{
  "score_after": {
    "hsef_level": "Α",
    "hsef_descriptor": "Speculative / narrative",
    "confidence": "Moderate",
    "confidence_rationale": "51 primary reports with 1 selected partial-body examinations; density, heterogeneous controls and incomplete access set the confidence, not correctness.",
    "rests_on_non_peer_reviewed_work": false,
    "rationale": "Overall Α applies to SC3, the preregistered clinical-equivalence proposition. It does not deny the efficacy of regulated GLP-1 medicines or prove that every research-market preparation is inactive. Product identity, exposure and clinical equivalence cannot be supplied by a chemical label or transferred from a registrational trial."
  },
  "primary_comparisons": [
    {
      "doi": "10.2196/65440",
      "study_group": "PMID39509151",
      "access_depth": "Original primary abstract plus selected full-text body passages; already in frozen ledger source 1",
      "pmid": "39509151",
      "result_comparison": "Three delivered products from six purchase attempts were substandard/falsified; low purity, excess measured content and reported endotoxin. Agrees directionally with provider answer, but small selected sample does not justify prevalence/frequency language."
    },
    {
      "doi": "10.1136/ejhpharm-2025-004656",
      "study_group": "PMID41125326",
      "access_depth": "Original primary PubMed abstract; already in frozen ledger source 51",
      "pmid": "41125326",
      "result_comparison": "Single confirmed online-sourced falsified product contained insulin; supports a documented hazard, not market frequency."
    },
    {
      "doi": "10.3389/fphar.2026.1805842",
      "study_group": "EudraVigilance ICSR dataset 2018-2025",
      "access_depth": "Original primary PubMed abstract; absent from frozen 51-source ledger, supplemental",
      "pmid": "42137313",
      "result_comparison": "234 potential-counterfeit ICSRs and reporting-disproportionality signals; no denominator or confirmed authentication, so not incidence/causality."
    },
    {
      "doi": "10.1007/s11095-024-03771-6",
      "study_group": "PMID39379664",
      "access_depth": "Original primary abstract; already in frozen ledger",
      "pmid": "39379664",
      "result_comparison": "Follow-on-product assay supports formulation/impurity variability; distinct category from illicit research-chemical products, no clinical consequence established."
    },
    {
      "pmid": "42533250",
      "doi": "10.1007/s11095-026-04146-9",
      "source_type": "primary in-vitro study; supplemental, outside frozen ledger",
      "access_depth": "Consensus fetch record saved verbatim; bibliographic publication-year metadata and PubMed record checked; abstract-level primary findings",
      "study_group": "follow-on and compounded GLP-1 product samples, in-vitro assay",
      "result_comparison": "Different impurities and in-vitro immunogenic peptide presentation versus originators; does not test grey-market online products or clinical immunogenicity/safety; author conflicts include Novo Nordisk employees/shareholders."
    }
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  "grade_changed": false,
  "raw_paths": [
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  "queries": [
    "grey-market semaglutide quality source verification (browser request in browser-thread.json)",
    "semaglutide online research products purity identity contamination analysis compounded products 2023 2025"
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  "cutoff": "2026-10-09",
  "score_before": {
    "hsef_level": "Α",
    "hsef_descriptor": "Speculative / narrative",
    "confidence": "Moderate",
    "confidence_rationale": "51 primary reports with 1 selected partial-body examinations; density, heterogeneous controls and incomplete access set the confidence, not correctness.",
    "rests_on_non_peer_reviewed_work": false,
    "rationale": "Overall Α applies to SC3, the preregistered clinical-equivalence proposition. It does not deny the efficacy of regulated GLP-1 medicines or prove that every research-market preparation is inactive. Product identity, exposure and clinical equivalence cannot be supplied by a chemical label or transferred from a registrational trial."
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  "conclusion": "No direct clinical efficacy equivalence comparison found. Supplementary pharmacovigilance adds a signal but does not change the preregistered SC3 conclusion or score.",
  "addendum_path": "deliverables\\consensus_consistency_audit_2026-10-09\\checks\\grey-market-glp1\\addendum.md",
  "original_counts_preserved": {
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    "sources_total": 51
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  "independent_blinded_audit": false,
  "provider_mode": "Consensus Pro browser thread plus Consensus keyword search/fetch",
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      "status": "present",
      "id": "PMID 39509151 / DOI 10.2196/65440",
      "location": "selected-records.json, evidence.json, review, appraisals.tsv; source 1"
    },
    {
      "study_group": "same product-purchase family, pending methods-level overlap determination",
      "status": "absent from selected-records.json",
      "id": "DOI 10.1001/jamanetworkopen.2024.28280",
      "location": "Consensus-cited related Ashraf/Mackey research letter; likely same online-purchase family, not an independent sample based on source description"
    },
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      "study_group": "PMID41125326",
      "status": "present",
      "id": "PMID 41125326 / DOI 10.1136/ejhpharm-2025-004656",
      "location": "selected-records.json; frozen evidence report"
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      "study_group": "PMID39379664",
      "status": "present",
      "id": "PMID 39379664 / DOI 10.1007/s11095-024-03771-6",
      "location": "selected-records.json; frozen evidence report"
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      "study_group": "EudraVigilance potential counterfeit ICSRs",
      "status": "absent",
      "id": "PMID 42137313 / DOI 10.3389/fphar.2026.1805842",
      "location": "supplemental primary pharmacovigilance report"
    },
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      "study_group": "follow-on/compounded GLP-1 assays",
      "status": "absent",
      "id": "PMID 42533250 / DOI 10.1007/s11095-026-04146-9",
      "location": "supplemental primary in-vitro report; Consensus fetch JSON saved"
    }
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  "primary_comparison_count": 5,
  "additional_original_source_receipts": [],
  "status": "completed_retrospective_original_source_reconciliation",
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  "literature_cutoff_preserved": true
}