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It is also beginning to be prescribed by many of the subscription medication/doctor businesses that are springing up, powered by VC cash and looking to build st

It is also beginning to be prescribed by many of the subscription medication/doctor businesses that are springing up, powered by VC cash and looking to build strong forward flowing subscription businesses. Their model is: - find areas that aren’t medically serious (speaking relatively, and in relation to life threatening - erectile dysfunction and male pattern baldness) - run people through online questionnaires - get an online subscription runner stamped by a doc on their payroll - send out generic medications that they get cheap, package them nicely, and make bank on markup - catch them on the next condition they roll along to The last year I’ve seen a lot of them shifting into metformin (after finasteride and viagra/cialis) for weight loss

nradov 5y ago
I expect those guys will start pushing SGLT2 inhibitors (gliflozins) next.
- robbiep 5y ago
  I just discovered that apparently that is exactly what they’re doing, not metformin presently. And there a planned shift to GLP1s - but the injectables present some interesting administration aspects
freedomben 5y ago
Do you see this as a bad thing? As someone who doesn't have any insurance, I'm extremely grateful for these. I don't want to have to go through the current medical racket where unless you pay a doc $300 you won't be allowed to purchase the medication you want. And then of course there's the follow up appointments, a "med check" where they can bill you $150 every 90 to 180 days just to hear you say, "yep, things are fine."
- fragmede 5y ago
  Good or bad, it's the logical conclusion given the free market, healthcare, and the Internet. The real problem is the "as someone without insurance" bit, the bigger question is what is best for society?
- robbiep 5y ago
  In responding to your example first - to start with, I live and practice in a country where it isn't a choice between healthcare and food on the table. Beyond that, I believe that it is a basic human right to have free healthcare. The next bit is a bit more complex. I don't think it is right or sensible to advertise medications to people directly. The US is almost alone amongst industrialised/western countries in having prescription medications being directly advertised to consumers. From my time in the US as a medical student, I saw directly how that changed the patient-doctor relationship, and I don't believe in a positive way. So - I don't think it's right that there's a medical racket that fleeces you to see a doctor, but I don't think it's right that you decide your prescription anyway. On the other hand, it should (speaking of an idealised utopian world) be easy to get refills of medications that have been appropriately prescribed. So here is where it gets interesting with the VC-backed Subscription healthcare model. I did a touch of consulting for one starting in Australia (well, it would probably be a stretch to call it consulting but I sat down with the founders as they were running through their spin-up process). My concerns are that you can't just prescribe anything to anyone, and for the vast majority of prescription medications there are often side-effects that need to be monitored (some of which can be serious), as well as inappropriate prescribing. The 2 examples the company I was talking to were Finasteride as well as Viagra. Seperating these two out, my concerns with Erectile Dysfunction are that it could be inappropriately funnelling everyone into prescription treatment, when there is in a reasonable percentage of cases other psychological issues that are impinging on erectile function, and whilst it might be all well and good to get viagra to get to the end result, it is also missing the broader holistic picture of aiming to achieve better health. For finasteride, there are a reasonable percentage of people who experience quite unwanted side-effects, from gynaecomastia to erectile dysfunction. Since the target audience is young men, these effects are often more psychologically concerning than the cosmetic issue they were trying to solve with a serious prescription medication and I was concerned about follow-up, referral and support in these instances. I was able to be reassured by them that they had adequate safeguards in place and good clinical governance oversight to achieve good all round care and then we split ways. I have no idea if they have or are maintaining those protections; additionally I have recently heard they have been pulled infront of the regulators here in Australia for cutting a few corners so my suspicion is that the money and growth hacking has gotten the better of their product development. Ultimately it is going to be an interesting bounce between both the regulation and the inevitable clinical disasters that will pop up. There's no doubt there is room for innovation in the space, and I feel that there is certainly a way to do it safely - ensure that, for certain conditions, you can answer a few questions, get your medication, and still have safe follow-up, and do this in a innovative way that reduces overall demands on a healthcare professional for a full sit-down (ie wrap up a bunch of the bullshit in algorithms and decision trees and take care of a lot of the back room stuff). But after 9 years as a doctor and a health-tech founder, I am also convinced that there are a number of elements of health that just do not scale, at least not with anything like the technology we currently have (ie well developed expert systems - I am also fairly fundamentally convinced that the use of AI for diagnosis and the black-box internals is going to cause issues due to uncertainty over where the fuzzy edge lies) So - TLDR: do I see VC driven subscription prescription as a bad thing? No, but also potentially yes

nradov 5y ago

I expect those guys will start pushing SGLT2 inhibitors (gliflozins) next.

robbiep 5y ago
I just discovered that apparently that is exactly what they’re doing, not metformin presently. And there a planned shift to GLP1s - but the injectables present some interesting administration aspects

freedomben 5y ago

Do you see this as a bad thing? As someone who doesn't have any insurance, I'm extremely grateful for these. I don't want to have to go through the current medical racket where unless you pay a doc $300 you won't be allowed to purchase the medication you want. And then of course there's the follow up appointments, a "med check" where they can bill you $150 every 90 to 180 days just to hear you say, "yep, things are fine."

fragmede 5y ago
Good or bad, it's the logical conclusion given the free market, healthcare, and the Internet. The real problem is the "as someone without insurance" bit, the bigger question is what is best for society?
robbiep 5y ago
In responding to your example first - to start with, I live and practice in a country where it isn't a choice between healthcare and food on the table. Beyond that, I believe that it is a basic human right to have free healthcare. The next bit is a bit more complex. I don't think it is right or sensible to advertise medications to people directly. The US is almost alone amongst industrialised/western countries in having prescription medications being directly advertised to consumers. From my time in the US as a medical student, I saw directly how that changed the patient-doctor relationship, and I don't believe in a positive way. So - I don't think it's right that there's a medical racket that fleeces you to see a doctor, but I don't think it's right that you decide your prescription anyway. On the other hand, it should (speaking of an idealised utopian world) be easy to get refills of medications that have been appropriately prescribed. So here is where it gets interesting with the VC-backed Subscription healthcare model. I did a touch of consulting for one starting in Australia (well, it would probably be a stretch to call it consulting but I sat down with the founders as they were running through their spin-up process). My concerns are that you can't just prescribe anything to anyone, and for the vast majority of prescription medications there are often side-effects that need to be monitored (some of which can be serious), as well as inappropriate prescribing. The 2 examples the company I was talking to were Finasteride as well as Viagra. Seperating these two out, my concerns with Erectile Dysfunction are that it could be inappropriately funnelling everyone into prescription treatment, when there is in a reasonable percentage of cases other psychological issues that are impinging on erectile function, and whilst it might be all well and good to get viagra to get to the end result, it is also missing the broader holistic picture of aiming to achieve better health. For finasteride, there are a reasonable percentage of people who experience quite unwanted side-effects, from gynaecomastia to erectile dysfunction. Since the target audience is young men, these effects are often more psychologically concerning than the cosmetic issue they were trying to solve with a serious prescription medication and I was concerned about follow-up, referral and support in these instances. I was able to be reassured by them that they had adequate safeguards in place and good clinical governance oversight to achieve good all round care and then we split ways. I have no idea if they have or are maintaining those protections; additionally I have recently heard they have been pulled infront of the regulators here in Australia for cutting a few corners so my suspicion is that the money and growth hacking has gotten the better of their product development. Ultimately it is going to be an interesting bounce between both the regulation and the inevitable clinical disasters that will pop up. There's no doubt there is room for innovation in the space, and I feel that there is certainly a way to do it safely - ensure that, for certain conditions, you can answer a few questions, get your medication, and still have safe follow-up, and do this in a innovative way that reduces overall demands on a healthcare professional for a full sit-down (ie wrap up a bunch of the bullshit in algorithms and decision trees and take care of a lot of the back room stuff). But after 9 years as a doctor and a health-tech founder, I am also convinced that there are a number of elements of health that just do not scale, at least not with anything like the technology we currently have (ie well developed expert systems - I am also fairly fundamentally convinced that the use of AI for diagnosis and the black-box internals is going to cause issues due to uncertainty over where the fuzzy edge lies) So - TLDR: do I see VC driven subscription prescription as a bad thing? No, but also potentially yes