Daily Insight: The Yassification Of Prescriptions
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Yassification: the process of beautifying something, typically something that is unappealing or heteronormative.
Back in 2016, Andrew Dudum had a rather embarrassing conversation with his younger sister. She pointed out his dry skin and his breakouts and admonished him for not using products that could clear these issues. According to her: “there is stuff you can buy that works — it’s science”.
Overnight, Dudum, with the help of his sister, built a skincare routine featuring products from brands like Ole Henriksen and Glossier. Despite the hefty cost, Dudum was happy to have the help but soon realized other men didn’t. So, he set out to change that.
Fast forward to 2017 and this idea became Hims, a direct-to-consumer, vertically-integrated wellness site aimed at men ages 20-40. Its focus would be the embarrassing things that are hard to talk about: skin, hair loss, and erectile dysfunction.
In early surveying Dudum and his team found that “less than 10 percent of guys in [their] target age group had a physician they would feel comfortable emailing or giving a call to ask about questions related to hair loss or sexual wellness”. That looked like a clear opportunity, so Hims focused on being likable, approachable, and easy-to-use.
Dudum, a self-described “design and brand nut”, brought in an all-star marketing team. The site advertised Viagra with cactus imagery and eggplant jokes, questionnaires that looked like sleek Silicon Valley apps, and pills that arrived to consumers in aesthetic, discreet packaging.
But, unlike Dudum and his skincare routine, treatments for hair loss and erectile dysfunction presented a new challenge: the need for prescriptions and medical supervision.
A telehealth-lite service that would screen patients via medical surveying and then send this information to a board-certified physician for approval. Suddenly, Hims was toeing the line between wellness and healthcare, and this line would only get thinner as the company evolved.
In 2021, Hims is now Hims & Hers, and has expanded its treatments to include birth control, antidepressants, anti-anxiety medication, and primary care consultations. Its branding and mission have expanded as well.
According to the company’s investor video, Hims now views itself as a solution to a myriad of issues within the American healthcare system. CEO Dudum lists off the fact that 50% of American families cannot afford their insurance deductible, 80% of rural counties are considered primary care deserts, and most patients wait 3 to 4 weeks to see their primary care physician.
All are true, but it’s unclear how any of these are being addressed by Hims or other direct-to-consumer telemedicine services such as Ro, Pill Club, Lemonaid Health, Kick Health, and Nurx.
A study published by the American Medical Association found that, while “telemedicine companies advertise their potential to improve health care access in many dimensions, including accommodation, acceptability, availability, and affordability”, they only really address “accommodation barriers, such as inconvenient hours and appointment systems”.
The vast majority of these services’ patients are young and tend to live in wealthier urban communities. Nearly 60% of all users made more money annually than the national average, 32% were making more than $73,000 a year. These patients are not rural families left behind by industry and governments but rather affluent Millennials keen on strong-arming their own healthcare.
So, why are telemedicine companies incredibly popular and who are they benefitting?
To understand that, we have to go back to Dudum and his skincare routine. The wellness trend emerged from the aisles of your local health food store in the early 2000s and took to the internet faster than a duck to water. Not long behind was a new cohort of powders, teas, lotions, and pills that promised you everlasting life and a snatched waist.
According to the Financial Times, this industry is expected to be worth $216 billion by 2026. However, on the way to fame and fortune, it also created a generation of consumers who expect to be able to dictate their own medical protocols.
Lisa Payne, a senior editor at the trend-forecasting agency Stylus, calls these consumers “health hackers” and they are on the rise. According to her, they have a “Millennial mindset that you are the CEO of your own health” and are “intent on assessing for themselves what’s right for their bodies”.
It’s clear that this is the group most targeted by Hims. Just take a look at its fun, care-free branding and stated desire to put “consumers in the driver’s seat when developing a treatment plan”.
Some view this inversion of the traditional healthcare model as empowering. Others see problems, believing it will relegate physicians to mere prescription gatekeepers. This is especially true when a doctor works for a telemedicine company that generates revenue from drug sales. There is a tangible conflict of interest.
While Hims and other telemedicine services are quick to state they do not pay doctors based upon the number of prescriptions they write, many within these services state they felt pressure to keep their numbers up. Current and former Hims doctors spoke to Bloomberg Businessweek and said it was “clear the company saw them as salespeople” and felt they were “leasing [their] medical license for $100 an hour”.
The journey from patient concern to prescription drug is meant to have some friction. Ideally, a patient doesn’t enter a doctor’s office primed to request a drug by name, but this reality has been created by advertising law.
Currently, the United States and New Zealand are the only two countries that allow for direct-to-consumer magazine and television advertisements for pharmaceuticals. This helps drug companies leap over healthcare providers and meet patients at home. Services like Hims take this to the extreme, encouraging users to select a drug and then seek doctor approval. Medical advice is an afterthought, a bureaucratic inconvenience.
This type of model may suit low-risk drugs like prescription shampoo, but it poses real risks for others. Hims was critiqued by the New York Times for inadequately warning users of fainting risks when combining certain medications with alcohol. These risks were not mentioned in the drug’s usage guide and were instead placed on an F.D.A. information insert at the bottom of the box, printed in a tiny typeface.
Hims’ reliance upon medical questionnaires rather than in-person interviews can also allow other medical conditions to fly under the radar. Erectile dysfunction, Hims most revenue-generating ailment, can be caused by or a warning of other, more serious conditions that cannot be detected via a brief medical history. Depression, heart disease, and neurological disease all have high rates of comorbidity with erectile dysfunction — especially for young people, telemedicine’s target market.
Dr. Douglas Savage, a GP specializing in sexual medicine, stated it would be a “tragedy if someone wanted to take the shortcut and buy unregulated pills online, or licensed drugs from a high street chemist, and other serious health issues were then missed”.
Hims and other direct-to-consumer telemedicine services are taking advantage of the collapse of the American healthcare system. The commercialization, expense, and lack of effective, modern regulation have left the industry open to disruption that lacks quality and care. The very legality of these services exists in a complete gray area as they are not “manufacturers, labelers, or medical practitioners. They don’t really fit any description of entities that the FDA regulates”.
Hims may look like a trendy, tech startup but it's really no different from drug companies of the past. It’s reliant upon affluent consumers seeking easy and fast treatment because consistent, compassionate treatment is nowhere to be found.
Aestheticism and branding can’t plaster over the faults at the heart of this industry.