As wellness, longevity, and anti-aging medicine continue to grow, physicians face increasing scrutiny around marketing claims, off-label therapies, and regulatory compliance. In this episode, Jeff Segal, MD, JD—ByrdAdatto partner and founder of Medical Justice—breaks down the growing legal risks facing these emerging areas of medicine. Tune in to learn how medical boards evaluate wellness practices, the difference between FDA approval and standard of care, and where providers most commonly get into trouble. Explore what steps physicians can take to responsibly innovate without putting their medical license at risk.
Listen to the full episode using the player below, or by visiting one of the links below. Contact ByrdAdatto if you have any questions or would like to learn more.
Transcript
*The below transcript has been edited for readability.
Intro: [00:00] Welcome to Legal 123s with ByrdAdatto. Legal issues simplified through real client stories and real-world experiences, creating simplicity in three, two, one.
Brad: [00:13] Well, welcome back to Legal 123s with ByrdAdatto. I’m your host, Brad Adatto, with my co-host, Michael Byrd
Michael: [00:19] As business attorneys for health care practices, we meet a lot of interesting people and learn their amazing stories. This season’s theme is the Future of Wellness, where longevity, advanced weight loss solutions, and anti-aging innovations collide. Get ready for insights from the people driving the evolution of the medical industry.
Brad: [00:41] Now, Michael, for anyone who might be our first-time listener on this podcast, where we talk about healthcare law very seriously, just serious enough to be dangerous.
Michael: [00:53] Sounds like you’re trying to do a movie promo or something with that setup.
Brad: [00:58] Should I do a better movie voice next time?
Michael: [01:00] Yeah, when I was picturing you talking, I thought if you had movie voice, it would have been better.
Brad: [01:09] Okay, I’ll work on that next time.
Michael: [01:10] Yeah.
Brad: [01:10] All right. For today’s opening, I’m actually going to set the stage here, Michael. Have you ever noticed how popular plastic surgery or reality TV shows are, like “Botched” or “Skin Decision: Before & After,” “Extreme Makeover,” “Dramatic Transformations,” “Emotional Journeys,” “Chaos, Confidence, Redemption,” all these revisions? Have you watched those?
Michael: [01:32] I know some of the names you just said. I’m aware that there are a lot of these shows, so I guess yes.
Brad: [01:41] Yeah.
Michael: [01:41] Okay.
Brad: [01:41] So think about this, cameras are everywhere, and the unspoken lesson is always the same, just because you can does not mean you should.
Michael: [01:51] I feel like that applies to reality TV, medicine, and actually most of your wardrobe choices. So do you have a story that somehow ties to reality TV or cosmetic procedures or some sort of regulatory overreach?
Brad: [02:09] I’m glad you asked, Michael, because yes, I do.
Michael: [02:11] Movie voice.
Brad: [02:13] So picture this. A high-profile beauty contest that is televised every year. Judges have very serious scrutiny in their different categories. The contestants get ready, perfecting literally every detail, aiming for whatever edge they can.
Michael: [02:32] This sounds like you’re talking about “Miss America,” which, I will give you a little tip, Brad. It has been around forever, or did they pay you to promote them this year?
Brad: [02:42] This podcast is now sponsored by… No, no, we did not do that.
Michael: [02:45] Okay.
Brad: [02:45] Anyway, not “Miss America,” audience. The inspectors started noticing that some of the contestants looked a little too polished, a little too enhanced, and it turns out several competitors were disqualified and banned for cosmetic enhancements, including Botox, lip fillers, hormone treatments, and even silicone additions.
Michael: [03:07] I actually know exactly what story you’re about to say. I read the same article from the same publication. First of all, bravo for how innocently you are presenting it. Secondly, I will not ruin the punchline and let you build it up like you have, but I do have a question.
Brad: [03:30] Yeah.
Michael: [03:30] Did they not read the rules?
Brad: [03:31] Based on the shock from those who worked with the competitors, they did not. The judges were unimpressed with their protests, and ultimately, 20 competitors were disqualified. The lesson is clear. Botox, lip fillers, hormone treatments, and even silicone additions may enhance the competitor but also deflate your chance of winning.
Michael: [03:55] Nice use of the word deflate, Brad. Let’s hear it.
Brad: [04:01] Michael.
Michael: [04:01] What beauty contest was this?
Brad: [04:03] Audience members, it was a camel beauty pageant. To be exact, the 2026 Camel Beauty Show Festival held in Oman.
Michael: [04:13] And I actually did a deep dive on this.
Brad: [04:17] Yes.
Michael: [04:17] It is a shockingly big deal.
Brad: [04:20] Yes.
Michael: [04:20] The reason they are doing all this is because it is so competitive, and the prize pool is so huge. We are talking millions. I do not remember what the grand prize itself was, but the prize pool was stunning for something I had never heard of, which was a camel beauty contest.
Brad: [04:38] Yeah, and did you ever think Botox and fillers would be something used to enhance a camel?
Michael: [04:44] Well, do you want my 13-year-old sensibility to answer that or a mature person answer?
Brad: [04:52] I am not sure how to answer that.
Michael: [04:54] I am going to move on.
Brad: [04:55] Okay.
Michael: [04:55] What does this have to do with our guest today?
Brad: [04:57] Our guest today is the owner of Incredible Stories, and I thought this would be a good one to add to his arsenal of incredible stories.
Michael: [05:06] I would not go too fast. I would not be surprised if he has his own camel story.
Brad: [05:12] Fair. He is also a surgeon, so maybe he has some ideas too. Whether you are a surgeon or specialize in camel cosmetics, rules still apply, Michael, which brings us perfectly to today’s topic, medical board investigations.
Michael: [05:26] Joining us today is our law partner and friend, Dr. Jeff Segal. He is an attorney licensed in California. He also is a doctor. He went to medical school at Baylor College of Medicine in Texas. He is a neurosurgeon. Of course, his most important degree, as we have highlighted in the past, is that he went to undergrad at UT. He is the founder of Medical Justice, which includes eMerit. His wife is Shelly, and Josh and Jordan are his twins. He is a cyclist, scuba diver, climber, and truly, audience, you do not know how many stories Jeff has, which may be why he is a six-time guest on our show.
Brad: [06:15] Record holder.
Michael: [06:16] Jeff, thanks for being here.
Jeff: [06:18] Wow. That is great. I did not realize I am a record holder. You will be surprised to know that today I have actually brought my camel.
Brad: [06:28] I believe that. Well, first off,
Jeff: [06:30] In the back, waiting.
Brad: [06:31] Yes. Are you familiar with the 2026 Camel Beauty Show Festival scandal?
Jeff: [06:36] First I’ve ever heard of it. But I am intrigued. Call me camel curious. I think next year you will find me in Oman, probably as a spectator. I do not have an entry.
Michael: [06:52] I want to see some before and after pictures.
Jeff: [06:55] Oh, you will.
Michael: [06:56] Yeah.
Jeff: [06:56] Oh, you will, my friend. You will.
Michael: [06:59] All right. Let’s get into it. As we said, you have been on a bunch with us, but we have some audience members who may not have met you yet, so I would love to give you the floor to talk a little bit about Medical Justice and what you do.
Jeff: [07:18] Medical Justice started when I was sued for a frivolous reason. I practice neurosurgery, and the single expert who testified against me had actually been expelled from our professional society, the American Association of Neurological Surgeons, for delivering frivolous testimony, yet he was still making a handsome living serving as an expert. I thought there had to be a better way. So I created Medical Justice as a way to keep doctors from being sued for frivolous reasons and, more broadly, to address and manage thorny medical-legal conflicts, including board of medicine issues and reputational assaults on the internet. That is the whirlwind tour of who we are and what we do.
Brad: [08:09] That is awesome, Jeff. Thanks again for being here today. This season our focus is on wellness, and for those not knowing, when we say wellness, we are including longevity, weight loss, and anti-aging. As wellness has grown, it is reshaping the interaction between medical practices and medical boards looking at these wellness clinics. Talk to us about what is happening when medical boards look at the services being provided in these clinics.
Jeff: [08:45] Physicians have come late to the party. Others have focused on this for years, including exercise and nutrition. Now there are many powerful compounds, some tested and some not, available to promote health span. They get a lot of buzz in traditional and social media. Demand is high, and licensed professionals are trying to fill it. But there are cautionary tales because medical boards view medicine through a traditional lens. They ask whether you are treating conditions and what claims you are making. Are you claiming it will make someone live longer? Are you claiming chronic conditions will be reversed? Those hyperbolic marketing claims put you on a medical board’s radar. Medical boards are also complaint-driven. They are busy and not scouting the media to target practices. Complaints often come from patients who paid a lot of money and did not get what they thought they would. That is the changing paradigm we are living in right now.
Brad: [11:18] So if someone says, “Come here, use our product, and you can live forever,” and they die, that is a bad promotion?
Jeff: [11:27] That is a bad promotion.
Brad: [11:28] Okay.
Jeff: [11:29] I would suggest being subtle with claims. Anyone who watches television sees supplements being sold with no explicit claims, although there is a wink that you will be healthier. The background noise is that the supplement is not designed to diagnose or treat anything, which would be the practice of medicine. We have lived in that world with oral supplements for a long time, and it is a massive industry. Now we are moving into a different domain, not just oral supplements, but injectable supplements, and that is a different fork in the road.
Michael: [12:26] That is a great point, especially the regulatory difference between the supplement industry and the medical industry. I am thinking back 15 or 20 years to the movement around human growth hormone and other anti-aging treatments. From my perspective, it came and went without much regulatory enforcement. I am curious if there is anything from that period that is instructive for the risks practices face now, given the heavy demand.
Jeff: [13:23] Part of it is supply and demand. Human growth hormone was touted as a way to supplement declining natural levels as we age. Early on, before genetically engineered versions, it was sourced from cadaver pituitary glands, and there was not enough to go around. Those who truly needed it were patients with congenital hypopituitarism and short stature. There was a big uproar to take the limited supply and allocate it to those who truly did need it, so it was heavily regulated. Human growth hormone, a non-controlled substance, was regulated by the Food and Drug Administration. Normally, healthcare is regulated by state licensing boards, while the Food and Drug Administration helps shepherd drugs to market. They oversee trials for safety and efficacy. There is usually a sponsor for the drug with an intellectual property position they are trying to support. Once everything is submitted through a new drug application, the Food and Drug Administration may approve it and grant the right to market the compound for a specific indication. That is when advertisements appear claiming it is the latest and greatest treatment for a particular condition. Doctors, however, are free to use medications that have entered interstate commerce for any indication. They are not limited to the label. The term off-label is commonly used, but a better description is silent label, meaning no formal application was submitted for that use. Many physicians use drugs in this way, and it may be the standard of care. For example, an antibiotic may be approved for adults over 18, but that does not prohibit prescribing it to a child. As long as it aligns with the standard of care and others are doing it, it is acceptable. There is a distinction between what is FDA-approved and what is allowed. There is some overlap, but the story does not end there. If something is not FDA-approved, that does not mean it is forbidden. The next question is what others are doing and whether there is literature to support it. If you are the only person doing it, it is arguably research and not the standard of care.
Brad: [16:58] Well, and Jeff, that’s a perfect segue, especially in this space with wellness. You were talking about the term of art in the industry, on-label versus off-label. But right now in the wellness space, we are seeing a lot of people use unapproved FDA drugs. They are relying on informed consents where the patient agrees to it and rushing to treat by saying, “They signed a consent and understood this is an unapproved FDA drug.” Going back to the medical board, how would a medical board view someone using an unapproved drug?
Michael: [17:37] You’re talking about things like exosomes, with no label.
Brad: [17:39] No label at all. There is nothing. The FDA has never looked at it.
Jeff: [17:42] Correct. Putting aside the FDA issue of inserting a new compound into interstate commerce in breach of the Food, Drug, and Cosmetic Act, which most doctors will not touch, the medical board often does take a position on this. A consent form may help in some states that allow alternative medicine practice, but the consent form is the bare minimum. You need a consent form so the patient understands the status of what is being used. It is the floor. In many states, a consent form will not save you. That is not surprising. There are some things you simply cannot do. For example, consent does not override the law. Just because a patient agrees does not mean the activity is allowed. Having a consent form is not the end of the discussion. If what you are doing does not comport with the standard of care, the fact that a patient says they knew what they were getting into does not protect you. I think it just suggests that you engaged in an activity that others, that you’re the only person doing it, or very few people are doing it. Now, if you want to engage in actual research, which the board of medicine doesn’t necessarily oversee, then you can formally start a research project, which you would do under IRB, Institutional Review Board, and they would evaluate the safety, and that would come into the consent form. So there is research that can be done on compounds that have yet to be approved by the Food and Drug Administration. For example, what does Pfizer do when they are doing a phase two clinical trial with, let’s say, a cancer drug? Well, it’s a drug that has not come to market, and the patient needs to understand what they’re getting into. It is a bona fide research trial, and the two bare minimums for a research trial are IRB approval, Institutional Review Board approval, and a consent form. And for those who are participating as physicians in these research trials, you need to have a specific type of professional liability coverage to manage that. Because your typical bread-and-butter med mal policy mostly focuses on the standard of care, but if you’re doing research, that’s not the standard of care. You’re trying to advance the science, which means you don’t know what the outcome will be. It may become part of the standard of care down the road, but there are lots of details in there. So getting back to one of the high-level questions, if you’re going to promote or prescribe compounds that are not FDA-approved, I would certainly have a conversation with your carrier, letting them know what you’re doing and seeing whether they will entertain the risk. Because the last thing you want to do as an ER doctor is submit a claim for something that’s never been FDA-approved and then learn you’re on your own. You hire your own attorney, and good luck in your endeavors, and then they cancel your policy anyway because they didn’t like what you were doing. Nobody likes a surprise, so these are some of the things you need to think about. Is the compound FDA-approved for any indication? That’s number one. Number two, how does your state treat some of the alternative practices related to compounds that are either not FDA-approved at all, or you’re using it for a different indication? And then do you have any type of coverage to the extent you get a bad outcome and a lawyer decides to sue you?
Michael: [22:07] Yeah. So that’s great. I’m curious, kind of to put a bow on this talk track that you’ve just gone down. So in light of this, and if a practice is thinking about adding these services and they walk through those kind of three big areas that you just summarized, what other practical steps would you recommend a practice take if they’re looking to add one of these wellness services? So they’re doing normal medicine, so to speak, right now, and then they are looking to add it. What advice would you give them to get started?
Jeff: [22:57] Yeah. So if you’re warming up, I’d start with what is safest. There are peptides that are out there that do a wonderful job, but they’re FDA-approved for a specific indication. Let’s look at GLP‑1 agonist. They do so many different things. I would call them wonder drugs. Are they perfect? No. But they treat so many different conditions, and they also, in a way, promote wellness. I would call it, this may be hyperbole, but exercise in a pill. It’s not a pill, although a pill may be coming out, but I’d start with what has been proven. We understand the safety, we understand the clinical outcomes. You’re not over‑marketing by getting into that space. It may be crowded, but you are delivering a compound that has already passed the test with the Food and Drug Administration, and there’s a tremendous amount of demand for it. So plenty of demand. Finding the business model would make sense. Number two would be compounds that have at least been tested in the past. They may not be currently in market. You may have to get them through compounding pharmacies, but that would be the next step where there is a track record. Perhaps they’re using them overseas, and at least many people have been exposed to it. To me, the most worrisome compounds are the ones that have limited safety record. We just don’t know. If the studies are just in mice, I would argue that mice aren’t humans, and while there may be tremendous benefits, we’d be better-
Michael: [24:33] Can you explain that to Brad?
Brad: [24:35] I’m so confused by that statement.
Jeff: [24:37] Yeah, well it depends on the type of mouse, actually.
Brad: [24:39] What about if it’s a talking mouse? Because I’ve seen a lot of cartoons with talking mice. Are they not human either?
Jeff: [24:45] That reminds me of the dog that walks into the bar, and he says, “I’d like a beer,” and the bartender drops his jaw. The bartender just goes ballistic or just is shocked, and the dog looks at him and says, “What’s the matter? You’ve never seen an electrician before?”
Jeff: [25:04] Okay, never mind.
Brad: [25:04] And audience members, there you have it. So yeah, so what about the mouse? Yeah
Jeff: [25:09] … so if there’s limited safety information, I’m not sure I’d start there. Now, you could actually do a research trial.
Brad: [25:17] Yeah.
Jeff: [25:17] You could actually, but if you do research and you ultimately want to move it through, you got to have consent, you got to have an IRB. You can get a private IRB, but then you have to source the material, and I think the biggest challenge for physicians today is sourcing pharmaceutical‑grade compounds. If the packet comes in with a label that says, “Research chemical for animal use only,” while we are animals, arguably, I’m not sure that’s the type of compound you want to be promoting.
Michael: [25:52] Or much less-
Jeff: [25:52] Because you don’t know where it came from. You don’t have any source control, and if there’s a problem with an infection or an untoward effect, or just that the patient is getting what you believe they’re getting, I think you’ll burn. I don’t think that’s going to be supportable.
Brad: [26:09] Okay. Agree. Thank you. I can’t believe our time just flew by. Thanks for joining us for the sixth time on The Legal 123s.
Jeff: [26:17] Oh my God, I didn’t even have a chance to introduce my camel.
Michael: [26:21] That’ll be on the seventh episode.
Jeff: [26:23] Okay.
Michael: [26:23] We’ll go to break. After break, Brad and I’ll do a quick wrap‑up, but it was a really interesting conversation. Thanks for joining us.
Jeff: [26:32] Thank you. Appreciate it.
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Brad: [27:08] Welcome back to Legal 123s with ByrdAdatto. I’m your host, Brad Adatto. I’m still here with my co‑host, Michael Byrd. Now, Michael, and audience members, this season we’re focused on the Future of Wellness, and we just had a great conversation with Jeff Segal, Dr. Jeff Segal, on wellness and understanding how it impacts medical decision‑making, which eventually impacts how you handle medical boards. And, Michael, he talked about a lot of different things, but one of the things he mentioned more than once was IRBs. What are your thoughts on those, just in general?
Michael: [27:39] Yeah. I mean, I loved how he focused on just the medical side of offering these alternative treatments. And so it was interesting. I do think that there could be for our audience members a little bit of maybe false hope of what an IRB can offer because these review studies are pretty formal and a pretty big deal, and not easy. I don’t know if you want to give kind of a summary, high level of what they are.
Brad: [28:15] Yeah. I mean, just in a super high level, first off, they’re very expensive. To do them correctly, there’s all these controls and other elements that you have to have. You have to sign through a process, so you can’t just say, “I’m quote unquote researching something.” It’s a whole application process you go in. It’s a formalization of it. The study itself has to have different ways in which you can track it. So it’s not just like, “Oh, I’m going to research this in my next 20 patients that walk through the front door,” and then apply later on. So Jeff’s point is you can do independent studies, but at the same time, it’s through an institute. So be very mindful that if that’s a route you’re doing, or if you’re just giving it and they’re consenting to quote research, but you’re really not a part of research, your exposure goes up again.
Michael: [29:00] They’re super formal.
Brad: [29:01] Yes, they’re super formal. Great analysis. But Michael, unfortunately that is all the time we have today. But audience members, do not panic. We are back next Wednesday when we continue to explore the future of wellness, when we bring on a good friend who will be in studio, Amy Anderson, discuss operating a successful wellness practice.
Brad: [29:22] Thanks again for joining us today. And remember, if you liked this episode, please subscribe, make sure to give us a five-star rating, and share with your friends.
Michael: [29:30] You can also sign up for the ByrdAdatto newsletter by going to our website at byrdadatto.com.
Outro: [29:36] ByrdAdatto is providing this podcast as a public service. This podcast is for educational purposes only. This podcast does not constitute legal advice, nor does it establish an attorney-client relationship. Reference to any specific product or entity does not constitute an endorsement or recommendation by ByrdAdatto. The views expressed by guests are their own, and their appearance on the program does not imply an endorsement of them or any entity they represent. Please consult with an attorney on your legal issues.
