The author is missing a massive segment of that gray market: people who buy FDA-approved weight loss drugs (e.g., semaglutide or tirzepatide) at 2–5% of the brand-name price. This route carries some risk, but there are ways to mitigate it, such as performing third-party testing. I assume most people who do this couldn't realistically afford the brand-name drug anyway, making this their only viable treatment.