Posted by quadrin 6 days ago
> 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.)
In the case of antibiotics, they provably will not work beyond a placebo.
Despite the article's hang-wringing and attempts to brand them as "chinese knock offs", Hims boner pills work just fine because they're the exact same medication as the stuff you get from wading through the establishment.
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
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.
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.
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.
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.
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).
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.
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?
No association with it but have used it multiple times.
https://allfamilypharmacy.com/
Mods if this is not ok, my apologies
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.