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.

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)

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.

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?”

"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”.

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.

> 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.

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:

https://www.astralcodexten.com/p/the-compounding-loophole

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.

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?

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.

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.

And I know full well I’m paying more than I should. One of these days I’ll look for a cheaper alternative.

It is not an "illegal combination".

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.

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!