I have so many patients struggling with horrible arthritis pain! All the treatments we have either really don’t work well or have side effects, and many times cause more harm than good. I found myself having a risk-benefit discussion with every single patient with chronic pain, and at times, feeling like I was doing more harm than good when trying to help treat the pain.

Patients are taking NSAIDs, and I will watch as their kidney function declines, not to mention NSAIDs actually degrade cartilage in the joint and make arthritis worse over time. Tylenol doesn’t work, and it depletes glutathione levels, which leads to worsening oxidative stress (which we know causes inflammation that leads to chronic disease). Pregabalin and gabapentin have multiple side effects and cause weight gain, so lots of patients trying to lose weight are stalemated on these drugs and dependent on them due to debilitating arthritic or neuropathic pain.

Topical treatments fail or only provide temporary relief. Knee replacements are risky and invasive, and many patients who have had one still had pain afterward. Steroid joint injections degrade cartilage even more, and while they provide some relief, they are just a Band-Aid. Don’t even get me started on how harmful opioids are!

Chronic pain is one of the most common complaints I hear in primary care. Because of this, I’ve spent my career treating pain and trying to find solutions. I served as a chronic pain champion in the VA job I held. I learned and implemented auricular acupuncture. I did training in prolotherapy, platelet-rich plasma injections, and perineural injection therapy. I told my patients to do yoga, massage, physical therapy, TENS therapy, tai chi, music, and art therapy to cope with and manage pain. I treated pain from every angle. Some of it really helped my patients. Some of my patients didn’t respond. They still had debilitating pain that was causing ongoing severe suffering.

Enter peptides

I had a few patients ask me about them. I had no idea what they were. I looked them up. I started looking mainly at BPC-157; studies showed me they had potential for treating chronic pain and a myriad of other conditions. I was already familiar with using other peptides: insulin and the weight-loss GLP-1 peptides.

I read a study in which researchers cut the Achilles tendons of a bunch of rats. Half got nothing and the other half got BPC-157. The rats that got BPC-157 had fully functioning Achilles tendons by the end of a month of therapy. Using this peptide seemed like a no-brainer for my patients, but when I looked for a human drug version, I was disappointed. From what I read, they were “experimental” and not able to be prescribed by doctors. This wasn’t very clear to me, given the results in the scientific studies.

I kept having patients ask me about them, so I looked at what science there was already. I read the anecdotal reports. I started to learn more about what we knew about the drug and the safety data we had. It looked safe on paper, but we didn’t have long-term safety studies in humans for any off-label use. I struggled with whether to dig deeper to learn to use this peptide. Was it ethical? I use drugs off-label all the time, but I had never prescribed a medication that hadn’t been approved for use in humans before.

I looked at the suffering of my patients, and I started asking them what they thought, especially the really sick patients who had trouble walking to the clinic chair to sit and see me. The ones who struggled to get out of bed every day. They absolutely wanted to try peptides. They asked me to dig deeper and figure it out for them. They wanted my honest opinion on whether it was safe.

The danger of research chemicals

I started a deep dive to give them my professional opinion. “Research peptides” ordered online weren’t safe, and the FDA even banned the BPC-157 because of reports of someone ordering a dirty vial online getting meningitis and dying from not safely injecting the medication. Turns out the world of peptide injecting is a multibillion-dollar industry with very little regulation or oversight.

This concerned me deeply. I knew we were losing our patients’ trust, but this whole underground world of peptides proved that patients no longer trusted traditional health care. Patients didn’t care about whether something was approved or not; they wanted to heal. Patients on multiple other medications and supplements trying to inject themselves with a research chemical had the potential to be extremely dangerous.

I kept digging. I learned more about peptides. Where to source safe peptides. What peptides had good studies we could rely on. Which ones worked and how to dose them. I found other doctors like me who authentically wanted to help their patients heal. I spent thousands of dollars and countless hours studying and learning about peptides and other alternative medicines, and about things I didn’t learn in medical school. In all this, I kept safety as my number one priority. I could never abandon the oath I took to first do no harm. I was looking for something safe and that worked.

It paid off. I started using peptides on myself before I told anyone publicly. I tried them out on patients who wanted to do it safely and needed something that helped. The clinical results have been incredible. I have had multiple patients who have started peptides who have sat in my office and thanked me from the bottom of their hearts for providing relief so they can finally live their lives. I’ve had patients and their families in tears, telling me how I saved their lives. Peptides do save lives because they give people their lives back. They help sleep, energy, tissue repair, and cellular health. They are studied, safe, and open to be used safely and ethically by clinicians.

Why aren’t they approved?

So, after all that touchy-feely stuff and my story, let me tell you about what I learned.

Many clinicians wonder why peptides such as BPC-157, studied for decades with consistent preclinical signals for inflammation reduction and tissue repair, have not progressed into large human trials or regulatory approval. While regulatory and scientific explanations are often cited, they do not tell the full story. The reality is that modern drug development is shaped as much by financial incentives and institutional priorities as by science. “Big pharma” controls much of what comes to market as a usable human drug, and they make decisions not based on how much a substance helps, but rather on multiple other factors that make a drug profitable.

Large clinical trials require enormous capital, and that capital almost exclusively comes from industry. Short peptides like BPC-157 are cheap to make, hard to protect with patents, and poorly aligned with the blockbuster drug model. A compound that could be manufactured cheaply, used episodically, and potentially reduce long-term medication dependence offers little financial upside in a system optimized around chronic disease management instead of truly healing patients.

Even in medical school, I was trained to use pharmaceuticals first and foremost. I was never really taught cause; I just learned how to fix. This is how our system operates. Traditional health care is great at saving lives but it sucks at preventing disease. Promising therapies don’t get approved for human use because they do not fit into a one-pathway fix, not because they are ineffective or unsafe, but because they are not profitable enough to justify the regulatory investment. BPC-157 treats chronic pain, inflammatory bowel disease, and neuroinflammation. It’s one treatment for many different things, making it very hard for a pharmaceutical company to market and study. We have a system built around scalable, long-term pharmacologic use, a system I was trained in. These peptides just don’t fit into that system.

Navigating the regulatory landscape

Regulatory structures further reinforce this imbalance. As FDA oversight of compounded peptides tightened, many compounds fell into a gray zone: not approved drugs, not permitted bulk substances for routine compounding, and therefore not realistically studyable in large human trials. This creates a self-reinforcing cycle: No approval without trials, no trials without funding, and no funding without exclusivity. The system does not explicitly ban these compounds; it simply provides limited viable pathways for advancement or prescribers like us to use them or understand them for human use.

This context helps explain why peptides can be prescribed in certain states. Some peptides exist within a more permissive regulatory framework at the state level. For example, Florida’s pharmacy and medical board regulations allow licensed compounding pharmacies to prepare certain peptides when they meet criteria for physician-directed, patient-specific prescribing and are not explicitly prohibited by the FDA. This does not mean the peptide is FDA-approved, many times it is not, but it does mean that, under state authority, physicians can legally prescribe it when pharmacies are willing to compound it and assume responsibility for compliance. In effect, state-level regulation has created a narrow but functional clinical pathway where federal approval has not.

Other compounding pharmacies want in on the money and don’t care about oversight, offering banned and even unsafe compounds. Doctors are the only thing standing between these compounding pharmacies, research peptide distributors, and pharmaceutical companies. We have a responsibility to our patients to navigate these spaces and understand them. And we have an ethical obligation not to prescribe “research chemicals.”

For us, as doctors who care about our patients, the takeaway is not to abandon scientific rigor or regulatory caution, but to recognize the structural and economic biases that determine which therapies advance and which stagnate. The absence of large human trials does not automatically imply inefficacy or danger; it often reflects misalignment with the financial and institutional incentives that currently drive medicine. Understanding this landscape allows physicians to engage peptide therapies thoughtfully, ethically, and with clear eyes about both their potential and their limitations.

We can conduct a risk-benefit discussion with our patients and safely prescribe some peptides, but it’s up to each clinician to decide what to offer, and up to the patient to decide what to take. It is our responsibility to navigate this space cautiously, with consent, in the doctor-patient relationship and within the confines and respect of our state laws and overseeing boards. It is possible, it is safe, and in my opinion, it is the right thing to do, so we can continue to do what we came to this space to do: help our patients truly heal.

Stephanie Phillips is a family physician.