The FDA warning letter was sent before the Times story ran. This is a detail the profile mentioned towards the end. Matthew Gallagher did use AI to build Medvi — ChatGPT and Claude wrote the code, Midjourney and Runway generated the ads. AI handled customer service. What he compressed to near-zero was not just the operational cost of a health company but also the friction cost of building one that looks trustworthy without being trustworthy. The before-and-after patient photos were deepfakes. The doctor profiles were fabricated. The website disclaimer — small print at the bottom — reads: "Individuals appearing in advertisements may be actors or AI portraying doctors and are not licensed medical professionals." One paragraph later, the site promises "doctor-led plans and coaching."

What Medvi was actually selling is the more troubling part. Compounded GLP-1s were legal during the US drug shortage period; Medvi, like hundreds of similar storefronts, kept selling them after the FDA declared the shortage over in April 2025. Its oral tirzepatide tablets — one of its headline products — are, according to a class action filed in March 2026, biochemically incapable of working: tirzepatide is a large peptide molecule that digestive enzymes destroy before it reaches the bloodstream. The only FDA-approved oral GLP-1 required a specialised absorption enhancer developed over years of research. A compounding pharmacy cannot replicate that. The customers paying $150-300 a month were largely buying something with near-zero efficacy, sold to them by an AI-generated doctor who does not exist. Sam Altman told the Times he would "like to meet the guy." He should probably meet the 250,000 customers first.

GLP-1 receptor agonists — the class of drugs behind Ozempic, Wegovy, and Mounjaro — have produced the first sustained decline in US obesity rates in decades. North America represents 77% of a $64 billion global market. In Europe and most of the world, access is almost exclusively private and unaffordable for most.

The coming fork is the patent expiry. Semaglutide patents expire in 2026 in Brazil, Canada, China, India, and Turkey — covering roughly 40% of the world's population. The Lancet published analysis in March 2026 estimating that generic injectable semaglutide could be produced for $28 per person-year and distributed across 160 countries covering 84% of the global obesity burden by end of 2026. The incumbents' response is to build patent thickets around delivery devices and new formulations — Novo Nordisk and Eli Lilly are both investing heavily in oral versions, combination therapies, and device patents that could extend exclusivity regardless of what happens to the core molecule.

The obesity burden is highest where income is lowest — Mississippi, West Virginia, and Louisiana all have obesity rates above 40% and some of the worst affordability ratios in the US. The same pattern holds globally. If the biosimilar wave reaches patients rather than being blocked by device patents and regulatory barriers, this becomes a genuine public health intervention at scale. If it doesn't, it remains an expensive consumer product for wealthy countries with a parallel grey market of dubious compounded versions for everyone else. Both outcomes are currently possible. The industry's track record on access suggests we should not assume the better one.