>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.
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.
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.
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.
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.
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 anecdotally done some research and in SoCal a true concierge medicine for what I would be looking for with a brick-and-mortar location and imaging on-site is ~$5000/yr.
Curious what that fee covers beyond having direct access to the physician (and even there, beyond just consultations). If you needed imaging work or even procedures or surgeries - would that be extra fees?
Can't speak to the parent posters' experience, but for me, it covers a lot of imaging, routine bloodwork, cheap Rx for a lot of basic medicines (think blood pressure medications, diabetes meds.) I can get a full basic blood panel (CBC, CMP, LDH, ALT, TPT..etc) done for a few bucks instead of paying several hundred, that alone has saved me a good chunk of change over the years.
One of the huge benefits for me has been that I have much simpler access to specialists. They are somehow able to punch through a lot of the scheduling bullshit for me, so when I do need to see a specialist, I am not waiting for weeks or months; Sometimes I've been able to get appointments at a specialist through them within a few days instead of the few weeks it would have been had I tried doing the same myself.
That included lab work, talking to the front desk people, the nurse who took the blood, the GP, the drivers, the janitors, the record-keepers, the lab techs, and the calibration work on equipment and who knows who else.
I recently got a physical exam, including ultra sound, two urine samples, and bloodwork, at a private doctor in Austria and it cost 150€. You Americans are crazy.
I'm not sure how a physical would be more than 15 minutes of work. Lab techs? Standard blood tests are all automated, the most complicated part is putting the stickers on the vials. Yes, someone needs to calibrate the machine, but the machine processes 1000s of samples per day. I just checked, the price for a standard blood panel at a local lab is 14€. It's really not a complicated procedure.
Drivers? Janitors? What the hell are you paying those guys to justify a $1000 bill? And you really don't need to hire a driver to get a box of samples to the lab at the end of the day.
Supposedly in the Salzburg airport in Austria, there's an information counter for people who have learned that they are in fact in Austria, not Australia...
Americans can order their own lab tests for pretty cheap as well. In regards to pricing, the overhead for billing is about 1/3rd of the price, though not relevant in the poster's situation. It is part of why some prices here are so inflated though.
If a patient goes to see their doctor at a major hospital, part of that bill goes to pay for uninsured patients in the ER. Hospitals in the US by law have to treat everyone who come to the emergency room, which results in a lot of losses for hospitals that they have to make up for by charging higher prices on other services.
> And you really don't need to hire a driver to get a box of samples to the lab at the end of the day.
Smaller doctor's offices do their labs offsite, in the US just a couple of companies do the majority of blood work, as part of the contract with the lab, a driver comes by and picks up samples. In the great name of outsourcing, I imagine this driver works for a separate company as well, so now there is 2x outsourcing overhead, once for the lab, and again for the transport company. For doctor's offices that cannot justify their own lab, this makes some sense.
FWIW in my city at least, the majority of doctors are affiliated with large hospitals. They either work in a large hospital, in a satellite campus, or have an affiliate relationship (which from what I can tell just means medical records are automatically transferred over).
I go to a "smaller" office, it is a 3 story campus that is the satellite office of a huge hospital nearby. They do some of their own lab work and outsource other stuff. The hospital network is publicly owned and accordingly much nicer to deal with than many of the horror stories I hear online and from friends. (also the prices are reasonable and they always give me a price sheet up front of what everything will cost, which isn't always the case for some doctors...)
> I just checked, the price for a standard blood panel at a local lab is 14€. It's really not a complicated procedure.
Is that a 100% unsubsidized price?
In the US, cash price for a Comprehensive metabolic panel (CMP) is just $50. The same labs that the hospitals outsource to actually offer direct to consumer tests at really reasonable rates.
I just checked my hospitals cash rates:
A yearly checkup for an existing patient is $48.
Lab work is $48 (a $2 discount!)
Urine tests are another $20.
So in summary, OP got ripped off by their doctor's office.
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.
And even if it didn’t treat something now, it can treat things later
For example, a lot of asymptomatic STDs get accidentally cured by people taking antibiotics for unrelated reasons. Less paternalistic countries let people buy very significant drugs over the counter.
Being able to rule out that a simple infection is viral instead of bacterial is a huge boon. Doctors who want to cry about risk of superbugs (while eating McDonald’s during their break) can shove their opinion alongside side their antibiotic doused meat slurry straight down their pie hole.
Every nice pain killer I get I keep for emergencies. You never know when you’ll actually hurt yourself and be very happy to have some extra Vicodin.
Paternialism in medicine has been destructive for the human race and it has led to a lot of very very negative outcomes.
Im sorry that has been your experience. I am too on a patient of a doctor who belongs to a "large health system/insurance system provided by my employer with no choice". I have never once discussed billing. Every visit, while short 10-15 minutes, is focused on my health and if I asked questions, can extend to 30+ or more... really depends on my questions. I have never needed an hour with a GP, maybe a specialist.
I should clarify: the billing talk would come out when talking about options. “Let’s try X because insurance will need to see that we tried it before we try Y.” I don’t blame the provider. Navigating insurance still comes up with my direct primary care doc, but it’s not most of the visit. The real value I see is a willingness to take the whole picture into account (not just symptom -> med/specialist) and teach me about how things work and why. I have some complexity in my history for which this helps a lot.
Regarding the patient load discussion elsewhere, our entire family uses this doctor, we’re in for $200/mo but if we added up the interaction time even with me (a more complicated customer) it’s maybe 5 hours a year + some text communications with the MA / prescription wrangling. Their model seems to be all about effective scaling, I hope it is worth it for them, because my experience is vastly improved.
I admit I went to Hims a while ago. I filled out the questionnaire and had a "physican interview" where I was literally told "You need to change this answer from this to that, and this answer to this" if I wanted to get medicine, and "would [I] like a chance to review my questionnaires and we could discuss again in a few minutes?"
That's what you want until you have a serious and expensive health care problem. Segmenting off the healthy people like this simply means the people with chronic conditions or acute catastrophes are bearing more of the cost rather than pooling the risk.
Everyone wants to be the sickest person in whatever health care pool they are in, but that's not sustainable
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.
Same. For relatively safe medications, people should have the freedom to get medications that will resolve their issues without jumping through a bunch of hoops. As long as companies are providing full disclosure on the medications they are providing and side effects, I don't see any issue with it.
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".
Why not? It shouldn’t cost me $450 to go speak to my doctor for 5 minutes and say ‘I need Viagra’ and then have them write me a prescription, but it does cost $450 for me to do that. I can get (4) quarterly shipments from Hims for less than $450.
Personally I think viagra should be OTC, there’s no reason to gatekeep erectile dysfunction medicine.
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 like the US healthcare system? At least my on-the-ground, lived experience into middle age has been great. I've always had high-deductible insurance through my employer, never had a problem getting a specialist (even during the supposedly horrible HMO years) or special service, eg. MRI.
With an HSA, I'm basically self-insured for everything short of something catastrophic.
I don't know if I'm an outlier in this American Carnage, but with very few exceptions, this is the norm in my circles.
Just looking at pricing, I am lucky enough to have a similar insurance setup, yet we are still vulnerable to unlucky pricing and uncertainty about what insurance will cover. The price you pay is an unknown power law distribution random number with an unbounded upper value.
Ban insurance coverage for the quack bullshit like chiropractors, most forms of physical therapy , cupping, acupuncture, etc first.
If you’re not willing to do that than don’t try to take a holier than thou attitude against the supplement crowd. At least fish oil actually does help a tiny bit. Certainly more effective than 99.99% of adjustments.
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.
> 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.
+1000 to this. If your primary care physician works for a large medical chain (which most do), they aren't allowed to prescribe anything that goes against the chain's so-called "evidence-based" standards. Never mind that most medical chains also have insurance company arms and that these "standards" just happen to line up with whatever it is the insurance company thinks is appropriate to pay for. If you go to an independent clinic you can usually get prescriptions for "lifestyle" issues such as the ones Hims treats and then use GoodRx or a cheap online pharmacy to fulfill your prescriptions. Unfortunately, one of the side effects of the 2010 Affordable Care Act was to incentivize consolidation in the health care space, so independent clinics and practitioners are a dying breed.
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”.
What are you smoking? I’m a normal middle class guy with insurance and my PCP is an overworked but very cool guy who I’ve spent years getting to know. All of my peers in their 50s have similar PCPs.
While I agree the GOP is doing everything in its power to make sure lower income families cannot get good healthcare, lots of people actually have it. Not sure why you’re lying to make a point.
I don't understand US medical schools in the least. My son is interested in medicine, and I have sat through presentations where the admissions officers describe how they pick the student that has the best sob story from dozens of overqualified candidates. Then the poor jerk that is selected will work 20hr days out of med school in residency and finally patients will wait weeks to months to see them because there are not enough physicians (or they will see someone with a foreign degree). How does any of that make sense? Why not admit a couple more kids, stop causing overtired residents to make mistakes and address the shortage?
> you should absolutely have a personal physician you have a personal relationship with
best we can do here is the closest walk in clinic that isn’t fully booked by 9am and a doctor I’ve never met before. All they ever do is send me for blood work which is always flawless. Eventually my issues resolve themselves. If I get cancer or something serious I expect to just find out shortly before I die
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.
>there are legitimate reasons to think institutions are illegitimate but I think there’s something self-perpetuating about distrust, people find meaning in it.
The lack of institutional self-awareness is why it's not especially mental to find most humans more trustworthy than any institution. There's a bit of grandma's wisdom in not worrying about Kennedy or being a fan of Luigi.. then there are borderline cases like Shkreli or the CEO of UHC-- they seem to have the non-sentience of the upper-percentile institution (which btw includes almost every place of higher learning in the US, exceptions to be investigated for their unusual processes..)
I suspect the Ben Franklin thought of Congress as a bunch of his peers & not an institution (placeholder for one of PG's underworked cluster of ideas around informality)
This kind of thing heavily depends on your doctor and insurance plan. A lot of plans won't cover things like ED meds, weight loss, or hormone therapy. TBH I'm not entirely sure that's a bad thing as long as affordable alternatives are available outside of the insurance plan. Plans covering every little thing will increase premiums, so maybe for the products that Hims sells, this is a case of the market solving a problem.
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.
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)
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.
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.
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.
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.
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).
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.
You're being downvoted because you're saying something factually incorrect, and now you're being flagged for blatantly breaking the HN guidelines and degrading the discourse.
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.
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.
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.
That is not to say that Hims's drugs were unsafe, or that they even came from China to begin with. What I am saying, is that it's not racism to mention that Chinese products are, in fact, occasionally shady (of poor quality).
Sure; and a bunch of Phillips (a European company) CPAP machines (which had received full FDA clearance) killed over 500 people [1]. The J&J COVID vaccine gave over 100 people GBS [2]. We could go back to the 80s and pick on the Therac-25, which caused six incidents of severe radiation exposure or death [3]. And a thousand other examples in-between, of western made, FDA approved, vetted, and tested medicines or therapies that ended up killing people.
It would be stupid to believe that the FDA doesn't serve an important purpose. But, it would be equally daft to believe that even FDA-cleared products aren't, in fact, occasionally shady (of poor quality). It would be racist to believe that China is unique in the production of occasionally shady products; that the same things don't happen all the time in western manufacturing facilities.
> The number of times the article specifically calls out "shady Chinese knockoffs" is honestly, actually, racism.
Factually incorrect. A country is not a race. You cannot be racist against a country, by definition, and China in particular has a very well-documented pattern of making low-quality clones of products from other countries (often using IP stolen from those countries), so the concern is well-justified.
More generally, the use of "racism" as a response to well-justified concerns about products of a country is completely irredeemable. It's logically invalid, emotionally manipulative, breaks the HN guidelines, is blatantly anti-intellectual, and is mostly used as a propaganda technique by state actors. Please keep this drivel off of platforms like HN that are designed for intellectual curiosity.
It's interesting to consider why criticisms of China in particular are often interpreted as racism. No one makes the same accusation if you criticize America. Part of the explanation may be that China is much more ethnically homogenous: Han Chinese are 92% of the population. It seems that in the name of opposing racism, people are effectively rewarding China for being an ethnostate.
> It seems that in the name of opposing racism, people are effectively rewarding China for being an ethnostate.
My understanding of criticism of China (in particular - although I have also seen this effect with many other countries) being interpreted as racism is very different than the explanation that you provided, but that's too long to get into. Meanwhile, this is an extremely interesting second-order effect that you pointed out that I hadn't realized before. Thank you for pointing this out!
> It's interesting to consider why criticisms of China in particular are often interpreted as racism.
Astroturfing of the criticism of China = racism view is presumably a part of it. I don't consider investigating bot account networks to be a hobby of mine, so no, I don't think it's "interesting to consider."
Typically I would agree on the separation of nationality and race; but in the case of China its actually far more accurate to intrinsically tie the country and the race, given that this is the official position of the CCP.
No, it's factually not more accurate. The CCP's policies do not dictate reality, and the morally objectional ethnostate policy is both not actually the reality within China (given that about 9% of the population is not Han Chinese), and is not practiced by the majority of other nations/states in the world.
Most importantly, the author of the article is not based in China, or in any other nation that has an ethnostate policy, but in the US[1]. Therefore, even if you could make the argument that every person in China believes that states = races (which is clearly false), it still wouldn't apply to the author. Or, you know, almost anyone else on Hacker News.
So no, claiming that attacks on China are "racist" is still factually incorrect, and I really would hope that you'd invest the bare minimum of effort to verify that your claim is correct before throwing such an extreme accusation at someone.
There are concerns around safety. Compounding is somewhat controversial because they produce versions of FDA-approved drugs that are not FDA-approved, and may use chemical formulations (such as semaglutide salts) that aren't FDA-approved. [1]
The problem isn't that compounding pharmacies provide cheap versions of the same drug, it's that the compounding process doesn't produce exactly the same drug, and hasn't undergone the same stringent quality controls as Wegovy etc.
Ideally, these drugs should be cheap. The compounding is only done because there's a loophole that provides a market opportunity. The correct solution would be to improve the regulations in a way that would let more manufacturers produce safe generics.
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.
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.
Hims just outsources fulfillment to a compounding pharmacy. Usually they add vitamin B-12 to make it "customized". Are they crushing rybelsus? Getting raw materials through some mysterious supply chain from Ukraine, China or Israel?
You have no idea.
On the flip, I think access to basic drugs for stuff like ED, hair loss, etc is fine. But they also do stuff like off-label anti-depressants, etc can potentially be dangerous... but at the same time, people are going to urgent cares and getting antidepressants with just more cost and friction.
> 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.
Yup. And using it as the wonder drug it is, I.e women using it to get “beach bodies” should be celebrated and not stigmatized.
I want bodily autonomy and control. The right to experiment with weight loss drugs is analogous to the right to be trans or to not have your foreskin removed at birth.
It’s crazy that these drugs even have further benefits like anti addiction properties!
Semaglutide is linked to NAION, a "stroke" in the retinal blood vessels linked to a blood pressure drop there, typically when sleeping. I think I already have one of these in one eye. I DO NOT want to risk getting it in the other. Staying off semaglutide until it's really necessary.
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?
> 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!
> 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.
Yes, I learned this the hard way, when I was trying to figure out why I have zero libido, brain fog and brain fog having a healthy BMI and lifting weights.
As a 35 year old, I had the T levels of a 65 year old men, yet doctors refused to consider this an issue because it was in the "normal" range.
It took me over a year to get a diagnosis of Secondary Hypogonadism in Canada and that was after I went to see a male private urologist after giving up on a public health care in Canada.
This was finally revealed once I finally did more specialized tests for LH, FSH, Estradiol, Testostrone and Free Testosterone at the requested of my urologist.
After 3 months of HCG treatment and all the symptoms were gone. It has now been 2 years and I have never felt better in my life.
> 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.
Just to add, for anyone considering using minoxidil and/or finasteride - I can highly recommend both for the recovery of my hairloss.
But - read up in the side effects and potential risks, they can both cause other issues in some people, and for me it took a while to find the right finasteride dose.
Another downside is oral finasteride use means I can no longer give blood.
Finasteride alone won't reverse that much, it stops the path for testosterone becoming DHT (the cause of androgenic alopecia). Taken orally, it stops or slows all hair loss.
Minoxadil increases blood flow and restores the natural growth cycle lengths of weakened follicles. This is applied topically, and promotes hair growth pretty much anywhere - beard, crown, temples. You can take it orally, and it will promote hair growth everywhere (more body hair). However, it can't fix follicles already dormant or scarred over. So if things are already bald, it may not give the results you want.
A word of warning that about 5% of those who take Minoxadil experience a shedding period where it gets worse. Because it restores normal hair follicles growth cycles, this includes the process of pushing out old hairs. This is not permanent and will last, at most, a month. This is why most providers like "Keeps" will try to sell in batches of 3 months.
In 2026, a new drug will finish phase 3 human trials. That one targets (IIRC) stem cells and can restore even advanced hair loss where the follicles are dormant or dead. Very exciting!
It is far better than it was, my thinning was definitely crown but also hairline - I went for a walk one day and got really wet and when I looked in the mirror I could see just how thin my hair was. I've applied liquid minoxidil for 5 years now, and it reversed the balding to a good degree, but my hair is still thinner than it was at 30, but it is far far better than it was at 40. I've been using finasteride (tablets 1mg ever 3 days) for a year and it has certainly helped, but at my low dose I expect it to be another year before I know if it is really making a good difference.
My hair is very grey now which I think makes it also look thinner, but I don't want to dye it - though I tried Alpecin 'grey targeting shampoo' and it turned my hair blue... Not a good look for the office and extra visible in video calls
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.
You really should be drinking water, though. I get all sorts of odd effects that aren't obviously linked to not drinking enough water. I increased my intake for a few days and they all disappeared.
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.
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.
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.
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)
Kaiser isn't necessarily the best example here. Your doctor likely did that because Kaiser will generally not cover things like that, just as they'll almost never prescribe sildenafil or tadalafil or semaglutide (but they will happily refer you for gastric bypass...).
There are good things about Kaiser, but definitely not-so-good things. I'm still pissed at them for my fiancée, fresh from the dentist after a few root canals with a script for pain medication was told (at their hospital pharmacy, no less, so it wasn't that they didn't have it available) that they would only fill pain medication via mail order. "Oh good, so I just need to wait 5-7 business days for relief from my root canals."
Yeah they can definitely be archaic. I’ve stuck with them because they are the only provider offered to me that covers double jaw surgery. The cost of paying out of pocket for that would be prohibitively expensive.
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.
This is the one aspect of this article I’d have liked to understand better. It can simultaneously be the case that these compounding pharmacies are regulated, and also that they’re buying peptides from Chinese suppliers that aren’t regulated and hence there’s some room for serious problems. I’d be much happier if I felt that these suppliers were being carefully regulated and monitored but I’m not convinced that this is the case.
> 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.
My doctor keeps prescribing it and the pharmacy keeps not filling it. I’m not really sure what’s going wrong, I haven’t taken the time to debug the situation. I shouldn’t need to, and I’ve never needed to with hims.
So you’re not even willing to look into the issue, or understand what your problem is. You could have resolved this with like two calls to your pharmacy, but whatever keep shilling hims lol
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.
Yeah, please don't repeat this. This is the same thing that insurers say to Congress for other things too. "We're not denying care, we're just not going to be the ones paying for it", be it cardiac surgery, or (in the case of United) even Heli EMS from MVAs, because it wasn't "pre-authorized".
I’m not sure what exactly the issue is. The doctor prescribes and the prescription never gets filled. I assume the insurance said no and the pharmacy just decided not to fill it, they’re pretty inconsistent about what information they give out.
> 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.
Deviated septum with 90% occlusion in one nostril, see an ENT, also on a "platinum" plan. "Great, let's schedule surgery." ENT: "Hold fast. First, I'm going to prescribe you these two nasal sprays so you can come back to me in four weeks and tell me that, to our mutual surprise and disappointment, they didn't realign the cartilage, and that way, insurance will pre-authorize the surgery."
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.
It IS overly antagonistic. Maybe this stuff is overpriced but I think there is a need in the market. Lots of medication is protected by patents and overpriced. Doctors also gatekeep a lot of basic medications like Viagra. Third world countries are not nearly as uptight about medication, and probably sell Viagra and such as OTC medications. Perhaps the prescription system in the US can detect drug interactions, but for something like that there is probably little benefit to having a doctor in the loop. As for the quality of the medication, that could be debated. But it is quite possibly made at the same factories as the prescription stuff.
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.
> 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 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.
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.
They have to make it sound overly serious, because if it wasn't then you might question why you must go to a doctor or why the prices are (or were) high. When a new version comes on the market, they will conveniently find lots of negative side effects to make you take the newer and more expensive one.
I had to laugh at the gas station sex pill thing. In other countries not only do they have the gas station pills with Viagra in them, but they have a lot of basic "prescription" meds for sale over the counter at the pharmacy.
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).
Yeah, they're real good at doing needless work with a smile on their face.
Next time you go to a GP's office for no reason other than to gatekeep a specialist you know you need ask yourself what all those people are being paid for any why the situation deserves anything more than someone on the order of an RN saying "yeah looks like an infection to me" via a screen, to pick but one example.
Like all bureaucracy, every single part of the system has some skin deep reason to justify its existence or scope but when you take a step back and look at it all you'll find that huge swaths are either redundant or completely unnecessary, and that the industry is rife with this BS from top to bottom and we're all made effectively poorer for it.
You might not even notice it just from dealing with one referral. It really starts to gall when you see the pattern of nearly every actor in the system doing the least amount possible and then quickly passing responsibility on to someone else, often via yourself. The only exceptions I've seen are hospital doctors when there is an immediate acute problem that they can't just punt, and pediatrics where frequent repeating followups can be justified. Healthcare workers join this system because they want to help people, but the administrative parasites grind up their attention into tiny pieces until it is all but meaningless.
One thing about people in the US is that they really don't have as much bureaucracy as other developed nations and culturally we put a huge premium on service. So I think for a lot of people healthcare (or other forms of insurance) is the where they encounter it. That said, this is something I like about the US and I would like to see healthcare be more service oriented.
Doctor visits usually aren't so bad. But if you ever go to the ER or have to do something major like stay in the hospital, you will be surprised how expensive that gets.
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.
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.
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.
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.
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.)
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.
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.”
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.
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".
Pausing unlocks bulk pricing for customers taking meds as-needed (ED pills etc.). I'm not sure about Hims pricing since they require a questionare/login, but similar sites offer a sizable discount for larger quantities, and then it's just pause/unpause as needed.
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 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.
> 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.
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.
>> 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.
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.
You can get generic finasteride 1mg/180 (6 month) for as low as ~$17 if you go to a Kroger pharmacy and use their preferred savings program (I forget the name off hand) and no insurance coverage. Kroger discontinued their Kroger savings and now have a preferred card, which ended up being half the cost of the best deal on GoodRX.
>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.
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.
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.
Started out as Testosterone Replacement Therapy (TRT). I had low overall testosterone due to age (low 300's). Mid 40's. Not necessarily low for my age but low overall. Who wants the testosterone levels of an old man? Before I got on I was lethargic, unfocused and had no real drive. My evenings would consist of just sitting on the couch. I had been like that for years. I was middle aged. I didn't want to be like that so I saw a hormone doctor and got on. Best decision I have ever made. I am in the best shape of my life and the only time I sit on a couch is if I am watching something with my family. I have get up and go in spades now.
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.
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.
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.
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 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.
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.
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.
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.
What practically happens is that these people get worked by the health care system far worse than Hims does. And the regulators that are supposed to protect them enable the abuse.
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.
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.
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.
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.
"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 ...
Stupid article. Bottom line is I’ll pay a premium not because of shame but because I don’t want to schedule and drive to a physical location for a Drs appointment
This is one of the absolute dumbest things I have ever read. People want their problems solved without waiting months for an appointment and spending an insane amount of money, case closed. The fact that this market exists is an indictment of the current system.
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.
Article is unreadable. The auther is trying to be funny and clever but it just ends up being a slog. Im like 4 paragraphs in and still have no idea what Hims did wrong at all. Just present the information...
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 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.
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.
>She still remembers me just fine, asking how is my CrossFit doing.
That's because just before she walks in she reads your chart.
My chart doesn’t mention my hobbies. But yes, she does read my chart. It’s not very interesting.
Which seems plenty good enough for the care op wants
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.
I've anecdotally done some research and in SoCal a true concierge medicine for what I would be looking for with a brick-and-mortar location and imaging on-site is ~$5000/yr.
Curious what that fee covers beyond having direct access to the physician (and even there, beyond just consultations). If you needed imaging work or even procedures or surgeries - would that be extra fees?
Can't speak to the parent posters' experience, but for me, it covers a lot of imaging, routine bloodwork, cheap Rx for a lot of basic medicines (think blood pressure medications, diabetes meds.) I can get a full basic blood panel (CBC, CMP, LDH, ALT, TPT..etc) done for a few bucks instead of paying several hundred, that alone has saved me a good chunk of change over the years.
One of the huge benefits for me has been that I have much simpler access to specialists. They are somehow able to punch through a lot of the scheduling bullshit for me, so when I do need to see a specialist, I am not waiting for weeks or months; Sometimes I've been able to get appointments at a specialist through them within a few days instead of the few weeks it would have been had I tried doing the same myself.
$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.
That included lab work, talking to the front desk people, the nurse who took the blood, the GP, the drivers, the janitors, the record-keepers, the lab techs, and the calibration work on equipment and who knows who else.
That is way, way more than 15 minutes of work.
Still not $1000 worth.
I recently got a physical exam, including ultra sound, two urine samples, and bloodwork, at a private doctor in Austria and it cost 150€. You Americans are crazy.
I'm not sure how a physical would be more than 15 minutes of work. Lab techs? Standard blood tests are all automated, the most complicated part is putting the stickers on the vials. Yes, someone needs to calibrate the machine, but the machine processes 1000s of samples per day. I just checked, the price for a standard blood panel at a local lab is 14€. It's really not a complicated procedure.
Drivers? Janitors? What the hell are you paying those guys to justify a $1000 bill? And you really don't need to hire a driver to get a box of samples to the lab at the end of the day.
Americans are so much more fat and unhealthy than aussies. That’s the primary reason why it’s so much cheaper in Australia.
I’m not sure that’s true. The average BMI in the US isn't much higher than in Australia.
That’s one component. It’s a lot easier for Australians to easily afford to seek healthcare before an issue becomes acute.
Supposedly in the Salzburg airport in Austria, there's an information counter for people who have learned that they are in fact in Austria, not Australia...
Hahaha I just saw! They're two letters apart!
Americans can order their own lab tests for pretty cheap as well. In regards to pricing, the overhead for billing is about 1/3rd of the price, though not relevant in the poster's situation. It is part of why some prices here are so inflated though.
If a patient goes to see their doctor at a major hospital, part of that bill goes to pay for uninsured patients in the ER. Hospitals in the US by law have to treat everyone who come to the emergency room, which results in a lot of losses for hospitals that they have to make up for by charging higher prices on other services.
> And you really don't need to hire a driver to get a box of samples to the lab at the end of the day.
Smaller doctor's offices do their labs offsite, in the US just a couple of companies do the majority of blood work, as part of the contract with the lab, a driver comes by and picks up samples. In the great name of outsourcing, I imagine this driver works for a separate company as well, so now there is 2x outsourcing overhead, once for the lab, and again for the transport company. For doctor's offices that cannot justify their own lab, this makes some sense.
FWIW in my city at least, the majority of doctors are affiliated with large hospitals. They either work in a large hospital, in a satellite campus, or have an affiliate relationship (which from what I can tell just means medical records are automatically transferred over).
I go to a "smaller" office, it is a 3 story campus that is the satellite office of a huge hospital nearby. They do some of their own lab work and outsource other stuff. The hospital network is publicly owned and accordingly much nicer to deal with than many of the horror stories I hear online and from friends. (also the prices are reasonable and they always give me a price sheet up front of what everything will cost, which isn't always the case for some doctors...)
> I just checked, the price for a standard blood panel at a local lab is 14€. It's really not a complicated procedure.
Is that a 100% unsubsidized price?
In the US, cash price for a Comprehensive metabolic panel (CMP) is just $50. The same labs that the hospitals outsource to actually offer direct to consumer tests at really reasonable rates.
I just checked my hospitals cash rates:
A yearly checkup for an existing patient is $48.
Lab work is $48 (a $2 discount!)
Urine tests are another $20.
So in summary, OP got ripped off by their doctor's office.
Beause people don't want to die or be uncomfortable
Well I didn't know until I got sent a bill.
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.
And even if it didn’t treat something now, it can treat things later
For example, a lot of asymptomatic STDs get accidentally cured by people taking antibiotics for unrelated reasons. Less paternalistic countries let people buy very significant drugs over the counter.
Being able to rule out that a simple infection is viral instead of bacterial is a huge boon. Doctors who want to cry about risk of superbugs (while eating McDonald’s during their break) can shove their opinion alongside side their antibiotic doused meat slurry straight down their pie hole.
Every nice pain killer I get I keep for emergencies. You never know when you’ll actually hurt yourself and be very happy to have some extra Vicodin.
Paternialism in medicine has been destructive for the human race and it has led to a lot of very very negative outcomes.
Im sorry that has been your experience. I am too on a patient of a doctor who belongs to a "large health system/insurance system provided by my employer with no choice". I have never once discussed billing. Every visit, while short 10-15 minutes, is focused on my health and if I asked questions, can extend to 30+ or more... really depends on my questions. I have never needed an hour with a GP, maybe a specialist.
I should clarify: the billing talk would come out when talking about options. “Let’s try X because insurance will need to see that we tried it before we try Y.” I don’t blame the provider. Navigating insurance still comes up with my direct primary care doc, but it’s not most of the visit. The real value I see is a willingness to take the whole picture into account (not just symptom -> med/specialist) and teach me about how things work and why. I have some complexity in my history for which this helps a lot.
Regarding the patient load discussion elsewhere, our entire family uses this doctor, we’re in for $200/mo but if we added up the interaction time even with me (a more complicated customer) it’s maybe 5 hours a year + some text communications with the MA / prescription wrangling. Their model seems to be all about effective scaling, I hope it is worth it for them, because my experience is vastly improved.
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.
I admit I went to Hims a while ago. I filled out the questionnaire and had a "physican interview" where I was literally told "You need to change this answer from this to that, and this answer to this" if I wanted to get medicine, and "would [I] like a chance to review my questionnaires and we could discuss again in a few minutes?"
That's not medical care.
That's what you want until you have a serious and expensive health care problem. Segmenting off the healthy people like this simply means the people with chronic conditions or acute catastrophes are bearing more of the cost rather than pooling the risk.
Everyone wants to be the sickest person in whatever health care pool they are in, but that's not sustainable
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.
Same. For relatively safe medications, people should have the freedom to get medications that will resolve their issues without jumping through a bunch of hoops. As long as companies are providing full disclosure on the medications they are providing and side effects, I don't see any issue with it.
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.
>what does that say about our existing system that people are eschewing?
"clearly we need to spend more on lobbying to get our ability to extract out pound of flesh more thoroughly written into the law"
-the system
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.
Why not? It shouldn’t cost me $450 to go speak to my doctor for 5 minutes and say ‘I need Viagra’ and then have them write me a prescription, but it does cost $450 for me to do that. I can get (4) quarterly shipments from Hims for less than $450.
Personally I think viagra should be OTC, there’s no reason to gatekeep erectile dysfunction medicine.
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 like the US healthcare system? At least my on-the-ground, lived experience into middle age has been great. I've always had high-deductible insurance through my employer, never had a problem getting a specialist (even during the supposedly horrible HMO years) or special service, eg. MRI.
With an HSA, I'm basically self-insured for everything short of something catastrophic.
I don't know if I'm an outlier in this American Carnage, but with very few exceptions, this is the norm in my circles.
Just looking at pricing, I am lucky enough to have a similar insurance setup, yet we are still vulnerable to unlucky pricing and uncertainty about what insurance will cover. The price you pay is an unknown power law distribution random number with an unbounded upper value.
The only thing they will "wake up" to is that they could be doing the same thing and probably make more money doing it.
Ban insurance coverage for the quack bullshit like chiropractors, most forms of physical therapy , cupping, acupuncture, etc first.
If you’re not willing to do that than don’t try to take a holier than thou attitude against the supplement crowd. At least fish oil actually does help a tiny bit. Certainly more effective than 99.99% of adjustments.
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...
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.
Amazon Prime is facilitating prescription medications now.
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
> 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.
+1000 to this. If your primary care physician works for a large medical chain (which most do), they aren't allowed to prescribe anything that goes against the chain's so-called "evidence-based" standards. Never mind that most medical chains also have insurance company arms and that these "standards" just happen to line up with whatever it is the insurance company thinks is appropriate to pay for. If you go to an independent clinic you can usually get prescriptions for "lifestyle" issues such as the ones Hims treats and then use GoodRx or a cheap online pharmacy to fulfill your prescriptions. Unfortunately, one of the side effects of the 2010 Affordable Care Act was to incentivize consolidation in the health care space, so independent clinics and practitioners are a dying breed.
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.
“Maybe a dozen?”
What are you smoking? I’m a normal middle class guy with insurance and my PCP is an overworked but very cool guy who I’ve spent years getting to know. All of my peers in their 50s have similar PCPs.
While I agree the GOP is doing everything in its power to make sure lower income families cannot get good healthcare, lots of people actually have it. Not sure why you’re lying to make a point.
I don't understand US medical schools in the least. My son is interested in medicine, and I have sat through presentations where the admissions officers describe how they pick the student that has the best sob story from dozens of overqualified candidates. Then the poor jerk that is selected will work 20hr days out of med school in residency and finally patients will wait weeks to months to see them because there are not enough physicians (or they will see someone with a foreign degree). How does any of that make sense? Why not admit a couple more kids, stop causing overtired residents to make mistakes and address the shortage?
Unfortunately, the AMA is a cartel of doctors that lobbies to put limits on government-funded residency slots to keep salaries high. [1]
1. https://petrieflom.law.harvard.edu/2022/03/15/ama-scope-of-p...
> you should absolutely have a personal physician you have a personal relationship with
best we can do here is the closest walk in clinic that isn’t fully booked by 9am and a doctor I’ve never met before. All they ever do is send me for blood work which is always flawless. Eventually my issues resolve themselves. If I get cancer or something serious I expect to just find out shortly before I die
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.
>there are legitimate reasons to think institutions are illegitimate but I think there’s something self-perpetuating about distrust, people find meaning in it.
The lack of institutional self-awareness is why it's not especially mental to find most humans more trustworthy than any institution. There's a bit of grandma's wisdom in not worrying about Kennedy or being a fan of Luigi.. then there are borderline cases like Shkreli or the CEO of UHC-- they seem to have the non-sentience of the upper-percentile institution (which btw includes almost every place of higher learning in the US, exceptions to be investigated for their unusual processes..)
I suspect the Ben Franklin thought of Congress as a bunch of his peers & not an institution (placeholder for one of PG's underworked cluster of ideas around informality)
This kind of thing heavily depends on your doctor and insurance plan. A lot of plans won't cover things like ED meds, weight loss, or hormone therapy. TBH I'm not entirely sure that's a bad thing as long as affordable alternatives are available outside of the insurance plan. Plans covering every little thing will increase premiums, so maybe for the products that Hims sells, this is a case of the market solving a problem.
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...
[2] https://en.wikipedia.org/wiki/Serenity_Prayer
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.
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)
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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.
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.
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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.
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).
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.
You're being downvoted because you're saying something factually incorrect, and now you're being flagged for blatantly breaking the HN guidelines and degrading the discourse.
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.
It’s no wonder someone with a mustache and green hat was pushed over the edge.
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.
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.
China provably has seen issues with adulteration of food: https://en.wikipedia.org/wiki/2008_Chinese_milk_scandal
That is not to say that Hims's drugs were unsafe, or that they even came from China to begin with. What I am saying, is that it's not racism to mention that Chinese products are, in fact, occasionally shady (of poor quality).
Sure; and a bunch of Phillips (a European company) CPAP machines (which had received full FDA clearance) killed over 500 people [1]. The J&J COVID vaccine gave over 100 people GBS [2]. We could go back to the 80s and pick on the Therac-25, which caused six incidents of severe radiation exposure or death [3]. And a thousand other examples in-between, of western made, FDA approved, vetted, and tested medicines or therapies that ended up killing people.
It would be stupid to believe that the FDA doesn't serve an important purpose. But, it would be equally daft to believe that even FDA-cleared products aren't, in fact, occasionally shady (of poor quality). It would be racist to believe that China is unique in the production of occasionally shady products; that the same things don't happen all the time in western manufacturing facilities.
[1] https://www.fda.gov/medical-devices/recalled-philips-ventila...
[2] https://www.yalemedicine.org/news/covid-vaccine-guillain-bar...
[3] https://en.wikipedia.org/wiki/Therac-25
> The number of times the article specifically calls out "shady Chinese knockoffs" is honestly, actually, racism.
Factually incorrect. A country is not a race. You cannot be racist against a country, by definition, and China in particular has a very well-documented pattern of making low-quality clones of products from other countries (often using IP stolen from those countries), so the concern is well-justified.
More generally, the use of "racism" as a response to well-justified concerns about products of a country is completely irredeemable. It's logically invalid, emotionally manipulative, breaks the HN guidelines, is blatantly anti-intellectual, and is mostly used as a propaganda technique by state actors. Please keep this drivel off of platforms like HN that are designed for intellectual curiosity.
It's interesting to consider why criticisms of China in particular are often interpreted as racism. No one makes the same accusation if you criticize America. Part of the explanation may be that China is much more ethnically homogenous: Han Chinese are 92% of the population. It seems that in the name of opposing racism, people are effectively rewarding China for being an ethnostate.
> It seems that in the name of opposing racism, people are effectively rewarding China for being an ethnostate.
My understanding of criticism of China (in particular - although I have also seen this effect with many other countries) being interpreted as racism is very different than the explanation that you provided, but that's too long to get into. Meanwhile, this is an extremely interesting second-order effect that you pointed out that I hadn't realized before. Thank you for pointing this out!
> It's interesting to consider why criticisms of China in particular are often interpreted as racism.
Astroturfing of the criticism of China = racism view is presumably a part of it. I don't consider investigating bot account networks to be a hobby of mine, so no, I don't think it's "interesting to consider."
Typically I would agree on the separation of nationality and race; but in the case of China its actually far more accurate to intrinsically tie the country and the race, given that this is the official position of the CCP.
No, it's factually not more accurate. The CCP's policies do not dictate reality, and the morally objectional ethnostate policy is both not actually the reality within China (given that about 9% of the population is not Han Chinese), and is not practiced by the majority of other nations/states in the world.
Most importantly, the author of the article is not based in China, or in any other nation that has an ethnostate policy, but in the US[1]. Therefore, even if you could make the argument that every person in China believes that states = races (which is clearly false), it still wouldn't apply to the author. Or, you know, almost anyone else on Hacker News.
So no, claiming that attacks on China are "racist" is still factually incorrect, and I really would hope that you'd invest the bare minimum of effort to verify that your claim is correct before throwing such an extreme accusation at someone.
[1] https://www.alexkesin.com/p/who-is-alex-kesin
Truthfully China is the source for a huge amount of “legitimate” generic and brand name patent protected drugs.
China produces things. Of high quality as well as low. More and more, it’s the only source for high quality things.
The OP’s conniption is about intellectual property and monopoly protection, not health.
Everyone in the world (almost) would be far healthier with weekly injections of Chinese chemicals.
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?
There are concerns around safety. Compounding is somewhat controversial because they produce versions of FDA-approved drugs that are not FDA-approved, and may use chemical formulations (such as semaglutide salts) that aren't FDA-approved. [1]
The problem isn't that compounding pharmacies provide cheap versions of the same drug, it's that the compounding process doesn't produce exactly the same drug, and hasn't undergone the same stringent quality controls as Wegovy etc.
Ideally, these drugs should be cheap. The compounding is only done because there's a loophole that provides a market opportunity. The correct solution would be to improve the regulations in a way that would let more manufacturers produce safe generics.
[1] https://www.goodrx.com/classes/glp-1-agonists/compounded-sem...
The 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.
Hims just outsources fulfillment to a compounding pharmacy. Usually they add vitamin B-12 to make it "customized". Are they crushing rybelsus? Getting raw materials through some mysterious supply chain from Ukraine, China or Israel?
You have no idea.
On the flip, I think access to basic drugs for stuff like ED, hair loss, etc is fine. But they also do stuff like off-label anti-depressants, etc can potentially be dangerous... but at the same time, people are going to urgent cares and getting antidepressants with just more cost and friction.
> 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.
Sugar is arguably more “effective” than it is “safe.” But I know you are referring to sugar pills not sugar diet
How would you even test for that?
Yup. And using it as the wonder drug it is, I.e women using it to get “beach bodies” should be celebrated and not stigmatized.
I want bodily autonomy and control. The right to experiment with weight loss drugs is analogous to the right to be trans or to not have your foreskin removed at birth.
It’s crazy that these drugs even have further benefits like anti addiction properties!
> The right to experiment with weight loss drugs is analogous to the right to be trans or to not have your foreskin removed at birth
Both things the current administration is fighting against, so the metaphor is really apt.
There are a lot of trans people on HRT that DIY their meds, especially transfemmes, because estrogen is not a controlled substance.
Miracle drugs. I wouldn’t be mad if we made these injections required for entry into public schools or employment
Semaglutide is linked to NAION, a "stroke" in the retinal blood vessels linked to a blood pressure drop there, typically when sleeping. I think I already have one of these in one eye. I DO NOT want to risk getting it in the other. Staying off semaglutide until it's really necessary.
That’s a pretty bold claim, got a citation to back it up?
https://pubmed.ncbi.nlm.nih.gov/38958939/
Can you give some specific examples of compounding pharmacies buying up Rybelsus or using grey market GLP-1
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?
Why would this product be different from any other product?
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> 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!
> 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.
Yes, I learned this the hard way, when I was trying to figure out why I have zero libido, brain fog and brain fog having a healthy BMI and lifting weights.
As a 35 year old, I had the T levels of a 65 year old men, yet doctors refused to consider this an issue because it was in the "normal" range.
It took me over a year to get a diagnosis of Secondary Hypogonadism in Canada and that was after I went to see a male private urologist after giving up on a public health care in Canada.
This was finally revealed once I finally did more specialized tests for LH, FSH, Estradiol, Testostrone and Free Testosterone at the requested of my urologist.
After 3 months of HCG treatment and all the symptoms were gone. It has now been 2 years and I have never felt better in my life.
> 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.
Just to add, for anyone considering using minoxidil and/or finasteride - I can highly recommend both for the recovery of my hairloss.
But - read up in the side effects and potential risks, they can both cause other issues in some people, and for me it took a while to find the right finasteride dose.
Another downside is oral finasteride use means I can no longer give blood.
Did it fill in your crown area??
Finasteride alone won't reverse that much, it stops the path for testosterone becoming DHT (the cause of androgenic alopecia). Taken orally, it stops or slows all hair loss.
Minoxadil increases blood flow and restores the natural growth cycle lengths of weakened follicles. This is applied topically, and promotes hair growth pretty much anywhere - beard, crown, temples. You can take it orally, and it will promote hair growth everywhere (more body hair). However, it can't fix follicles already dormant or scarred over. So if things are already bald, it may not give the results you want.
A word of warning that about 5% of those who take Minoxadil experience a shedding period where it gets worse. Because it restores normal hair follicles growth cycles, this includes the process of pushing out old hairs. This is not permanent and will last, at most, a month. This is why most providers like "Keeps" will try to sell in batches of 3 months.
In 2026, a new drug will finish phase 3 human trials. That one targets (IIRC) stem cells and can restore even advanced hair loss where the follicles are dormant or dead. Very exciting!
Wow that would be a blockbuster drug if it passes. Know the name of it?
It is far better than it was, my thinning was definitely crown but also hairline - I went for a walk one day and got really wet and when I looked in the mirror I could see just how thin my hair was. I've applied liquid minoxidil for 5 years now, and it reversed the balding to a good degree, but my hair is still thinner than it was at 30, but it is far far better than it was at 40. I've been using finasteride (tablets 1mg ever 3 days) for a year and it has certainly helped, but at my low dose I expect it to be another year before I know if it is really making a good difference.
My hair is very grey now which I think makes it also look thinner, but I don't want to dye it - though I tried Alpecin 'grey targeting shampoo' and it turned my hair blue... Not a good look for the office and extra visible in video calls
I’m afraid of the reproductive and erectile dysfunction side effects
Sounds like they've consigned you to the knacker yard. It would be easier to get if you were intending to abuse it.
I wonder if physicians standards for normal are warped by spending most of their time in contact either with the ill or the overworked?
Is this in the US? If so I think you just need to switch doctors or go through a telemedicine consult. Your current doctor sounds like a jerk.
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.
You really should be drinking water, though. I get all sorts of odd effects that aren't obviously linked to not drinking enough water. I increased my intake for a few days and they all disappeared.
The awfulness of the American health care system may explain, but does not justify a turn to things like quackery and faith healing.
A justification is just a moralization of the explanation. It happened because of the explanation, regardless of the morality of it.
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
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.
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.
Kaiser isn't necessarily the best example here. Your doctor likely did that because Kaiser will generally not cover things like that, just as they'll almost never prescribe sildenafil or tadalafil or semaglutide (but they will happily refer you for gastric bypass...).
There are good things about Kaiser, but definitely not-so-good things. I'm still pissed at them for my fiancée, fresh from the dentist after a few root canals with a script for pain medication was told (at their hospital pharmacy, no less, so it wasn't that they didn't have it available) that they would only fill pain medication via mail order. "Oh good, so I just need to wait 5-7 business days for relief from my root canals."
Yeah they can definitely be archaic. I’ve stuck with them because they are the only provider offered to me that covers double jaw surgery. The cost of paying out of pocket for that would be prohibitively expensive.
What did you need double jaw surgery for?
Sleep apnea
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.
This is the one aspect of this article I’d have liked to understand better. It can simultaneously be the case that these compounding pharmacies are regulated, and also that they’re buying peptides from Chinese suppliers that aren’t regulated and hence there’s some room for serious problems. I’d be much happier if I felt that these suppliers were being carefully regulated and monitored but I’m not convinced that this is the case.
> 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.
My doctor keeps prescribing it and the pharmacy keeps not filling it. I’m not really sure what’s going wrong, I haven’t taken the time to debug the situation. I shouldn’t need to, and I’ve never needed to with hims.
So you’re not even willing to look into the issue, or understand what your problem is. You could have resolved this with like two calls to your pharmacy, but whatever keep shilling hims lol
I was able to buy it two times from an Indian website. I have no concerns about its safety profile.
Fuck the AMA gatekeepers. Bodily Autonomy means I should get to buy and use any medicine I decide it worth my personal risk assessment.
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.
Yeah, please don't repeat this. This is the same thing that insurers say to Congress for other things too. "We're not denying care, we're just not going to be the ones paying for it", be it cardiac surgery, or (in the case of United) even Heli EMS from MVAs, because it wasn't "pre-authorized".
I’m not sure what exactly the issue is. The doctor prescribes and the prescription never gets filled. I assume the insurance said no and the pharmacy just decided not to fill it, they’re pretty inconsistent about what information they give out.
Meanwhile with hims I order it and I get it.
> 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.
Deviated septum with 90% occlusion in one nostril, see an ENT, also on a "platinum" plan. "Great, let's schedule surgery." ENT: "Hold fast. First, I'm going to prescribe you these two nasal sprays so you can come back to me in four weeks and tell me that, to our mutual surprise and disappointment, they didn't realign the cartilage, and that way, insurance will pre-authorize the surgery."
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.
It IS overly antagonistic. Maybe this stuff is overpriced but I think there is a need in the market. Lots of medication is protected by patents and overpriced. Doctors also gatekeep a lot of basic medications like Viagra. Third world countries are not nearly as uptight about medication, and probably sell Viagra and such as OTC medications. Perhaps the prescription system in the US can detect drug interactions, but for something like that there is probably little benefit to having a doctor in the loop. As for the quality of the medication, that could be debated. But it is quite possibly made at the same factories as the prescription stuff.
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.
> 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.
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.
They have to make it sound overly serious, because if it wasn't then you might question why you must go to a doctor or why the prices are (or were) high. When a new version comes on the market, they will conveniently find lots of negative side effects to make you take the newer and more expensive one.
I had to laugh at the gas station sex pill thing. In other countries not only do they have the gas station pills with Viagra in them, but they have a lot of basic "prescription" meds for sale over the counter at the pharmacy.
It can cause increased eye pressure and other scary eye stuff if you take it too often. Definitely look into it
"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).
Yeah, they're real good at doing needless work with a smile on their face.
Next time you go to a GP's office for no reason other than to gatekeep a specialist you know you need ask yourself what all those people are being paid for any why the situation deserves anything more than someone on the order of an RN saying "yeah looks like an infection to me" via a screen, to pick but one example.
Like all bureaucracy, every single part of the system has some skin deep reason to justify its existence or scope but when you take a step back and look at it all you'll find that huge swaths are either redundant or completely unnecessary, and that the industry is rife with this BS from top to bottom and we're all made effectively poorer for it.
You might not even notice it just from dealing with one referral. It really starts to gall when you see the pattern of nearly every actor in the system doing the least amount possible and then quickly passing responsibility on to someone else, often via yourself. The only exceptions I've seen are hospital doctors when there is an immediate acute problem that they can't just punt, and pediatrics where frequent repeating followups can be justified. Healthcare workers join this system because they want to help people, but the administrative parasites grind up their attention into tiny pieces until it is all but meaningless.
One thing about people in the US is that they really don't have as much bureaucracy as other developed nations and culturally we put a huge premium on service. So I think for a lot of people healthcare (or other forms of insurance) is the where they encounter it. That said, this is something I like about the US and I would like to see healthcare be more service oriented.
Doctor visits usually aren't so bad. But if you ever go to the ER or have to do something major like stay in the hospital, you will be surprised how expensive that gets.
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.
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.
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.
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.)
Your example is not a comparable case.
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 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.”
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.
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".
Pausing unlocks bulk pricing for customers taking meds as-needed (ED pills etc.). I'm not sure about Hims pricing since they require a questionare/login, but similar sites offer a sizable discount for larger quantities, and then it's just pause/unpause as needed.
I guess my question was "why offer a pause that ends after 6 months when you have surely forgotten about it"
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:
https://www.astralcodexten.com/p/the-compounding-loophole
> 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.
>> 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.
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.
You can get generic finasteride 1mg/180 (6 month) for as low as ~$17 if you go to a Kroger pharmacy and use their preferred savings program (I forget the name off hand) and no insurance coverage. Kroger discontinued their Kroger savings and now have a preferred card, which ended up being half the cost of the best deal on GoodRX.
Source: I picked up a 6 month supply last week.
>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
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.
Except finding a doctor that genuinely cares about their patients personal needs is exceedingly rare. This is what Hims takes advantage of.
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?
Started out as Testosterone Replacement Therapy (TRT). I had low overall testosterone due to age (low 300's). Mid 40's. Not necessarily low for my age but low overall. Who wants the testosterone levels of an old man? Before I got on I was lethargic, unfocused and had no real drive. My evenings would consist of just sitting on the couch. I had been like that for years. I was middle aged. I didn't want to be like that so I saw a hormone doctor and got on. Best decision I have ever made. I am in the best shape of my life and the only time I sit on a couch is if I am watching something with my family. I have get up and go in spades now.
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.
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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%)
https://archive.md/Wsuoz
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?
People buying crypto gain more from others buying crypto
> 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.
> 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.
Best part is most GLP-s are not even daily, just once a week. Even easier.
Not according to the data about the change in proportion of obese people over time.
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 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.
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?
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
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.
What practically happens is that these people get worked by the health care system far worse than Hims does. And the regulators that are supposed to protect them enable the abuse.
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.
>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.
> 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.
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.
"sildenafil and tadalafil — an illegal combination"
It is not an "illegal combination".
The author has yet to reach puberty or move out of his parents' house, so he doesn't yet appreciate the company's products.
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.
They make a case for not trusting Hims but not sure why that means I should trust Novo Nordisk
Is there a literary/journalistic term for the style of writing in this piece?
It's a tongue-in-cheek style.
“bad” seems fine?
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.
Stupid article. Bottom line is I’ll pay a premium not because of shame but because I don’t want to schedule and drive to a physical location for a Drs appointment
This is one of the absolute dumbest things I have ever read. People want their problems solved without waiting months for an appointment and spending an insane amount of money, case closed. The fact that this market exists is an indictment of the current system.
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.
In a wild turn of events, this is actually a genius marketing piece paid for by Hims & Hers.
What is Hims?
In Australia there is a company named Pilot which appears to follow an identical playbook.
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.
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Article is unreadable. The auther is trying to be funny and clever but it just ends up being a slog. Im like 4 paragraphs in and still have no idea what Hims did wrong at all. Just present the information...
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.