Strongly disagree with almost everything in this article, but specifically this. The reason people make these choices is not because of slick marketing working against them, it's because the existing process to get medical treatment is paternalistic, hard to navigate and often expensive.
If you want safe and really high quality medical care you should absolutely have a personal physician you have a personal relationship with, who understands your lifestyle, your risk factors for side effects, and your medical needs deeply. How many Americans have that? Maybe a few dozen? The market has responded to just how terrible the existing system is.
A bit of a tangent: I have this here in the US, through a model called Direct Primary Care. I pay $50/mo for a single provider, unlimited visits / communication, and highly discounted labs. She makes house calls on occasion. This doctor is working solely in my interest, and has little concern of insurance, except to help me navigate that system should I need a specialist, prior authorization, etc.
I do worry that it's sustainable, but I think there must by a way to scale up this practice of the general practitioner working in the interest of the patient.
My previous doctor was part of a large health system, who also happens to be directly associated with the large regional insurance provider whom my employer supplied to me without another choice. Every 8 minute visit centered around insurance and billing, with my health seeming to be a distant second. It seemed every visit had to end in some kind of prescription or referral, arrived at quickly and without much discussion. It quickly became clear they were not working in my interest, and I sought other options, eventually landing on the Direct Primary Care model. Now I have full 1 hour visits, and someone who seeks to understand what is happening for me completely, not through the lens of a payer.
Someone's presumably paying her more than $50/hr, which will burn through your monthly fees pretty quickly. Where's the money coming from?
A lot of these 'concierge medicine' services are set up to deal with mostly people who don't need all that much medical care, beyond relatively brisk access to the doctor in a few rare circumstances. Since they also don't really do much in terms of specialty care, they tend to have fewer Px who need extensive personal care.
That's 420+ patients at $50/m.
Doesn't seem feasible to know them all personally and deeply.
Other revenue would be needed.
We're talking about basic preventative care here. Your doctor doesn't need and probably doesn't want to be your friend for these sorts of things. There doesn't need to be a deep personal relationship there if it's not necessary.
(But also, $50/mo is a very low price. I've seen plenty of such services that are in the $500+/mo range. It's still way cheaper than health insurance would cost out of pocket, but it's not 'cheap' either.)
You're paying for the bedside manner, not the medicine.
I see my wife’s doctor more often than my own because he is also our newborn son’s doctor.
They both have thousands of patients. The waiting rooms mostly have elderly, parents with their newborns and obese people.
That's because just before she walks in she reads your chart.
200 patients at one hour per is a bit more than a month of 9-5s.
If I visited my GP once per 1.5 months I’d be paying a fuckload more than $50/mo in copayments alone, in addition to my incredible premiums.
Healthcare becomes pretty affordable when you’re not paying for actuaries and other scammers.
I'm at about 1 hour per year with my GP (I guess they can be spending additional time on notes or whatever, but I don't think it's much).
I could see something like this being useful for me; I'm constantly nagging my physician for different drugs I am triaging for a condition I'm dealing with. But, in that case, I wouldn't be the ideal patient for the physician. I wish this kind of thing could work, but I'm not sure how I see it working in practice, unless you move up market and charge more.
But the figures I’ve seen quoted for such service usually begin in the four digits, sometimes five digits, annually.
One of the huge benefits for me has been that I have much simpler access to specialists. They are somehow able to punch through a lot of the scheduling bullshit for me, so when I do need to see a specialist, I am not waiting for weeks or months; Sometimes I've been able to get appointments at a specialist through them within a few days instead of the few weeks it would have been had I tried doing the same myself.
For example, a lot of asymptomatic STDs get accidentally cured by people taking antibiotics for unrelated reasons. Less paternalistic countries let people buy very significant drugs over the counter.
Being able to rule out that a simple infection is viral instead of bacterial is a huge boon. Doctors who want to cry about risk of superbugs (while eating McDonald’s during their break) can shove their opinion alongside side their antibiotic doused meat slurry straight down their pie hole.
Every nice pain killer I get I keep for emergencies. You never know when you’ll actually hurt yourself and be very happy to have some extra Vicodin.
Paternialism in medicine has been destructive for the human race and it has led to a lot of very very negative outcomes.
> I do worry that it's sustainable
That is way, way more than 15 minutes of work.
I'm not sure how a physical would be more than 15 minutes of work. Lab techs? Standard blood tests are all automated, the most complicated part is putting the stickers on the vials. Yes, someone needs to calibrate the machine, but the machine processes 1000s of samples per day. I just checked, the price for a standard blood panel at a local lab is 14€. It's really not a complicated procedure.
Drivers? Janitors? What the hell are you paying those guys to justify a $1000 bill? And you really don't need to hire a driver to get a box of samples to the lab at the end of the day.
If a patient goes to see their doctor at a major hospital, part of that bill goes to pay for uninsured patients in the ER. Hospitals in the US by law have to treat everyone who come to the emergency room, which results in a lot of losses for hospitals that they have to make up for by charging higher prices on other services.
> And you really don't need to hire a driver to get a box of samples to the lab at the end of the day.
Smaller doctor's offices do their labs offsite, in the US just a couple of companies do the majority of blood work, as part of the contract with the lab, a driver comes by and picks up samples. In the great name of outsourcing, I imagine this driver works for a separate company as well, so now there is 2x outsourcing overhead, once for the lab, and again for the transport company. For doctor's offices that cannot justify their own lab, this makes some sense.
FWIW in my city at least, the majority of doctors are affiliated with large hospitals. They either work in a large hospital, in a satellite campus, or have an affiliate relationship (which from what I can tell just means medical records are automatically transferred over).
I go to a "smaller" office, it is a 3 story campus that is the satellite office of a huge hospital nearby. They do some of their own lab work and outsource other stuff. The hospital network is publicly owned and accordingly much nicer to deal with than many of the horror stories I hear online and from friends. (also the prices are reasonable and they always give me a price sheet up front of what everything will cost, which isn't always the case for some doctors...)
> I just checked, the price for a standard blood panel at a local lab is 14€. It's really not a complicated procedure.
Is that a 100% unsubsidized price?
In the US, cash price for a Comprehensive metabolic panel (CMP) is just $50. The same labs that the hospitals outsource to actually offer direct to consumer tests at really reasonable rates.
I just checked my hospitals cash rates:
A yearly checkup for an existing patient is $48.
Lab work is $48 (a $2 discount!)
Urine tests are another $20.
So in summary, OP got ripped off by their doctor's office.
Regarding the patient load discussion elsewhere, our entire family uses this doctor, we’re in for $200/mo but if we added up the interaction time even with me (a more complicated customer) it’s maybe 5 hours a year + some text communications with the MA / prescription wrangling. Their model seems to be all about effective scaling, I hope it is worth it for them, because my experience is vastly improved.
The system sucks, but Hims are also terrible, and medical care should not be like Amazon prime.
Speak for yourself; that is exactly what I want. And anyone else who wants a similar experience should be able to purchase it.
Everyone wants to be the sickest person in whatever health care pool they are in, but that's not sustainable
That's not medical care.
The way I see it, services like Hims are forcing a discussion that needs to have happened a long time ago. If people are willing to rely on them for medicines that can have some pretty serious side effects, what does that say about our existing system that people are eschewing? When you're asking people to choose between being able to afford to eat, and being able to afford something like insulin, why the fuck would you expect the decision making process to be anything otherwise?
Maybe many americans would disagree, right until the moment when they're nearly vomiting their guts out at the pharmacy, waiting for their zofran, which is going to cost them several hundred dollars, just because they're getting a version with a little glucose added so it doesn't taste as bad when you take it.
"clearly we need to spend more on lobbying to get our ability to extract out pound of flesh more thoroughly written into the law"
-the system
With an HSA, I'm basically self-insured for everything short of something catastrophic.
I don't know if I'm an outlier in this American Carnage, but with very few exceptions, this is the norm in my circles.
If you’re not willing to do that than don’t try to take a holier than thou attitude against the supplement crowd. At least fish oil actually does help a tiny bit. Certainly more effective than 99.99% of adjustments.
These are not the same magnitude of sin, particularly since one's shortcomings are large reason for the existence of the other.
Personally I think viagra should be OTC, there’s no reason to gatekeep erectile dysfunction medicine.
This article is pure FUD pearl clutching
1. https://petrieflom.law.harvard.edu/2022/03/15/ama-scope-of-p...
Hims is like that.
What are you smoking? I’m a normal middle class guy with insurance and my PCP is an overworked but very cool guy who I’ve spent years getting to know. All of my peers in their 50s have similar PCPs.
While I agree the GOP is doing everything in its power to make sure lower income families cannot get good healthcare, lots of people actually have it. Not sure why you’re lying to make a point.
Some of it is that there’s a general breakdown in trust that makes a lot of people think that somebody who shot a healthcare executive is a hero, or that there is little outrage that a lunatic like RFK jr is in charge of HHS. I mean, there are legitimate reasons to think institutions are illegitimate but I think there’s something self-perpetuating about distrust, people find meaning in it. It reminds me of the 1980s and 1990s when there were all the stories right out of Rambo that there were still POW in Vietnam and you’d see those black flags everywhere because it wasn’t patriotic enough to fly an American flag.
The lack of institutional self-awareness is why it's not especially mental to find most humans more trustworthy than any institution. There's a bit of grandma's wisdom in not worrying about Kennedy or being a fan of Luigi.. then there are borderline cases like Shkreli or the CEO of UHC-- they seem to have the non-sentience of the upper-percentile institution (which btw includes almost every place of higher learning in the US, exceptions to be investigated for their unusual processes..)
I suspect the Ben Franklin thought of Congress as a bunch of his peers & not an institution (placeholder for one of PG's underworked cluster of ideas around informality)
I suffered for 25 years from chronic pain that was referred TMJ. I've seen a cardiologist who is fine and all but much of his advice is the exact opposite of what I read on PubMed (and not just one paper on PubMed but 20 or 30 papers.) I've had several psych evals that I learned later were of very high quality for the their time but it took about 45 years for a book to practically jump into my hands at my university library which explained how I'm different from other people. I was annoyed as hell when a sports medicine doctor wrote NAD [1] on my chart when I was complaining about my activities being limited by knee trouble.
I work for a large employer in a state where it is illegal to offer junk insurance. My story was not too different when I was on Obamacare except I was paying what seemed an astronomical amount in premiums. I know a lot of people have it worse.
Looking at the how high the stakes are, I mean, you are all you've got, it's no wonder that people can't look at the limitations of the system with equanimity. The doctors I work accept me being a partner in understanding my conditions and my care but the moment they hear the voice of a professional fibromyalgia sufferer I bet they wish they could quit their job if they didn't have debt for student loans or to start their practice.
A lot of people seem to think "it would be allright if we just got more resources", I wish I could wave a magic wand and let them change places with Michael Jackson. Nobody is doing Elon Musk a favor shooting him up with Ketamine every week as well as other controlled substances. A lot of people just won't take help. I know people with schizophrenia who have no insight into their condition. Others with serious mental health diagnosis who refuse to take any med that isn't a controlled substance. For that matter, families where you get the kids a lot of nice and appropriate stuff for Christmas and you come back in a week and they've trashed all of it.
Having a positive attitude and just some gratitude for being here and the miracle that people have figured out as much they have and that a $10 prescription can cure conditions that were a death sentence just 100 years ago goes a long way. [2] I've personally tried to help a lot of poor people who seemed to have a bottomless pit inside them but if you look at the likes of Elon Musk, rich people can be like that too.
[1] https://www.quora.com/What-does-no-apparent-distress-mean-in...
I ended up paying over $1k out of pocket for two inconclusive sleep studies trying to get my sleep issue sorted out. I'm fortunate to work in technology where I can pay that sort of thing, but I still got zero results from my local medical community. I can't blame anyone for seeking self-treatment options. It can be pretty bad even with "good" insurance and the ability to cover co-insurance.
best we can do here is the closest walk in clinic that isn’t fully booked by 9am and a doctor I’ve never met before. All they ever do is send me for blood work which is always flawless. Eventually my issues resolve themselves. If I get cancer or something serious I expect to just find out shortly before I die
You can maybe talk about the hollow men of Novo and Lilly, who colluded with PBMs and insurers for most of a decade to push the cost of insulin analogues into the stratosphere, taking billions in profit while people died in agony rationing insulin. (in horrible agony -- blood turning into acid until brain death)
Oligopolies colluding to elevate prices of necessities to fatal levels is a product of regulation. In cases like these, incumbent businesses support regulation because it raises barriers to entry for new entrants; this results in oligopoly or monopoly, permitting the extraction of monopoly rents, even when people are literally dying in the streets because they can't afford products like insulin which are extremely cheap to produce.
(Insulin wasn't always cheap to produce, but for 43 years now it's produced by genetically engineered microorganisms, which makes it very cheap. It's a tiny protein, only 51 amino acids, produced from a 110-amino-acid precursor protein.)
> but these enforcement efforts feel perpetually behind the curve in an economy where regulatory complexity has become a competitive advantage
The only way for "regulatory complexity" to become a "competitive advantage" is for there to be very high levels of regulation.
I think that the solution isn't specifically more regulation, or less regulation, or more regulators (which would just compound the problem), but better regulation. Law should be treated like code - as a liability (not an asset), but one necessary to accomplish a purpose, and so written as carefully and simply as possible.
Where's our team of pen-testers looking to find holes in the draft of a new law? Our Unix-philosophy-adjacent lawyers proclaiming that "less is more" and striving for composability in separate laws instead of bundling everything together? Our git forge for legal documents where the public can view and comment on the legal system (even if actually making changes is more complicated)?
Software engineering and the law could learn so much from each other - it's a shame there's so little cross-pollination.
Consumers are so alienated that they'll pay out of pocket for a disruptor like Hims, which is doing its best to circumvent the entire system. Sadly, just as there's little government oversight to prevent pharma from becoming monopolistic, there's virtually no regulation on supplements. So you end up with the worst of both worlds; you can either take the $1000 monopoly pill or the $2 gas station pill filled with sawdust and raccoon repellant.
Those complexities may be relevant to other drugs, but not specifically to insulin, which is the case we're discussing here. Nobody needs to recoup their research investment for figuring out how to make insulin cheaply, and insulin prices are extremely far from "the point of maximum efficiency/optimization", which would be where drug companies were charging barely enough to cover the cost of production. Insulin is not regulated as a supplement, it cannot be administered as a pill, it is not sold in gas stations, and no cases of sawdust or raccoon repellent contamination have been reported in insulin.
All that's happening with insulin is that there's an oligopoly that's colluding to extract monopoly profits, which they can do precisely because regulation prevents biology students from hacking together insulin-producing yeasts over the weekend and selling the insulin to whoever is willing to risk it. That same regulation is what prevents Harbor Freight from importing insulin by the case from any of the dozens of other countries where it costs a tenth of what it costs in the US.
https://old.reddit.com/r/AskChina/comments/1j9zf2u/chinese_i... says of China, "I checked and found that rapid-acting insulin is $4 per bottle, long-acting insulin is $10 per bottle, and other brands of insulin cost between $5 and $8." So why does it cost US$100 per bottle in the US? You'd think you could make a big profit importing Chinese insulin, no? But regulations make it difficult to import that insulin from China, so difficult that incumbents can extract US$100 per bottle in monopoly rents.
Also recombinant DNA processes for making these meds is pretty mature tech it’s not like some crazy trade secret.
His parents have been doing IV infusions for the past two years, which seem to be having more of a positive impact than anything the health care system did, and now they are about to start peptide therapy, which is something I know little about.
Edit: had to do a quick double check, but the foods that I eat, and don't eat, are specifically for hEDS/ME/CFS brain fog which I believe is IL-1B cytokine related and I think it's plausible that this probably has a crossover to Crohn's. Listing it here as something to consider; A diet of zero sugar and zero fruit, a lot of kale, chia seeds, and pumpkin seeds. I do one meal a day, and an occasional extended water fast. For vitamins I take TUDCA, DIM, and D3.
Prolonged use of steroids can cause dysautonomia which causes a plethora of other issues. So understanding dysautonomia could help. I also use a weak ligand approach to dysautonomia which is unusual with the use of modafinil and amitriptyline.
Low Dose Naltrexone (LDN) is a rather benign medication that's been known to help. There is little downside to trying it - so it can be used as a bit of a diagnostic in addition to treatment. Of course DIY research rules apply.
One of my more out there theories that seems to be quickly gaining traction is that a low dose of GLP-1 agonists can be surprisingly good for autoimmune conditions.
Most of my other peptides are hEDS focused and include VIP, Ipamorelin, Selank/Semax, and BPc157/TB500. Though I really only take the ipamorelin and semaglutide these days. These are a bit more risky but since my alternative is to be very sick I have a different risk tolerance profile compared to most.
Your comment immediately above this was likely flagged because of your inflammatory accusations and assumptions about why your were downvoted, and IMO shows a alack of introspection about possible reasons as to why you were downvoted. Much better to ask why than to throw out accusations, at least if your goal is to have a useful discussion or learn something (bot of which require some level of assuming good faith to others here).
GLP-1 drugs may be a game-changer for obesity and diabetes, the same way that cholesterol (statin) drugs have greatly improved heart health. Hopefully reversing a long trend of increasing waistbands in developed / developing countries. Unfortunately, America will pay the highest price (including Medicare). I'm all for anything that makes them cheaper, including the many compounding pharmacies currently exploiting the loophole the author takes issue with.
The problem isn't that compounding pharmacies provide cheap versions of the same drug, it's that the compounding process doesn't produce exactly the same drug, and hasn't undergone the same stringent quality controls as Wegovy etc.
Ideally, these drugs should be cheap. The compounding is only done because there's a loophole that provides a market opportunity. The correct solution would be to improve the regulations in a way that would let more manufacturers produce safe generics.
[1] https://www.goodrx.com/classes/glp-1-agonists/compounded-sem...
The legit path for compounded semaglutide is buying up Rybelsus, impacting the supply for diabetics. Compounding pharmacies are notoriously shady, and are likely using grey market materials from questionable sources.
Are they? Compounding pharmacies are common and boring. If someone hasn't yet used a compounding pharmacy then it's likely they're in very good health -- yay for them!
What's being described doesn't feel like an issue with compounding rather folks setting up shop to peddle questionable drugs.
You have no idea.
On the flip, I think access to basic drugs for stuff like ED, hair loss, etc is fine. But they also do stuff like off-label anti-depressants, etc can potentially be dangerous... but at the same time, people are going to urgent cares and getting antidepressants with just more cost and friction.
Don’t forget “effective” too. If you just make the bar “safety” then you are accepting sugar pills as medicine for whatever condition. You should need to prove both safety AND effectiveness.
I want bodily autonomy and control. The right to experiment with weight loss drugs is analogous to the right to be trans or to not have your foreskin removed at birth.
It’s crazy that these drugs even have further benefits like anti addiction properties!
Both things the current administration is fighting against, so the metaphor is really apt.
There are a lot of trans people on HRT that DIY their meds, especially transfemmes, because estrogen is not a controlled substance.
They are in general shady, and the Florida pharmacies are notoriously under-regulated. Guess where most of the online dick pill outlets do their compounding?
Factually incorrect. A country is not a race. You cannot be racist against a country, by definition, and China in particular has a very well-documented pattern of making low-quality clones of products from other countries (often using IP stolen from those countries), so the concern is well-justified.
More generally, the use of "racism" as a response to well-justified concerns about products of a country is completely irredeemable. It's logically invalid, emotionally manipulative, breaks the HN guidelines, is blatantly anti-intellectual, and is mostly used as a propaganda technique by state actors. Please keep this drivel off of platforms like HN that are designed for intellectual curiosity.
My understanding of criticism of China (in particular - although I have also seen this effect with many other countries) being interpreted as racism is very different than the explanation that you provided, but that's too long to get into. Meanwhile, this is an extremely interesting second-order effect that you pointed out that I hadn't realized before. Thank you for pointing this out!
China produces things. Of high quality as well as low. More and more, it’s the only source for high quality things.
The OP’s conniption is about intellectual property and monopoly protection, not health.
Everyone in the world (almost) would be far healthier with weekly injections of Chinese chemicals.
Does the telemedicine appeal to people because they want to avoid embarrassment, or because they know that traditional doctors will schedule you for an appointment three months out just to say “have you tried getting better sleep, losing 30 pounds, and reducing stress?”
Hair loss is sucky, sure, but in the grand scheme of medicine it's nothing. Erectile dysfunction sucks, but are you old? That's just the name of the game.
I lost my testicles to cancer (yippee) and you would be shocked how difficult it is to just... get testosterone. My fundamental bodily functions no longer exist, but I'm technically fine so... I guess that's okay? Like I'm not dying, and quality of life is in the eye of the beholder or something. Never mind I'm literally castrated, like physically. And they'll talk your ear off about side effects.
Side effects? What about primary effects? Man, I have no balls! Everything sucks and I wake up feeling like I've been run over by a truck!
Yes, I learned this the hard way, when I was trying to figure out why I have zero libido, brain fog and brain fog having a healthy BMI and lifting weights.
As a 35 year old, I had the T levels of a 65 year old men, yet doctors refused to consider this an issue because it was in the "normal" range.
It took me over a year to get a diagnosis of Secondary Hypogonadism in Canada and that was after I went to see a male private urologist after giving up on a public health care in Canada.
This was finally revealed once I finally did more specialized tests for LH, FSH, Estradiol, Testostrone and Free Testosterone at the requested of my urologist.
After 3 months of HCG treatment and all the symptoms were gone. It has now been 2 years and I have never felt better in my life.
I wonder if physicians standards for normal are warped by spending most of their time in contact either with the ill or the overworked?
It's also pretty trivial to prevent or recover at onset. Finasteride and minoxadil are FDA approved on-label prescriptions for it (well, the later is OTC).
Dermatologists will happily write the prescription and check in with you as often as you want to schedule.
But - read up in the side effects and potential risks, they can both cause other issues in some people, and for me it took a while to find the right finasteride dose.
Another downside is oral finasteride use means I can no longer give blood.
Minoxadil increases blood flow and restores the natural growth cycle lengths of weakened follicles. This is applied topically, and promotes hair growth pretty much anywhere - beard, crown, temples. You can take it orally, and it will promote hair growth everywhere (more body hair). However, it can't fix follicles already dormant or scarred over. So if things are already bald, it may not give the results you want.
A word of warning that about 5% of those who take Minoxadil experience a shedding period where it gets worse. Because it restores normal hair follicles growth cycles, this includes the process of pushing out old hairs. This is not permanent and will last, at most, a month. This is why most providers like "Keeps" will try to sell in batches of 3 months.
In 2026, a new drug will finish phase 3 human trials. That one targets (IIRC) stem cells and can restore even advanced hair loss where the follicles are dormant or dead. Very exciting!
There's a lot of shame in society around all of these issues, and it's really appealing to a lot of Men to be able to spend an extra $100-200 to not have to have a conversation that embarrasses them with a Doctor who may know their wife, friends, or otherwise may be part of the community. That's the value proposition of Hims; a $200 fee to maintain the illusion of their inherent virility and masculinity. A lot of Men will happily pay that, and have the disposable income to do so.
Telemedicine isn't a panacea, but in a system with major constraints on doctor bandwidth and where in-person visits are very expensive, it's extremely helpful. And yeah, a lot of that is because so often the solution is as you said -- get more sleep, eat better, maybe work out a little, reduce your stress. I'd much rather have a quick 15 minute call to be told that, instead of having to take several hours off work to go visit the doctor in person.
If people could just “reduce stress” on a whim, they would. Having a doctor tell you reduce stress will actually increase stress.
It was enormously helpful /s
Don't forget that 3 month out appointment is probably 15 minutes long with a 30 min office wait which you'll then inevitably fight insurance over (Hims doesn't bill insurance either)
There are good things about Kaiser, but definitely not-so-good things. I'm still pissed at them for my fiancée, fresh from the dentist after a few root canals with a script for pain medication was told (at their hospital pharmacy, no less, so it wasn't that they didn't have it available) that they would only fill pain medication via mail order. "Oh good, so I just need to wait 5-7 business days for relief from my root canals."
"The most damning aspect is not their exploitation of loopholes or their willingness to combine dangerous drug cocktails or even their reliance on unvetted Chinese suppliers..."
"unvetted" is doing a lot of work here. There's no evidence provided for this claim of working with shady sources and doing no diligence on the products they are selling. I know that to be false from first-hand connections in the telehealth space.
Hims works with 503B pharmacies. They are FDA inspected. They run batch testing on their source material and require strict compliance. All safe, legal, vetted pathways.
It's bizarre to me that the author is linking Novo Nordisk newswire press releases as sources of truth but is unwilling to to do basic research on how Hims operates. NN is hardly a faultless player here. They're selling this medicine for $1k+ per month!
Separately -- Algorithmic care is fine because most decisions are algorithmic. It's no different than what you receive from the 5-minute dr visit in person.
In a perfect world we'd have primary care doctors to coordinate care, direct you to the perfect pharmacy for each medicine you need, etc. In our real world, convenience and access are a good things. The shift from "patient" to DTC "client" is a net win for the public.
No masters except the patients that are literally being empowered to make choices about their medical care and are paying a substantial premium (in many cases) to do so.
I would happily be empowered by my doctor and UnitedHealthcare instead, but sadly that’s not on the table.
Try getting tretinoin from a real doctor; I’ve been written prescriptions multiple times, never once succeeded in actually getting it, because insurance is a fucking nightmare. And I’m not on a cheap plan.
Also note that the compounded semaglutide is superior because it comes in adjustable dose vials, unlike the pens. But I’m sure the author would claim that taking a smaller dose to reduce side effects is “a dangerous and unproven approach to medicine that puts patient lives on the line purely for profit”.
Fuck the AMA gatekeepers. Bodily Autonomy means I should get to buy and use any medicine I decide it worth my personal risk assessment.
So if you're paying for it with Hims why wouldn't you be willing to pay for the medication the doctor prescribes to you if the insurance company is refusing to pay for it?
That's a distinction without meaning. Say an insurer won't pay for cancer treatments. Although they're not technically telling you that you can't have the treatment, for all practical purposes they absolutely are (unless you're so rich you can eat the cost).
The article talks about Semaglutide, which is $750/month from a traditional pharmacy after UnitedHealthcare rejects paying for it, or $300/month from Hims. If you believe the medicine's substantially the same between those sources, why wouldn't you take the $5400/year out of pocket discount?
Meanwhile with hims I order it and I get it.
Deviated septum with 90% occlusion in one nostril, see an ENT, also on a "platinum" plan. "Great, let's schedule surgery." ENT: "Hold fast. First, I'm going to prescribe you these two nasal sprays so you can come back to me in four weeks and tell me that, to our mutual surprise and disappointment, they didn't realign the cartilage, and that way, insurance will pre-authorize the surgery."
I had to laugh at the gas station sex pill thing. In other countries not only do they have the gas station pills with Viagra in them, but they have a lot of basic "prescription" meds for sale over the counter at the pharmacy.
This style of writing is a welcome change from all the AI slop or self promoting blogs out there.
It’s a personal touch without making it all about the author. Long form articles with some humor used to be all I wanted to read on the web.
To be clear, whether or not it is AI prose is beside the point in my opinion. I think this piece is informative and funny but could be edited down significantly, regardless of how it was produced.
Dude. This is AI slop. And quite obviously so! You think all those EM DASHes are there naturally? Or the constant use of reversal? No one writes like that. (Even the people who love em-dashes and make a point of using the Unicode point will change it up more than that, rather than using it like a metronome.) Even if there wasn't that adrafinil referral URL giving it away (which incidentally tells you that OP wasn't doing all his own research but relying on the search plugin to compile a report he could spin), at this point you should recognize the 4o style.
This just doesn't sound like the normal ChatGPT because the author prompted ChatGPT to make it as invective and rhetoric and axgrinding as possible (or possibly, just went through and heavily edited a more neutral ChatGPT draft but I doubt that is responsible for the bizarre analogies or rhetoric like the hot dog thing).
So, a good example of the "don't worry about seeing AI slop on HN; worry about when you stop seeing AI slop on HN" evolution. Stripping referrers or avoiding EM DASHes is, after all, easy to do...
Also, top keks:
>> It is worth noting that the culture that produced Hims—Silicon Valley's peculiar blend of messianic self-regard and algorithmic thinking—has convinced itself that traditional gatekeepers are inherently suspect, that disruption is inherently virtuous, and that the phrase "move fast and break things" applies as beneficently to human bodies as it does to software systems.
I mean just look at this. I didn't even need to look through more than a few paragraphs to find:
> But the subscription traps are where the real extraction occurs—and here we encounter the kind of business model innovation that would make a mobster tip his hat in professional admiration. Customers complain of being locked into year-long commitments they can't escape, like hotel California but with erectile dysfunction pills. Better Business Bureau complaints reveal the pattern with the reliability of a Swiss timepiece: ... Picture ordering a 3-month hair loss kit only to find Hims has shipped and charged for a fourth without consent, like a pharmaceutical version of that friend who keeps ordering shots when you've already said you're driving.
BTW, where's the referral URL you speak of? I didn't realize there was a smoking gun.
Well, according to the principle of lenity, or strict construction, that's exactly how the law is supposed to work.
As with most products, companies need a way to make promises to consumers about what's in the products. The only way the consumers will believe those promises is if the consequences for lying are severe. Clearly room for improvement here, maybe some of these 3rd party certification labs can start putting their seals on medications too.
The article mentions that medication from China isn't part of an FDA approved supply chain, but as a consumer I don't really care about that. I'd rather have mass spectrometry data on the side of the tin than the FDA's blessing.
And I don't doubt that it exists. But I will say the limited number of times I've needed to interact with the system it was surprisingly cheap and downright pleasant.
The only negative experiences I've had is interacting with government run health systems (the VA).
Next time you go to a GP's office for no reason other than to gatekeep a specialist you know you need ask yourself what all those people are being paid for any why the situation deserves anything more than someone on the order of an RN saying "yeah looks like an infection to me" via a screen, to pick but one example.
Like all bureaucracy, every single part of the system has some skin deep reason to justify its existence or scope but when you take a step back and look at it all you'll find that huge swaths are either redundant or completely unnecessary, and that the industry is rife with this BS from top to bottom and we're all made effectively poorer for it.
I hate that companies use sleazy practices like this all the time, and then people are like "well it's your fault for not reading the fine print".
If you are interested in learning something about a key part subject matter (compounding loopholes and their impact on drug prices), this article is much better:
Maybe.
> Finasteride for hair loss runs about $10-15 per month as a generic,
I wish. Generic finasteride costs ~$70+t¹/3mo but only from a PBM, and $80/mo from a pharmacy, and is utterly uncovered by insurance.
Or maybe, it is that this is what American Rx healthcare looks like: https://imgur.com/a/awRSOsA ²
> and can cost as little as $2 per month with a GoodRx coupon.
And how does GoodRx somehow magically make drugs cheaper?
> On February 25, 2020, Consumer Reports published an article stating that GoodRx shared user data—specifically, pseudonymized advertising ID numbers that companies use to track the behavior of web users across websites, the names of the drugs that users browsed, and the pharmacies where user sought to fill prescriptions—with Google, Facebook, and around twenty other internet-based companies.
> On February 1, 2023, the Federal Trade Commission fined GoodRx US$1.5 million for violations of the Breach Notification Rule and the Federal Trade Commission Act for allegedly failing to obtain specific, informed, and unambiguous consent from users before disclosing health-related information to Facebook and Google.
(https://en.wikipedia.org/wiki/GoodRx#Controversy)
Last time I was offered a GoodRx coupon (well past those dates) it came with no informed consent of any kind, being merely presented as "magic coupon make drug cheaper" which triggered my "that's too good to be true" alarm. AFAICT, selling your information is the company's business plan.
¹Cigna is utterly incompetent, and while the discount of playing their game is sizable, it costs a great deal of time. It took, I think, 4? 5? calls to customer support to set up a prescription?
²No, proceeding to checkout does not get you the price. You don't get to know the price until after you've placed the order. I have to go on past experience, and prayers.
>Maybe.
It's like the author has never hung out with men over the age of about 25-30. That stuff is all broadly considered a laughing matter.
Source: I picked up a 6 month supply last week.
Yes, problematic
>We threw in Elizabeth Holmes for a lot less—though one suspects her fatal error was not the fraud itself but the transparency of it, the sheer crudeness of promising blood tests that did not work rather than the more sophisticated approach of selling actual drugs through loopholes so baroque that even their exploitation carries a patina of legitimacy.
What?
>The pharmaceutical equivalent of putting both ketchup and mustard on a hot dog and calling it gourmet—though one suspects the hot dog vendor would display more honest shame about his craft.
Huh?
Yeah, that's quite a stretch of comparison...
Questionable quality control vs brazen fraud
It is not an "illegal combination".
> They make these choices not because the products are better, but because the entire experience has been optimized to feel more like shopping and less like confronting the mortality and vulnerability that define the human condition. This is what disruption looks like when applied to the oldest human needs: not improvement, but the illusion of improvement
And contrary to what the article claims with hundreds of words of flowery indictment, it is improvement. As everyone on this site should be able to tell you, UX matters, and the medical establishment has some of the most frustrating, unpleasant, and confusing UX of any necessary service.
Of course shady companies are going to get lots of business when all the competition following the law most faithfully provide a broken UX, and the only way to do otherwise is to bend the rules.
However, when I get referrals from OneMedical to specialists like eg sleep apnea, those 3rd party specialists usually have like 8 month waiting lists. So, back to Hims-style online-only providers for that sort of thing.
They’re still a great option if you have other needs, like Prep or stimulants.
A large percentage of people want their doctor to prescribe them antibiotics when they have a virus. It’s been shown that doctors who over-prescribe antibiotics get better patient reviews for example.
Now you have a “better UX” that pops up that gives people exactly what they want. They answer a few questions on a website and they get an antibiotic prescription.
There is no way for the medical establishment to compete with a site that will give people what they want even when it’s harmful to them without even requiring any kind of examination.
In the case of antibiotics, this kind of behavior breeds resistant bacteria that regularly kill people.
In the case of other drugs or combinations of drugs, the risks are usually only to the patient themselves. But the risks are real and patients assume this stuff is regulated.
Are they over-prescribing, or are the others under-prescribing? Comparing how hard it is to get antibiotics as a human with how easy it is to get them for animals (even if there's no evidence of disease) certainly makes one think.
And none of that has any impact on whether or not we should limit antibiotic overuse in humans.
Doctors certainly aren’t under-prescribing antibiotics if you look at the data.
As far as human antibiotic use, the flip side are the colleagues who will tell me that they did a thorough workup on a patient, found no indication for antibiotics, told the patient so to the best of their ability, and got dinged on the insurer's survey or castigated on doctor rating sites. I'm of course only hearing the provider's side of the story, but nobody likes to be told no, even when it's the right answer. (Also insert opioids, stimulants and benzodiazepines into this conversation.)
GLP-1s are a miracle drug, people want it so will do what they must to get it. Unfortunately for many of them they cannot afford the $1,000 a month price tag that comes with legitimacy. On top of that, regular doctors make you jump through hoops to get it, having to see the exercise and diet department of whatever hospital group they belong too. this adds hundreds / thousands to the cost.
Let people have what they want. Hims parasitized the process but I don't blame them for it. They gave the people what they wanted and made a profit at the same time.
Adults should be empowered to make their own health care decisions but unfortunately so many of those decisions are made either by insurance companies or the attractive sales reps that frequent the doctor offices. GLP-1's, testosterone, peptides, whatever, remove the gate keepers and allow the free market to compete. The fact that you can go to jail for ordering a 10ml bottle of test cyp over the internet is madness. I rarely go to the doctor now, except for things that are clearly beyond my limits, xrays, colonoscopy etc. For everything else there is the internet and chatGPT. GLP-1s, peptides, steroids, even anti biotics, almost everything you want can be found if you look. The way it should be. I even order my own labs and have chatGPT interpret them for me.
I'm in the best shape of my life at 46 and haven't been to a non hormone doctor except for specialists in several years. Last time I went to the doctor I told them I wanted GLP-1s and they said no, I would have to go and see their diet department. I told them if they did not prescribe them I would just get them online but I would prefer to use them under the supervision of a dr. They just shrugged.
I'm on cycle currently but when I am done and coasting again I am going to hop on metformin to take a crack at stabilizing my liver levels caused by fatty liver before I took control of my own health. Because... why not? Think a doctor would prescribe this?
Let people be the decision makers of their own health. I'm not knocking doctors, they are often highly intelligent people doing good work but their power as gatekeepers does not come with neutrality and they are often beholden to their own bottom line as opposed to the patients well being.
They don’t care that it helps people stick to their healthy diets and get better. They need these people to bear the stigma of the gluttony.
Still on it, I occasionally take a full steroid cycle once a year though to accomplish certain physical goals.
Generally run a single 14 week cycle each year where I essentially triple the amount of testosterone I take. I may add another substance for the 14 weeks as well. Then I return to the regular testosterone replacement therapy dose.
I feel and look 20+ years younger. I get blood work done 3x a year and additional 2x while on a cycle to ensure I am good.
My wife has also gotten on TRT, testosterone is required for women as well, just at much lower doses. Her levels were very close to zero, even her OBGYN was surprised. She has seen good results as well. Not the full new lease on life I have had as Testosterone is not as critical for women but an increased sex drive and more energy. She is very closely monitored by her doctor as too much will have negatives for women.
I'm also on GLP-1 medication (Semaglutide), I got on in January and have lost 30lbs. Started at 240lbs and am now 210lbs. I have visible abs again and can bench 405lbs. These are the only medications I am on. Blood pressure is perfect, cholesterol is perfect, etc. Only negative I have is fatty liver which I was diagnosed with in my mid 20's. I'm going to self prescribe Metformin in a couple months (I am currently on cycle) to see if I can resolve that. If I can fix that then I will essentially be healthier that I have ever been in my life.
If you go on a fad diet, lose weight, then gain it back when you stop, well, you haven't really lost anything other than time.
If you go on semaglutide, lose weight, then gain it all back when you stop, you're out thousands of dollars, I'm out money when my insurance premium goes up to support the new expensive drugs, and you might have permanent health complications (rare though they might be).
I haven't heard any success stories of people keeping the weight off after they stop taking it, though I've heard plenty of people gaining everything back, and being miserable from the side effects while they were on it.
If semaglutide worked as a stopgap to help you get to the point where you could manage your weight on your own, I think it would be hard to argue with it. So far, though, I've had people tell me that it should be treated as just another vitamin supplement that you'll be on for life, albeit one that costs $12k a year or whatever the case may be.
The "ooo scary medicine!" thing doesn't really work for people who are already sick and suffering. That ship has sailed.
Does obesity have permanent health complications and cost you extra in premiums?
For example, I could say, just start running/cycling/swimming if you want to lose weight. It's really easy! If you slowly work up to working out 5 hours a week, and keep at it, your obesity will probably disappear.
However, most people won't be able to do that, because it's boring, takes a lot of time, and they will stop sooner or later. There are some success stories of people who stuck with it and lost 50kg, but these stories are so rare that they are noteworthy.
Taking daily meds on the other hand is something that most people manage to do just fine.
It's a good thing then that insurance won't pay for it and these services don't even bill insurance.
It's also not $12k a year for the generic, it's around $1200 a year. The drug isn't that expensive to make, the brand is just jacking up the price.
They're also under prescribed for things like appendicitis.
I should also add that those pharmacies, if they are based on the United States, invariably have a licensed provider in there signing off (they would be illegal otherwise).
I believe many obtained ivermectin through similar channels despite it being a prescription drug
Ivermectin is available there as well. Never tried it though. Actually thinking of taking a mild course though. Why not?
Regarding the licensed provider, you are absolutely correct, I always get an email signed by whatever doctor works with the site. Its a rubber stamp but its does provide legality.
No association with it but have used it multiple times.
https://allfamilypharmacy.com/
Mods if this is not ok, my apologies
https://news.ycombinator.com/item?id=44318773
"What to do with this massive infrastructure and billions of dollars of investment and workers employed by this global machine?"
... and that is where gambling and vaping (and ED pills and hair thinning medication) come in.
I'm skeptical that the (personalized, aggregated data, pinpointed advertising machine) works for things of value and substance that require thought and nuance to purchase.
As a consumer of online advertising for over 25 years, I have found much of it to be a grift.
But if I were selling nicotine pouches ... or weightloss aids ... or access to gambling ...
I'll bet it finally delivers as promised.
The paternalism of medicine is infuriating. Doctors have been, for the most part, annoying gatekeepers of medication I already know I want or need. Way more medications should be over the counter.
And I know full well I’m paying more than I should. One of these days I’ll look for a cheaper alternative.
Honestly, this was way better than using insurance for a physician visit. Half the time you go to the doctor, you already know what they're going to tell you.
I could be wrong, but I believe this system was first made legal during COVID. Despite all the pearl clutching, it works exceptionally well, and should have been legal earlier.
Perhaps HN is full of people with high digital literacy, relatively high reasoning ability etc. People like this can benefit from the service.
The article's core point is that Hims uses unethical marketing. Maybe the HN crowd is privileged: people here may be able to resist marketing.
The article's unstated point is that many people who use Hims would be better off not using it.
HN people tend to be wealthy tech workers. I'm not sure how many people here know about the brutal conditions outside their cozy tech bubble.
There are tens of millions of Americans with low cognitive ability, low digital literacy, high susceptibility to advertising, high stress, poor health, and demeaning jobs - all at the same time.
Many of these unfortunate people spend pretty much their whole lives bouncing around from scam to scam. At age 15 they get exploited by an older boyfriend. At age 26 they get exploited by a for-profit college.
Then at age 45 they get exploited by unethical pharma companies. Like Hims.
The healthcare industry spends a lot of time dealing with this population. Many of these people tend to be "frequent flyers" of government-run programs. People who work in hospitals understand these unfortunate people intimately. When those hospital workers make laws, they spend a lot of time thinking about how to protect these people. Then Hims come along and targets them specifically.
The article's point is that Hims exploits vulnerable people. And I agree.
There is a difference in that hospitals and drug companies provide useful care while Hims more or less doesn't. But the amount of resources extracted by the health care system is way higher. It's an open question of whose worse.
Should these people be eligible to vote?
Absolutely. Being a victim of repeated scams isn't a crime. These people need help and ideally to be given tools to use to protect themselves. They don't deserve disenfranchisement.
Leave fat people that want to lose weight and men with weak dicks that want to be able to have sex again alone, for fucks sake.
"The shameful doctor visits."
The what? Seriously, doctors in urology and related fields have seen guys whose dicks haven't just malfunctioned, they were BLOWN OFF, so shame really isn't a factor here!