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>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-app

>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.

binarymax 1y ago
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.
- esseph 1y ago
  Amazon Prime is facilitating prescription medications now.
- WalterSear 1y ago
  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.
- alphazard 1y ago
  > 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.
  - bigyabai 1y ago
    I don't think it will take more than 5 teenage overdose deaths to get most Americans to disagree.
    - alphazard 1y ago
      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".
    - genocidicbunny 1y ago
      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.
      - potato3732842 1y ago
        >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
    - bongodongobob 1y ago
      Kind of tired of making life hard for everyone because a few stupid people might potentially make some bad decisions.
- malfist 1y ago
  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
- conradev 1y ago
  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-arise-over-amazons-one-medical-call-centers-after-document-leak https://www.pbs.org/newshour/show/patient-safety-concerns-ar...
- ryandrake 1y ago
  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…
  - Der_Einzige 1y ago
    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.
  - colpabar 1y ago
    The only thing they will "wake up" to is that they could be doing the same thing and probably make more money doing it.
  - FeloniousHam 1y ago
    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.
    - ryandrake 1y ago
      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.
- quickthrowman 1y ago
  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.
Spooky23 1y ago
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.
beejiu 1y ago
But access to medical treatment, particularly drugs, should be "paternalistic", so I strongly agree.
jeremy151 1y ago
> 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.
- bongodongobob 1y ago
  $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.
  - jjcob 1y ago
    How people justify paying $1000 for probably less than 15 minutes of work is beyond me.
    - esseph 1y ago
      Beause people don't want to die or be uncomfortable
    - 1y ago
PaulHoule 1y ago
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.
- culopatin 1y ago
  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
  - PaulHoule 1y ago
    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-medicine https://www.quora.com/What-does-no-apparent-distress-mean-in... [2] https://en.wikipedia.org/wiki/Serenity_Prayer https://en.wikipedia.org/wiki/Serenity_Prayer
zackify 1y ago
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
tstrimple 1y ago
> 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.
ike2792 1y ago
+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.
asdf6969 1y ago
> 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
1234letshaveatw 1y ago
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?
- eppsilon 1y ago
  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-practice-lobbying/ https://petrieflom.law.harvard.edu/2022/03/15/ama-scope-of-p...
coombos 1y ago
“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.

binarymax 1y ago

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.

esseph 1y ago
Amazon Prime is facilitating prescription medications now.
WalterSear 1y ago
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.
alphazard 1y ago
> 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.
- bigyabai 1y ago
  I don't think it will take more than 5 teenage overdose deaths to get most Americans to disagree.
  - alphazard 1y ago
    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".
  - genocidicbunny 1y ago
    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.
    - potato3732842 1y ago
      >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
  - bongodongobob 1y ago
    Kind of tired of making life hard for everyone because a few stupid people might potentially make some bad decisions.
malfist 1y ago
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
conradev 1y ago
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-arise-over-amazons-one-medical-call-centers-after-document-leak https://www.pbs.org/newshour/show/patient-safety-concerns-ar...
ryandrake 1y ago
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…
- Der_Einzige 1y ago
  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.
- colpabar 1y ago
  The only thing they will "wake up" to is that they could be doing the same thing and probably make more money doing it.
- FeloniousHam 1y ago
  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.
  - ryandrake 1y ago
    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.
quickthrowman 1y ago
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.

Spooky23 1y ago

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.

beejiu 1y ago

But access to medical treatment, particularly drugs, should be "paternalistic", so I strongly agree.

jeremy151 1y ago

> 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.

bongodongobob 1y ago
$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.
- jjcob 1y ago
  How people justify paying $1000 for probably less than 15 minutes of work is beyond me.
  - esseph 1y ago
    Beause people don't want to die or be uncomfortable
  - 1y ago

PaulHoule 1y ago

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.

culopatin 1y ago
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
- PaulHoule 1y ago
  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-medicine https://www.quora.com/What-does-no-apparent-distress-mean-in... [2] https://en.wikipedia.org/wiki/Serenity_Prayer https://en.wikipedia.org/wiki/Serenity_Prayer

zackify 1y ago

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

tstrimple 1y ago

> 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.

ike2792 1y ago

+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.

asdf6969 1y ago

> 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

1234letshaveatw 1y ago

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?

eppsilon 1y ago
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-practice-lobbying/ https://petrieflom.law.harvard.edu/2022/03/15/ama-scope-of-p...

coombos 1y ago

“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.