fuel prices have spiked 50%, significantly increasing airlines’ operating costs. That surge in jet fuel costs is the primary factor behind the 25.5% increase in airline ticket prices.

During the summer months, people are more eager than ever to use their PTO – whether that means relaxing on the beach, exploring a new city, or visiting family that lives far away. Despite the rising cost of travel, consumers have not stopped traveling altogether; rather, they have adapted their plans to fit the current economy. Travel remains a priority for many, but people are being forced to scale back their travel plans to stay within their budgets. NPR’s Stephen Basha spoke to a travel agent who reported a 10.5% decrease in fall bookings, along with a clear avoidance of “long-haul, far-off destinations”. Alternatively, spending on travel has pivoted towards more budget-friendly options, such as staycations and trips to nearby destinations.

As the summer ends and travel begins to slow for many consumers, the impact of the war in Iran and the subsequent increase in gas prices will continue to influence household spending well beyond travel. Although the rise in costs has been less abrupt in other categories, prices for groceries, retail goods, healthcare, and transportation continue to fluctuate and remain elevated. Consumers will be forced to meticulously plan and shift their budgets and lifestyles to account for the higher cost of living.

Uncertainty related to the trajectory and timeline of the war in Iran leaves consumers in the dark as to the future of prices. Until the Trump administration agrees to a deal with Iran that has the support to move forward, uncertainty is likely to persist, making the outlook for inflation, consumer spending, and the broader economy difficult to assess.

Nancy Glick

New Food Policy Reforms Are a Step Forward for Consumers

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By Nancy Glick, Director of Food and Nutrition Policy

In casual speech, geologic time is a way of describing an excessively long, painfully slow process of change. It is appropriate to describe how long it has taken the Food and Drug Administration (FDA) to issue a proposed rule to strengthen the agency’s oversight of food ingredients determined to be “Generally Recognized as Safe” (GRAS).

Going back to the Food Additives Amendment of 1958, Congress established a mandatory pre-market approval process under which manufacturers must submit safety data to the FDA before a new additive may be used in food production. At the same time, Congress recognized the need for a statutory carve-out for common, time-tested ingredients like salt, vinegar, baking soda, and flour and created the “Generally Recognized as Safe” provision for substances widely understood by qualified experts to be safe under their conditions of use. Thus, in December 1958, the FDA published the first GRAS list in the Federal Register, and soon hundreds of traditional ingredients received GRAS status.

Yet there were problems with the GRAS carve-out from the start. The 1958 statute did not lay out exactly how “general recognition” should be proven; the FDA was flooded with manufacturers’ requests for opinion letters on whether their conclusions of GRAS status were justified; and food chemical manufacturers started hiring their own experts to review proprietary safety data and declare a new chemical “GRAS.”

Then, in 1969, the FDA removed cyclamate salts from the GRAS list due to safety concerns, prompting a “comprehensive review” of presumed GRAS substances conducted over many years by an outside scientific body known as the Select Committee on GRAS Substances (SCOGS). By 1982, SCOGS submitted opinions to the FDA on the health aspects of more than 400 substances. At the same time, the FDA established rulemaking procedures for a GRAS affirmation petition process, which allowed companies to assert the GRAS status of a particular use of a substance. Under this framework, the FDA signed off on the GRAS status of numerous ingredients, including canola oil, whey, and cocoa butter substitutes.

However, because the GRAS affirmation petition process was resource-intensive, the FDA sought an alternative pathway and, in 1997, shifted to a voluntary GRAS notification system. In doing so, the FDA unintentionally created the GRAS loophole. This regulatory gap allows food companies to introduce new chemical additives into the food supply without getting approval from, or even notifying, the FDA. For consumers, this means a wide range of food products may contain undisclosed chemicals and alternative proteins that the FDA never reviewed for safety.

How serious is the problem? Reports from independent bodies and consumer and environmental organizations find that the GRAS loophole is overwhelming the food safety system. Specifically:

For decades, the National Consumers League has been advocating for closing the GRAS loophole through reforms that will increase FDA oversight, so food companies can no longer add ingredients without the FDA’s knowledge. And we are far from being alone. In May 2017, the Center for Science in the Public Interest (CSPI) and other public-interest groups filed a lawsuit challenging the FDA’s voluntary GRAS notification rule, first proposed in 1997 and finalized in 2016, as unlawful and undermining the integrity of the nation’s food system. (Sadly, the court sided with the FDA).

Then, in 2025, former FDA Commissioner Dr. David Kessler filed a citizen petition urging the FDA to revoke the GRAS status of refined carbohydrates used in industrial food processing, such as corn syrup, corn solids, glucose syrups, wheat, and corn flour. Dr. Kessler’s petition argues that processed refined carbohydrates can no longer be considered GRAS now that scientific evidence links their consumption to metabolic harm, leading to obesity, diabetes, and cardiovascular disease.

Now, 68 years after the FDA published the first GRAS list, there is potential for meaningful change. On August 10, 2026, the agency issued a proposed rule that would end the voluntary notification system for most GRAS substances by requiring companies to notify the agency and provide details on how the manufacturer deemed the additive “generally recognized as safe.” Manufacturers with GRAS substances already on the market would also need to let the FDA know how the additive is used, information that would be made public in a database of GRAS notices. According to FDA officials, these actions will modernize the GRAS framework, increase transparency, and give the FDA greater visibility into substances entering the food supply.

NCL considers the proposed rule a good start, but along with other advocacy groups, believes that improving the GRAS framework requires more than mandatory notification. For this reason, public health and consumer advocacy organizations will be pressing for guardrails to strengthen the proposed rule, such as a requirement that companies provide the underlying data supporting their independent GRAS conclusion and a premarket approval requirement, so companies cannot sell products with GRAS ingredients before completing the notification process. Other reforms include penalties or sanctions for noncompliance and the requirement that companies conduct post-market reviews of GRAS ingredients.

Complementing these reforms, organizations like NCL are also working to pass the Food Chemical Reassessment Act of 2025 (H.R. 4306), proposed federal legislation introduced by Representatives Jan Schakowsky (D-IL) and Rosa DeLauro (D-CT) that will require the FDA to systematically reevaluate the safety of chemicals added to food and packaging every three years, targeting aging approvals and the “Generally Recognized as Safe” loophole.

After decades of debate, there is broad consensus that the GRAS loophole must be closed for good. Now it is up to those speaking on behalf of consumers to ensure that the FDA’s final rule not only ends the loophole, but adds the regulatory guardrails needed to enhance the safety of the food supply.

 

 

 

AI and Medicine: Promising Future or Dangerous Mistake?

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By Ben Rozner, NCL Summer Communications Intern
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Artificial intelligence has encroached upon every aspect of people’s daily lives; health and wellness is no exception. While it can provide numerous benefits, including the ability to access straightforward medical advice without an appointment quickly, AI is far too prone to mistakes to be fully trusted with your health. Here are five things you should keep in mind when using AI to self-diagnose:
  1. AI is often wrong or deliberately misleading: AI accounts on TikTok that pose as doctors have been gaining millions of views recently, posing a “huge danger to public safety,” according to numerous experts. AI-generated physicians have peddled disproven myths about numerous activities causing cancer and, in some cases, fabricated medical products. Alex Ruani, health misinformation researcher at UCL, called these false claims an “industrialized exploitation of trust,” putting profits and engagement above people’s safety and health.
  2. AI may ignore emergency symptoms: While doctors are trained to ask specific questions that help patients recognize symptoms they might not otherwise mention, AI chatbots focus only on the prompt they are given.
  3. AI does not know your medical history. It does not know what medications you take, what surgeries you have had, or how your body works. AI can be used as a starting point, but it should not be the source of your official diagnoses. Generally, AI can provide surface-level education that a doctor can later clarify and work with.
  4. AI chatbots are not required to protect your personal information: Doctors must strictly follow HIPAA regarding patient confidentiality; AI chatbots such as ChatGPT do not have such restrictions. For example, a newer version of ChatGPT specifically designed to help people navigate health-related questions collects users’ personal information to make more accurate diagnoses and recommendations. While this may mitigate some of the other issues AI faces when giving medical advice, it also puts users at greater risk. Users often upload their entire medical history to these chatbots, meaning that a single cyberattack could expose their most sensitive information to bad actors online.
  5. Your doctor knows best: As mentioned above. At the same time, an AI chatbot can provide helpful answers to basic questions; you should always check with a real healthcare provider before making major medical decisions. Doctors spend years learning how to diagnose and treat patients on a case-by-case basis. AI chatbots cannot give you the same personalized care and attention you need in a medical emergency.
The influence of AI on medicine does not stop at online inquiries. Artificial intelligence is already in your doctor’s office, and it often proves more burdensome than helpful. Doctors have found that AI-drafted patient charts are also riddled with mistakes, forcing them to revise each document manually. According to Sarah Preum, a corresponding author of a recent study on this issue, “AI can sound like a doctor but not think like one.” Importantly, the study found that an AI trained to adapt to individual physicians’ communication styles is more accurate and requires less editing. These AI models could save doctors precious time, but must be under constant scrutiny to ensure that they are safe and unbiased.
AI can provide numerous benefits to the medical sector. A study from Johns Hopkins found that algorithms designed to spot nearly imperceptible variations in medical images may revolutionize cancer screening. Predictive models could warn doctors before a medical emergency happens. AI has already helped researchers identify and create new drugs, vastly reducing the time it takes to develop new vaccines. And while chatbots are not reliable for self-diagnosis, they can serve as virtual assistants, providing helpful instructions to patients navigating a range of medical issues. There are undoubtedly more benefits still to be discovered, yet whether they outweigh the risks will likely remain heavily debated.
​There is no single right way to use AI regarding health and wellness. Whether it is doctors using AI chatbots to streamline the communications process or patients asking important questions they may be too embarrassed to ask their physician, AI can and does help everyone involved. Yet we must not ignore its pitfalls, as the risk AI poses to patient safety and privacy is immense. A single data leak or repeated instances of algorithm bias could put lives at risk in a field that already carries a great deal of peril. If medical professionals fully adopt AI systems, they must be consistently monitored to ensure maximum security for both patients and physicians.
Nancy Glick

Playing Russian Roulette with Food Safety Can Be Very Costly

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By Nancy Glick, Director of Food and Nutrition Policy

The numbers are staggering. The nation is facing the largest cyclospora outbreak in U.S. history, with nearly 23,000 reported (over 10,400 laboratory-confirmed) cases since May 1, 2026, tied to contaminated shredded iceberg lettuce imported from central Mexico. Now traced to 47 states, the outbreak is hitting the Midwest and South hardest, with Michigan, Ohio, and Missouri reporting the largest number of infections.

However, the magnitude of the problem is far greater than the cases reported to date. While the illness caused by the cyclospora parasite is not generally life-threatening, the Centers for Disease Control and Prevention (CDC) classifies cyclosporiasis as a nationally notifiable disease requiring ongoing monitoring. This is because the symptoms of cyclosporiasis – including explosive bowel movements, frequent diarrhea, and vomiting – can last for weeks or months without treatment with antibiotics. And, in young children, older adults, and immunocompromised individuals, cyclosporiasis can be deadly. As of August 2026, there have been over 500 hospitalizations and two reported deaths linked to underlying conditions and severe dehydration.

Yet the most troubling aspect of this outbreak is that the federal food safety system we rely on is falling short. The system was designed to be comprehensive, giving shared responsibility for the safety of our food supply to the Food and Drug Administration (FDA), the U.S. Department of Agriculture (USDA), and CDC. It also involves healthcare providers, hospitals, and laboratories reporting probable cases of foodborne pathogens such as cyclospora to local and state health departments, which in turn voluntarily share the data with the CDC to track, prevent, and stop public health threats.

But in March 2025, the federal government’s investment in the food safety infrastructure started to change. First, USDA terminated two long-standing advisory panels – the National Advisory Committee on Microbiological Criteria for Foods (NACMCF) and National Advisory Committee on Meat and Poultry Inspection (NACMPI) – indicating to consumers that food safety will not be a priority at USDA in the foreseeable future. The agency’s Food Safety and Inspection Service (FSIS) also withdrew a strict rule that would have kept poultry products containing high levels or dangerous strains of Salmonella from being sold.

While USDA was stripping away food safety protections affecting meat and poultry processing, the “Department of Government Efficiency” (DOGE) zeroed in on the CDC, laying off roughly 18 percent of the workforce including eight of the 11 members of the CDC laboratory team specializing in cyclospora outbreaks. This was made worse by the dismantling of the Agency for International Development (USAID) and the loss of experts and labs dealing with diseases like cyclosporiasis in facilities that USAID shared with the State Department and CDC. These reductions, according to health experts, have left the agency under-resourced to handle large-scale monitoring and traceback efforts.

The other injustice also occurred in 2025 when CDC scaled back its Foodborne Diseases Active Surveillance Network (FoodNet), which was created in 1995 to track the top eight pathogens most responsible for the estimated 48 million cases of foodborne illness in the US every year: Campylobacter, Cyclospora, E-coli, Listeria, Salmonella, Shigella, Vibrio, and Yersinia.  Designed as a collaborative effort among CDC, state health departments, USDA, and FDA, FoodNet was considered the backbone of America’s foodborne illness surveillance system for 30 years because it gathered data from clinical laboratories at 10 sentinel sites, estimated the burden of foodborne infections, and guided prevention efforts.

Regarding cyclospora specifically, FoodNet captured infection data across roughly 15 percent of the U.S. population – which would have been valuable in addressing the current outbreak. But, as a budget-saving move rationalized by Administration officials as eliminating duplicative CDC programs, the agency restricted federal monitoring under FoodNet to only Salmonella and E. coli. Thus, the burden for tracking cyclospora and the five other pathogens now falls largely to participating state and local health departments– themselves facing localized funding and staff constraints.

When news of FoodNet became public, NCL spoke out about the potential consequences of this action, calling the measure tantamount to playing Russian Roulette with Americans’ health. We were joined by other consumer advocates, food safety experts, public health leaders and state health departments, all of whom stressed that foodborne disease surveillance is the foundation of our food safety system and requires the expertise, resources and coordination of information and data beyond borders that are beyond the ability of states.

Now, with the cyclospora outbreak, we are witnessing the consequences of not viewing foodborne illness surveillance as a national priority. Because investigators are working with incomplete information, it took six weeks from the start of the outbreak around May 1 for CDC and the FDA to link the source of the parasite to iceberg lettuce imported by Taylor Farms de Mexico. Thus, on July 14, CDC issued a Health Alert Network alert notifying clinicians and public health practitioners about the outbreak and followed on July 17 with a food safety alert warning the public not to eat this lettuce. On the same day, Taylor Farms initiated a recall covering shipments to food service operations like Sysco, restaurant chains including Taco Bell locations, and Marketside-brand products at select Walmart stores in at least 27 states.

However, we are not yet out of the woods. CDC and FDA are currently investigating six separate cyclospora outbreaks not yet linked to an identifiable product; it is unclear which cases across the country are connected, and food safety experts caution that multiple sources are likely contributing to the cyclospora surge. It is an object lesson that food safety requires a coordinated national system staffed by specialists in foodborne pathogens, based on collaboration among local, state, and federal agencies.

Underscoring the need for corrective action, recent polls by Gallup and the International Food Information Council reveal that only half of today’s consumers have confidence in federal food regulation (53%) and the overall safety of the food supply (55%). Even more troubling, a Quinnipiac University poll conducted as cyclospora cases passed 20,000 shows that only 12 percent of consumers express a lot of confidence in the nation’s food safety system while 31 percent express some support but another 30 percent say they have no confidence at all, Also of interest, polls show that Americans favor stronger food safety oversight and, in a 2022 survey, 74 percent said it would be worth a 1 to 3 percent increase in the cost of food to pay for added safety measures.

With this consensus as a starting point, NCL is one of the organizations pressing Congress to fully fund CDC’s foodborne illness surveillance and other food safety programs in the upcoming fiscal year. Recently, we joined with the Consumer Federation of America and 25 other organizations and food companies in sending a letter to the House and Senate Subcommittees on Labor, Health and Human Services, Education and Related Agencies urging Congressional appropriators to provide a 50 percent ($37 million) increase in funding to maintain FoodNet along with other critical problems needed to solve outbreaks. This would bring total funding to $111 million for FY2027, a small price to pay for Americans to have confidence in the safety of the foods we buy and eat.

If there is any good to come from the cyclospora outbreak, it is that we now know food safety cannot be taken for granted. It is a national priority that all Americans should count on.

Prevention Strategies
  • Cook poultry, eggs, and ground meats to safe internal temperatures.
  • Wash produce thoroughly.
  • Avoid raw or undercooked shellfish.
  • Keep perishables refrigerated promptly.
  • Practice safe food handling and cross-contamination prevention.
For detailed, interactive trend data, CDC’s FoodNet Fast tool provides maps, graphs, and tables for each of these pathogens.

The Medical Debt-idemic

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By Moses Boyd, NCL Summer Health Policy Intern

As a kid, I would count down the days until I was an adult. I yearned for freedoms like staying up late and being able to drive. Nothing in my imagination rivaled the maturity, respect, and independence that the milestone promised. Now, as a college student, I realize that the flagship freedoms of adulthood are, in fact, not free.

This discovery is not just a personal one. Balancing finances, building a stable career, and managing personal responsibilities is no easy task for anyone to learn. However, the newest generation to enter adulthood appears to be struggling to an unprecedented extent.

Generation Z, which currently encompasses the young adult population, has been slower to achieve financial benchmarks—such as homeownership or having children—than previous generations. This trend is driven by higher housing costs, stagnant wages, and rising education costs. Although economic inflation and political volatility are burdens affecting Americans of all ages, these challenges weigh most heavily on young adults. With limited work experience and fewer financial resources to absorb unexpected expenses, many members of Generation Z are particularly susceptible to financial instability.

Nonetheless, an often overlooked barrier also undermines Generation Z’s financial well-being—one whose impact, just like its origin, remains relatively hidden from public discussion.

Medical debt.

Nearly 38 percent of adults between the ages of 18 and 34 carry some form of medical debt. Unlike budgeting for groceries or buying a car, medical expenses cannot be adequately budgeted for in the United States. They are the result of a potent combination of unpredictability and systemic complexity. A single injury or diagnosis becomes an ultimatum, forcing young adults to choose between medical care and their livelihoods.

While it is true that Generation Z is the most uninsured generation, medical debt is an issue that extends beyond insurance status alone. Young adults can receive bills totaling thousands of dollars for relatively common procedures, even if they are insured. A Wall Street Journal reporter detailed that after insurance, his out-of-pocket cost for wisdom tooth removal surgery was $7,000—reduced from $10,000 only after negotiating directly with the provider. Although the procedure would have been three times more expensive without insurance, this anecdote nonetheless illustrates an uncomfortable truth: health insurance protects patients from catastrophic costs less effectively than many Americans assume.

Herefrom, two important questions arise:

First—what is so wrong within our healthcare system that this is such a significant problem?

Second—how do we fix it?

While the former question does not have an entirely straightforward answer, one obstacle is clear—our healthcare system is highly fragmented. Healthcare in the United States is achieved through a complex network composed of private insurers, public programs, independent providers, intermediaries, and employers. This structure creates administrative complexity, makes care harder to coordinate, and contributes to our country spending more on healthcare than any other developed nation but yielding worse health outcomes.

This cost is ultimately felt by the consumer and continues to inflate as time progresses. An inability to compare pricing for medical services, predatory insurance practices, inadequate primary care options, surprise events, and a pinch of juvenile naïveté in regard to healthcare forms the perfect recipe for a medical debt-idemic.

One way to help address the medical debt problem is through increased price transparency in the healthcare market. Unlike virtually every other expenditure—such as groceries, clothes, cars, or appliances—it is nearly impossible for consumers to compare healthcare service prices across insurance plans or providers. Consequently, consumers often do not receive the best value care simply because they are not aware that better options exist. By clarifying medical pricing data and cost estimates, information asymmetry dissipates, making healthcare a more economical pursuit through fair competition and predictability.

Namely, requiring hospitals and insurers to publish clear, upfront prices and limiting aggressive debt-collection practices puts consumers themselves in control of the healthcare market. Legislation such as the Patients Deserve Price Tags Act includes such provisions, alongside other common-sense reforms, to increase hospital price transparency so consumers can better understand the price for healthcare services they receive.

Healthcare should not require consumers to become financial experts before seeking treatment, particularly those who are just beginning to navigate adulthood. Generation Z is entering adulthood during a period of extraordinary economic uncertainty; their futures should not be jeopardized by medical debt—especially after surprise incidents. Healthcare is a basic, human need that everyone should be able to access, affordably.

I, and many of my peers, are tired. We do not want to deal with the stress of medical bills piled atop the already-towering mountain of adult life’s pressures. Adulthood is already hard; it should not be made harder by overcomplicated and artificial systemic deficiencies. Put plainly, the medical debt-idemic must end. Ensuring that healthcare is both accessible and financially sustainable must remain a national priority for the sake of both my generation and every one that follows.

The Impact of the One Big Beautiful Bill Act on Healthcare Accessibility Nationwide

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By Moses Boyd, NCL Summer Health Policy Intern

Between 9.9 and 14.9 million—the number of people that could become uninsured as a result of the cuts and work requirements imposed by H.R.1, commonly known as the One Big Beautiful Bill Act.

446—the number of hospitals across the United States that could shut down or cut services due to H.R.1.

One month—the new, shortened period that Medicaid expansion enrollees can receive retroactive coverage for services received prior to the application date (two months for individuals enrolled through traditional Medicaid), which could leave patients requiring care—including pregnant individuals—with considerable out-of-pocket expenses.

H.R.1 represents one of the most substantial changes to the U.S. healthcare system since the passage of the Affordable Care Act in 2010. The law’s provisions restrict access to healthcare for many low-income Americans and communities that rely on Medicaid. H.R.1 limits primary care access, fosters greater health center consolidation, and makes coverage requirements more stringent—all of which jeopardize access to affordable healthcare. As we mark one year since the bill’s passage, it is important to reflect on its impact on American consumers.

One of H.R.1’s most profound effects on the healthcare system is its restructuring of Medicaid eligibility and enrollment. The law sets strict new work requirements on numerous Medicaid beneficiaries, making it increasingly burdensome for low-income individuals to get and retain insurance coverage. This burden is not only felt by those seeking coverage—who must demonstrate compliance with the 80-hour-per-month work requirement or request an exemption when applying for or renewing coverage—but also by state governments, which must now implement systems that comply with those standards or risk losing federal funding. As many of those affected are already working, attending school, caring for family members, or managing health conditions, these restrictions may force them to forgo coverage entirely due to the difficulty in navigating the administrative barriers to maintain it.

Work requirements are far from a novel idea in the realm of Medicaid eligibility. Prior to the passage of H.R.1, 11 states had attempted to implement the practice in their Medicaid programs by applying for Section 1115 waivers—authorizations granted by the Centers for Medicare and Medicaid Services (CMS) which allow states to test experimental changes to their Medicaid programs. Some of these states’ legislatures also introduced legislation directing their Medicaid agencies to pursue and enforce these requirements. Just two out of these 11 states, Arkansas and Georgia, were able to successfully overcome federal lawsuits, court injunctions, and administrative rollbacks that challenged these requirements; only Georgia’s remain in effect. In Arkansas, an estimated 18,000 eligible beneficiaries lost coverage under work requirements because of logistical and reporting challenges—prompting a federal district judge to halt the program.

From this, an important question arises: why are we doing this again if it did not work the first time?

Because Medicaid primarily serves low-income Americans—a population disproportionately composed of people with disabilities, single-parent households, rural residents, and racial minorities—work requirements are likely to exacerbate existing disparities in healthcare access.

When health coverage is lost, even temporarily, patients are more likely to delay care, leading to worsened health outcomes.

Alongside the danger of individuals losing personal coverage, the legislation also raises concerns about the financial stability of hospitals that serve large numbers of Medicaid patients. According to Public Citizen, hospitals at risk of closing serve approximately 6.6 million patients annually and employ over 275,000 workers. As coverage losses increase, hospitals face higher levels of uncompensated care and reduced reimbursement revenue, placing additional pressure on facilities that already operate on narrow financial margins. Communities that depend on rural hospitals and safety-net providers, such as community health centers, are especially affected because these facilities are often the only source of emergency and specialty care.

Economic concerns have already led some health systems to reduce services. For example, MedStar Washington Hospital Center recently announced the closure of a postpartum unit and the elimination of nursing positions, citing financial pressures. In places where these medical centers are a major employer, local employment and industry are also negatively affected. When health systems cut services, consumers are left with fewer options for care and must travel further to see a healthcare provider. During medical emergencies, mere minutes can mean the difference between life and death; for pregnant individuals, a miscarriage, premature delivery, or other complication could be catastrophic. Additionally, because of H.R.1’s narrowing of the retroactive coverage window, such events could leave these patients responsible for significant medical debt if they are unable to apply for coverage in time.

Americans already spend more on healthcare than residents of any other developed nation, yet millions continue to face barriers to obtaining timely care. As more people become uninsured, hospitals and other providers absorb higher levels of uncompensated care, costs that are shifted throughout the healthcare system and ultimately borne by patients, employers, and taxpayers through higher premiums and healthcare costs. At the same time, more uninsured individuals are left to shoulder the full cost of essential medical care, driving increases in medical debt—a uniquely American problem that can damage credit, make it harder to qualify for a mortgage or other loans, and force families to delay additional healthcare and other basic necessities.

One year after its enactment, H.R.1 has become a defining test of the nation’s commitment to healthcare access. The coming years will reveal the full scope of its effects, but the warning signs are already clear. Millions of Americans face new barriers to coverage, hundreds of hospitals face mounting financial pressure, and patients who rely on Medicaid face a greater risk of losing access to care. The true cost of these changes will be seen in delayed care, rising medical debt, and diminished access to healthcare in communities across the country. Ensuring that healthcare remains accessible and affordable must remain a national priority.