hckrnws
>The real tragedy is not that Hims exists, but that it works so perfectly. Every day, thousands of people choose their compounded weight-loss drugs over FDA-approved alternatives, their combination ED pills over established single-ingredient treatments, their algorithmic consultations over actual medical care. 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.
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.
> 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?
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.
> 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.
Someone's presumably paying her more than $50/hr, which will burn through your monthly fees pretty quickly. Where's the money coming from?
It works the same way that health insurance works -- most people don't need all that much care, and when time-consuming care is needed, it is often pushed to the specialists rather than the generalist. Your $50/mo payment might not seem like much, but if all you're doing is a bi-monthly checkin with them over the phone, you're really paying more like $100/visit for a 15-30 minute visit.
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.
Doctors make $20k a month or more.
That's 420+ patients at $50/m.
Doesn't seem feasible to know them all personally and deeply.
Other revenue would be needed.
It is totally feasible and not uncommon for a family doctor to have 2000+ patients. Young healthy people can go years without interacting with the medical system, and when they do it's often some thing that barely involves their doc. I mean their doc doesn't know them personally then, but they have no problems worth surfacing clearly so why do they need to? The limiting factor really is the quantity of seniors and people with complex chronic conditions that you take on.
Comment was deleted :(
You're not going to be seeing every patient every month. Many you might only be seeing a few times a year; They will have a quick phone chat every few months to make sure their prescriptions are up to date, maybe order a blood panel or two to stay on top of things. They're not coming in every week for an hour-long deeply-personalized appointment. As long as the practice limits itself to a reasonable number of patients, they should be plenty solvent.
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.)
420 young, healthy patients probably see the doctor 2x a year at most. That's less than 20 visits a week for the doctor. And as soon as you become unhealthy you are passed along to a specialist or dropped.
You're paying for the bedside manner, not the medicine.
I’m 39 and I see my doctor once a year, at most. This year I had a urinary thing. Last year and the year before that I had a rash. The year before that I didn’t go. For all of my twenties I went three times. She still remembers me just fine, asking how is my CrossFit doing.
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.
In the models I've seen, they still require and bill insurance. The monthly fee is a supplement for the doc practices.
You're also probably fairly healthy and not much work. Concierge care for my elderly parents with complex diseases has been quoted at $20k/year.
How could this possibly work out for her financially? To make 120k a year, she would have to be doing this with.. 200 patients; and I think the average GP makes a bit more than that in the US. That doesn't like a good bargain on her end.
200 patients is an extremely small panel size for the typical primary care provider in the United States. Many have several thousand.
I do not think I have ever spent more than an hour per visit actually in the room with my GP. I have an annual checkup. For a while there my GP was world class and also a blood relative.
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.
Not paying someone to chase insurance saves something anyway.
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 guess I see this as somewhat different. These people are proactively choosing to maintain a relationship with a physician for an elective $50/month. I think the type of patient who wants a type of this relationship is the type who is going to solicit more than a single appointment per year; otherwise, why not just use what the current system gives us?
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.
I’ve heard of this, also known as concierge medicine right?
But the figures I’ve seen quoted for such service usually begin in the four digits, sometimes five digits, annually.
Studies have shown that patient satisfaction scores are highly correlated with whether the doctor writes a prescription. When patients leave with a prescription then they feel like they got their money's worth, regardless of whether they really need it.
a lot of actual conditions are actually treated with actual perscription drugs.
> I do worry that it's sustainable
$50 + health insurance? I saw my PCP after my health insurance had unknowingly lapsed and a physical was ~$1k with just some basic blood work.
How people justify paying $1000 for probably less than 15 minutes of work is beyond me.
Beause people don't want to die or be uncomfortable
It’s possible for both you and the article to be right.
The system sucks, but Hims are also terrible, and medical care should not be like Amazon prime.
> 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.
Personally, I am thankful that I have better options than going through hundreds of options with scant and unreliable information about which is actually effective and will be supplied as as claimed. If, however, that is your preference, you can certainly get it in the US, at almost any price point.
I don't think it will take more than 5 teenage overdose deaths to get most Americans to disagree.
Opposite those ODs you have thousands of people spending an arm and a leg on medicine that truly improves their lives, with no ill effect to them.
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.
It would only take that many for lobbyists to misrepresent the size of the problem and convince the public that it was a huge issue. Then they would enact regulations to widen the moat of legacy health care companies under the guise of "protecting the children".
Kind of tired of making life hard for everyone because a few stupid people might potentially make some bad decisions.
Yea the US healthcare system is truly, truly awful, but that does not justify a turn to supplements, quackery, faith healers and witch doctors. The fact that people are turning towards these things should be a wake up call to the medical system, but then again the medical system misses wake up calls over and over…
I want something like the Amazon Prime of healthcare, but the Amazon part is remarkably persistent: https://www.pbs.org/newshour/show/patient-safety-concerns-ar...
Amazon Prime is facilitating prescription medications now.
One's a storefront. The other is a foundation of society.
These are not the same magnitude of sin, particularly since one's shortcomings are large reason for the existence of the other.
That quiet literally is the paradigm for many countries. Get off a cruise ship in Latin America and walk to the nearest port side pharmacy and get almost anything you want.
This article is pure FUD pearl clutching
I helped setup vaccination sites during the pandemic. One thing that struck me was how the providers who were working and the patients were all like “this is so much easier than normal medical care”.
Hims is like that.
> it's because the existing process to get medical treatment is paternalistic, hard to navigate and often expensive
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.
Literally the only reason I would use them is price. Cannot get anything for the prices they offer at a normal place or through insurance
But access to medical treatment, particularly drugs, should be "paternalistic", so I strongly agree.
Really? I wanted to try Cialis, primarily for my enlarged prostrate but also for the erection effects. I asked my primary care doctor, that was a $20 copayment, I fill it my local pharmacy and it costs about a $5 copayment for a month’s supply. It’s a big practice where I might have to wait a long time if I want to see the head doctor but if I don’t care who I see I can usually get in pretty quick and they do a good job of keeping notes so care is well coordinated.
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.
Good for you but if you think your anecdote is the case for everyone you need to leave your personal bubble and talk to people
I don't think it's all a bed of roses.
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...
The explosive growth of Hims and other side-channel healthcare businesses (using this model -- telehealth combined with compounded meds) is entirely due to the "legitimate" healthcare system's complete and total failure to serve patients' needs.
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)
[flagged]
An oligopoly colluding to push the price of easily produced products into the stratosphere isn't a product of deregulation. In a deregulated or under-regulated market, thousands of cottage-industry insulin producers would be competing to shave pennies off the prices of their insulin. You might have a hard time finding safely produced insulin, but you wouldn't have a hard time finding cheap insulin.
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.)
To reinforce your point, here's a quote from the article:
> 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.
This is a complex picture, so there's much more going on here than Big Pharma trying to squeeze out white-knight compounding pharmacies and supplement makers. What we have in the US is an industry that is constantly at the brink of system collapse, because that's the point of maximum efficiency/optimization. Pharma charges whatever payers (insurance companies) will support, and payers pass on whatever consumers can bear before literally becoming insolvent.
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.
Comment was deleted :(
Your comment seems very far from relevant; possibly you posted it in the wrong thread? Either that, or you're stringing words together with no regard for what they mean.
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.
I am unsure why you have been down voted because fundamentally your point is correct. Health is a fully regulated space, and no entity should be supplying medical products without adherence to requirements appropriate to their role. Compounding GLP-1 seems to me to be in the higher bar space.
I owe my health to gray market peptides, and for that reason and others I’m very happy they are available.
Also recombinant DNA processes for making these meds is pretty mature tech it’s not like some crazy trade secret.
Can you expound on your use of peptides? My nephew was diagnised with crohns at the age of 10, but they now figure he was being mistreated when symptoms started at age 4. He is somehow still alive, but there have been significant developmental problems due to crohns and an overuse of steroids and other weird medications in his treatments.
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.
Sorry to hear that, my heart goes out to him. I post a lot about it here on HN, you can scroll through my prior posts, about half are on this. Also feel free to email me. Chrons is pretty common in people with hEDS, which is what I have, so while I don't have direct experience with having it myself I do know quite a few people who have had it.
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.
I'd hazard the downvotes are due to the existing toxic relationship between legislation and the medical cartel.
Comment was deleted :(
[flagged]
More likely your initial comment was downvoted because it provides little additional context and makes a claim without support, as if it's self evident. Comments such as that rarely do well on complex topics. My own rule of thumb is that if I'm stating something as fact and I'm writing a single sentence, it's likely a low effort and low usefulness comment that is unlikely to be beneficial to the conversation.
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).
Factually healthcare is more regulated than most industries in the US and the web of regulations has no design and where it does, patient safety is rarely the primary goal.
That really isn’t what the HN audience is. That comment has a mix of upvotes, downvotes and flags, and at least some of the downvotes I can see are from HN users who routinely downvote/flag inflammatory rhetoric, no matter what ideology it’s advocating or attacking.
Healthcare is one of the most regulated industries in existence. You are fundamentally incorrect.
How about supplements? Yeah…
Supplements are basically condensed food, not medicine. No supplement provider makes medical claims about what the supplements do. The closest they come is the claim that they "support" various natural functions of the body, though I suspect there's no shortage of supplements out there that are skirting the lines and grey areas of regulations that should probably be reviewed.
Huh? Healthcare is probably the most regulated industry in America, and the world. Many of the problems healthcare currently faces could be dampened considerably with greater market competition; while creating problems of its own, of course, but it is absolutely the case that drugs get cheaper when generics become available; that's marketplace competition.
This is a frustrating article. To pick one example:
"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.
Semaglutide / GLP-1 compounding is not limited to just Hims. Lot's of pharmacies do it. The manufacturer (Novo Nordisk) charges 5x-10x for the exact same thing. The author calls the GLP-1s used in compounding "Chinese Knockoffs", but offers no evidence of quality control problems, and is instead relying on the reader's prejudices.
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.
Isn't the point of regulation to set the bar you must prove you meet, rather than a bar you must prove others haven't met?
The problem with your position is simple: where does it come from?
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.
> 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.
Is there evidence that compounded Semaglutide from Hims pharmacies has harmed anyone?
Safe and effective. Side effects are very rare and are usually limited to soreness at the site of injection. Recommend everyone who is recommended semaglutide by a relevant authority, to get it. The obesity epidemic is a national security concern
I don't think the question was whether semaglutide was safe, but whether the version that Hims sells is safe. That includes things like being free from contaminants, stability of the compound, etc.
> I don't think the question was whether semaglutide was safe, but whether the version that Hims sells is safe.
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.
Can you give some specific examples of compounding pharmacies buying up Rybelsus or using grey market GLP-1
Why would this product be different from any other product?
There’s a bunch of material out there including acknowledgment from the association of compounding pharmacies.
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?
Agreed. The number of times the article specifically calls out "shady Chinese knockoffs" is honestly, actually, racism. If there's evidence that Hims' drugs are harmful: Present it. The article doesn't. I know tons of people who have used Hims and companies like it, for a variety of things. I'm aware of no specific or general problems anyone has had with their medication.
[flagged]
> The genius of Hims lies in understanding that consumers will pay almost any premium to avoid the humiliation of discussing erectile dysfunction or hair loss with an actual human being.
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?”
When it comes to Men's health, doctor's really don't give much of a fuck. Their primary concern is are you actually sick, they don't care about how you feel, or your self-image, or your sense of masculinity.
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!
> Hair loss is sucky, sure, but in the grand scheme of medicine it's nothing.
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.
I think it's both. Hims doesn't really even do the telemedicine bit all that well, and Hims customers know what they're there for. This is isn't a "by the way" conversation at the end of an annual physical, nor is it a dedicated full-cost office visit to discuss ED, Weight Loss, or Hair Loss. It's a quick website visit, and then maybe 5 minutes zooming with a doctor in another state you will never see again and who will never remember you among the thousands of patients they "see".
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.
It's a little of column A, little of column B, but in a mixed way. A lot of doctor visits for basic health issues are ones that can be dealt with over a phone or video call. Routine stuff like updating your medicines, changing dosages, showing a bruise or dealing with a mild fever don't require you to be physically present at the doctor's office. Having to deal with insurance, scheduling, waiting times, driving to the doctor's office in the middle of the workday are unnecessary for a large proportion of the sorts of day-to-day issues people deal with.
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.
I always lol at “reduce stress” as medical advice. May as well tell depressed people to “work on your attitude, turn that frown upside down!”
If people could just “reduce stress” on a whim, they would. Having a doctor tell you reduce stress will actually increase stress.
After having a stress-induced LAD heart attack at the age of 46, my cardiologist gave me the "you need to reduce stress" line and I responded with "Oh, so you're not going to send me a bill for that stent in order to help me reduce my stress?" Apparently he believed that my heart could handle the stress of that bill after all.
And yet, it works a lot more often than you'd think. Just having someone who you perceive to be in some kind of position of authority tell you that it's okay to relax and calm down can have a significant effect on one's stress levels. And it works even better when you're not having to worry about how much listening to the doctor tell you to reduce your stress levels is going to cost you financially.
While doing my PhD at a top-tier college, I went to their health center for psychological counseling and said "I can't study and concentrate well, I don't sleep enough, I don't do enough exercise, I eat crap, and I drink too much." The expert told me that I needed to study and concentrate better, sleep well, exercise more, eat healthily, and drink less.
It was enormously helpful /s
Diet and exercise!
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)
My Kaiser doctor recommended Hims for finasteride.
Every human is just one "are you drinking enough water? how much water are you drinking" interaction with their doctor away from instant radicalization against the traditional healthcare system. You can really tell the author of this article hasn't yet actually had to use the non-emergent American healthcare system for anything significant.
The awfulness of the American health care system may explain, but does not justify a turn to things like quackery and faith healing.
> Regulatory arbitrage disguised as innovation, dressed in the fashionable vocabulary of patient empowerment while serving no master but the quarterly earnings call.
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”.
Tretinoin is easily prescribed by seeing a dermatologist. What do you mean it’s a nightmare to get even with a prescription? I think a tube of cream cost like $10 at Costco. You don’t even need to use your own insurance to buy things from the pharmacy as long as you have a prescription. I never once had a problem filling it before I switched to Accutane.
I'm confused. An insurance company cannot reject a prescription. They can only reject paying for it.
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?
> An insurance company cannot reject a prescription. They can only reject paying 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?
The egregiously heinous thing, in my view, is how a half dozen states still have some kind of health insurance mandate in their laws, and up until 2019 the ACA required all Americans carry it.
The attitude in this article is suffocating. I’m 40, healthy, and picked up cheap generic Cialis for the hell of it with no shame, no crisis. It flipped my sex life on its head, instantly. The real scandal is how cheap, safe, and transformative this stuff is, and yet the medical world acts like you’re doing something dangerous by just wanting better sex. It’s not a problem. It’s the most fun I’ve had in years.
The writing is hard to engage with—possibly trying to be funny, but it comes off as overly antagonistic. Phrases like “—presumably in a conference room with aggressively modern furniture—” feel distracting and undermine the point.
I agree. I enjoy off the wall and humorous writing usually. This article is pretty bad. Somehow it made me want to like the subject they were trying to eviscerate. I wouldn't want to be too harsh though; at least they did write something! Perhaps I'll read another article by this same person in the future and find they've improved their tone.
I had the opposite take, actually. I had to think about it for a sec and suddenly, “oh, right. Novo nordisk == Danish == Scandinavian design” cute.
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.
I think it is potentially still AI prose, perhaps just well-edited or working from a good prompt. Aside from using quite a few em dashes and being relentless in shoving cleverness in, there's a link to Wikipedia with a `?utm_source=chatgpt.com` in there.
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.
Comment was deleted :(
> This style of writing is a welcome change from all the AI slop or self promoting blogs out there.
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.
The link on "adrafinil" has a utm_source=chatgpt.com
The constant use of metaphor and simile drove me crazy. I had suspected this might be AI due to the frequency as well as absurdity of some of the comparisons (Talmudic scholars? Renaissance cardinals??) but humans also write dumb things like this that make them feel smart more than they serve rhetorical purpose. Or so I think.
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.
This article is quite bad: haughty in tone and confused in content.
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:
"The law, as Hims understood it, was not about intent but about technicalities,"
Well, according to the principle of lenity, or strict construction, that's exactly how the law is supposed to work.
Im all-in for using technicalities to get what I want out of the healthcare system instead of having them all weaponized against me.
Given the healthcare bureaucracy in America, it's hard to find anything for the consumer to be mad about here other than the quality of the medications. The intended audience of this article must be pharma and healthcare investors, not consumers.
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.
I see a lot of complaints about "the healthcare bureaucracy in America".
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).
Even if it isn’t cheap or pleasant, does that mean we should all turn to supplements and quackery? I’m really surprised at the replies dunking on this article. The fact that anyone can just go out there and make claims about and market their snake oil “medicine” should be worrying to more people.
I might be crazy, but I am more sympathetic to Hims after reading this than I was before.
Up until the part where people couldn’t cancel their subscriptions or got charged out of the blue
That's absolutely not the case. I've had two scripts years apart with hims and had no issue canceling. It's just a wizard on their website, super simple, no human contact. Does it ask if your sure a couple of times? Sure. But the right button is obvious and easy to see
I hate subscriptions and dark patterns and the like as much as anyone, but I am not sure putting a six-month pause on your subscription and getting billed in month 7 is “out of the blue.”
WTF? Why offer a "pause" on your subscription at all? The only reason to do that is to trick customers. If the company was honest, they'd get confirmation before resuming the subscription.
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".
And it’s not the best customer service if you can’t cancel something that’s already shipping to you. But it’s also not outrageous. You could always chargeback if you don’t mind them backlisting you.
> The genius of Hims lies in understanding that consumers will pay almost any premium to avoid the humiliation of discussing erectile dysfunction or hair loss with an actual human being.
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.
In a wild turn of events, this is actually a genius marketing piece paid for by Hims & Hers.
Except finding a doctor that genuinely cares about their patients personal needs is exceedingly rare. This is what Hims takes advantage of.
>What happened in those eight weeks reveals something essential about the kind of company Hims has become. Even as they shook hands with Novo executives in April 2025—presumably in a conference room with aggressively modern furniture—Hims continued selling what their new partner called "illegitimate, knockoff versions" of Wegovy. These were compounded semaglutide injections sourced, according to Novo's investigation, from Chinese suppliers whose quality control standards remained opaque at best and terrifying at worst.
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, the sound of the axe grinding obscured the message.
>What?
Yeah, that's quite a stretch of comparison...
Questionable quality control vs brazen fraud
so Hims found a way to VC back, blitzscale, and legitimize those shady online internet pharmacies from the dark corners of your inbox
"sildenafil and tadalafil — an illegal combination"
It is not an "illegal combination".
Sorry but the new breed of companies like Hims is making our system massively more convenient and cheaper and I won’t pretend they aren’t.
This is what I was saying here, speaking of pinpointed, personalized advertisements:
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.
Hims is actually very expensive. I get the same Semaglutide for far cheaper either via my hormone dr. (provides a small, reliable dose of testosterone (trt) every month and legit access to hard to get compounds via a compounding pharmacy. No hoop jumping, they have a menu, I order from it. In real life I take 2 - 3x the testosterone dose when I am on but when I am coasting its easy no stress way to get what I want delivered monthly. When I am not using what they provide I just set it aside for the apocalypse :) )
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.
There’s a very vocal, puritanical anti-semaglutide crowd that thinks using the drug is a way of subverting the moral order. “You have poor willpower, you’re SUPPOSED to be fat as a punishment!”
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.
These people should be firmly ignored. I am very open with my drug use. If anyone objects I have labs that I will happily compare to anyone's and I am in better shape than 95% of 20 year olds. There should be no stigma associated with being the master and commander of your own body and health choices.
Why are you taking testosterone?
This is not a charitable take of the critics.
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.
Most obese people are going to be on lifetime drugs anyway, in the form of metformin, statins, insulin, you name it.
The "ooo scary medicine!" thing doesn't really work for people who are already sick and suffering. That ship has sailed.
A year after quitting semaglutide, 20% of people maintained their achieved weight. But, some 44% regained weight. Of that 44%, most (59% of them) still had improved weight: their weights had not fully rebounded to their pre-semaglutide level! Possibly even more importantly, the remaining 36% continued losing weight, either mildly (47%) or majorly (53%)
That's certainly a significantly better rate of success than what I'd heard from the people I know who took it! Perhaps there's just some weird selection bias in my network.
Bad news spreads better than good news.
Do you hear more from people that made money in crypto or that lost money?
> and you might have permanent health complications (rare though they might be).
Does obesity have permanent health complications and cost you extra in premiums?
There are other options for addressing obesity than "semaglutide or nothing".
Yeah, but they don't work for most people.
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.
> I'm out money when my insurance premium goes up to support the new expensive drugs
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.
Counterexample: what about antibiotics? There are negative externalities to their inappropriate use (yes, there are plenty of stories about the infections that were missed, but that has a lot of selection bias). There are countries that allow their use over the counter. Is that a good thing?
But antibiotics in the US are still over prescribed by doctors. There really are few cases for them for the mostly healthy adult; and they wreak havoc on your microbiome for what we're finding out is years. I know many people who will get antibiotics prescribed when they have a common cold (mostly a virus).
They're also under prescribed for things like appendicitis.
Yes. You can order a significant variety of antibiotics over the counter / web in the US. I have 2 Z-Paks, a bottle of Amoxicillin and a bottle of Doxycycline sitting in my medical drawer. You can order them legally via US based online pharmacies. If you are an adult you should have the freedom to treat yourself. Freedom does not absolve you of responsibility though. If I mess myself up I have no one to blame but myself.
I can't agree with you there, because if you're treating with the wrong dose or for the wrong length of time, you run the risk of making that infection resistant. For communicable illnesses, that can be a risk for others. But I appreciate your honesty.
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 don't know about op but I've heard the veterinarian versions of antibiotics are widely available. Who knows on the quality control
I believe many obtained ivermectin through similar channels despite it being a prescription drug
In the United States, at least, veterinary preparations are broadly manufactured to the same standard (some veterinary drugs are relabeled stock originally manufactured for human use, even). Dosing and concentrations may differ, however.
OP here, i only order from human sites :)
Ivermectin is available there as well. Never tried it though. Actually thinking of taking a mild course though. Why not?
I don't think either of us is wrong and I appreciate your viewpoint. Often ones opinion on these sorts of things depends on where on the sliding scale you stand with regard to the individuals duty to society and vice versa. What I always find interesting in these conversations is that often the position on the the scale differs by topic but such is human nature, we all have our personal pet areas of importance. I am sure there are topics where you and I would switch sides as to individual vs personal responsibility. Its what keeps life interesting :)
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.
Could you share some of those sites? I have chronic sinus infections and I'm so tired of having to go to the doctor to get the same antibiotic rx I've gotten 20 times before.
I see no way to DM on this site, so public it is.
No association with it but have used it multiple times.
https://allfamilypharmacy.com/
Mods if this is not ok, my apologies
This buried lede is really the core of the article:
> 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.
OneMedical (now owned by Amazon) provides a version of this that also connects you with a general practitioner doctor who you're able to see in your area. They additionally have telehealth-style prescription requests in the app, but you end up with the FDA approved version coming from Amazon pharmacy for $5/month (on top of the $200/year for OneMedical), or for $cheap at your regular pharmacy. A++ would recommend.
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.
I also have one medical, (cheaper if you have Prime), but they don’t do ozempic/wegovy, so you’re still at the mercy of insurance, or paying out of pocket if you want GLP-1s.
They’re still a great option if you have other needs, like Prep or stimulants.
Take the case of a antibiotics.
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.
> It’s been shown that doctors who over-prescribe antibiotics get better patient reviews for example.
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.
I think there is a big problem with antibiotic overuse in food animals, certainly. Although they can be useful for growth, large livestock farms are environments where drug-resistant infections can spread easily. I try to buy antibiotic-free meats as a rule but that doesn't really stop the damage caused by the meat companies that don't care about it.
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.)
Antibiotic overuse in animals is a problem. It was recently banned for use as a growth promoter however, and use in animals is inherently less likely to lead to human infectious drug resistant bacteria.
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.
They make a case for not trusting Hims but not sure why that means I should trust Novo Nordisk
What is Hims?
In Australia there is a company named Pilot which appears to follow an identical playbook.
I actually really like the compound hair loss solution they sell. I was already using ketoconazole after talking to my doctor and buying minoxidil over the counter. Getting something with finasteride as well consolidated and simplified things.
And I know full well I’m paying more than I should. One of these days I’ll look for a cheaper alternative.
I know it's funny because it's boner pills, but realistically, the article does not paint as bad a picture of hims as it is attempting to. The various rules they make to skirt the law seem silly, but are really the result of over-regulation. The simple truth about hims algorithmic care is that the vast majority of medical care could be given this way. This was a major revelation to me when I had a medical question that I asked through Amazon's online doctor platform (off-insurance) for just $30. The system asked me several quiz style questions. It determined exactly what was the problem (because again... most primary care is really not that hard). It gave a suggestion of what I'd probably get from the doctor. It sent all the details, including its suggestions to a board-certified medical doctor, who reviewed it within an hour, and then chatted directly with me via a secure messaging site. She agreed the plan suggested by the computer made sense. She asked a few more questions. Within 10 minutes, amazon pharmacy had my order and I received the medication the next day. I even received follow up care.
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.
PDE5 inhibitors and semaglutide should be OTC.
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.
Interesting how a few rare commenters strongly agree with this article and yet most comments here don't.
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.
>these unfortunate people spend pretty much their whole lives bouncing around from scam to scam.
Should these people be eligible to vote?
Thanks for asking a challenging question. I don't know. Historically most systems of popular representation have excluded them. I assume for reasons that made sense at the time. I guess I'd rather live in a country that had universal franchise + the means to escape these people's gravitational well. Rather than a country that disenfranchises them albeit for solid reasons. Basically you try to build a stronger engine rather than to reduce drag. These people are here and they're not going anywhere. We have to somehow make our shared world work. It's a large and difficult problem and most people really dislike talking about it.
[dead]
Those commercials are inane and stupid (along with BlueChew and FridayPlans).
"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!
The perspective of the doctors is not what a patient is embarrassed about
You don't get to speak for how other people feel.
Crafted by Rajat
Source Code