The Hollow Men of Hims

This buried lede is really the core of the article:

> They make these choices not because the products are better, but because the entire experience has been optimized to feel more like shopping and less like confronting the mortality and vulnerability that define the human condition. This is what disruption looks like when applied to the oldest human needs: not improvement, but the illusion of improvement

And contrary to what the article claims with hundreds of words of flowery indictment, it is improvement. As everyone on this site should be able to tell you, UX matters, and the medical establishment has some of the most frustrating, unpleasant, and confusing UX of any necessary service.

Of course shady companies are going to get lots of business when all the competition following the law most faithfully provide a broken UX, and the only way to do otherwise is to bend the rules.

OneMedical (now owned by Amazon) provides a version of this that also connects you with a general practitioner doctor who you're able to see in your area. They additionally have telehealth-style prescription requests in the app, but you end up with the FDA approved version coming from Amazon pharmacy for $5/month (on top of the $200/year for OneMedical), or for $cheap at your regular pharmacy. A++ would recommend.

However, when I get referrals from OneMedical to specialists like eg sleep apnea, those 3rd party specialists usually have like 8 month waiting lists. So, back to Hims-style online-only providers for that sort of thing.

I also have one medical, (cheaper if you have Prime), but they don’t do ozempic/wegovy, so you’re still at the mercy of insurance, or paying out of pocket if you want GLP-1s.

They’re still a great option if you have other needs, like Prep or stimulants.

Take the case of a antibiotics.

A large percentage of people want their doctor to prescribe them antibiotics when they have a virus. It’s been shown that doctors who over-prescribe antibiotics get better patient reviews for example.

Now you have a “better UX” that pops up that gives people exactly what they want. They answer a few questions on a website and they get an antibiotic prescription.

There is no way for the medical establishment to compete with a site that will give people what they want even when it’s harmful to them without even requiring any kind of examination.

In the case of antibiotics, this kind of behavior breeds resistant bacteria that regularly kill people.

In the case of other drugs or combinations of drugs, the risks are usually only to the patient themselves. But the risks are real and patients assume this stuff is regulated.

> It’s been shown that doctors who over-prescribe antibiotics get better patient reviews for example.

Are they over-prescribing, or are the others under-prescribing? Comparing how hard it is to get antibiotics as a human with how easy it is to get them for animals (even if there's no evidence of disease) certainly makes one think.

I think there is a big problem with antibiotic overuse in food animals, certainly. Although they can be useful for growth, large livestock farms are environments where drug-resistant infections can spread easily. I try to buy antibiotic-free meats as a rule but that doesn't really stop the damage caused by the meat companies that don't care about it.

As far as human antibiotic use, the flip side are the colleagues who will tell me that they did a thorough workup on a patient, found no indication for antibiotics, told the patient so to the best of their ability, and got dinged on the insurer's survey or castigated on doctor rating sites. I'm of course only hearing the provider's side of the story, but nobody likes to be told no, even when it's the right answer. (Also insert opioids, stimulants and benzodiazepines into this conversation.)

Antibiotic overuse in animals is a problem. It was recently banned for use as a growth promoter however, and use in animals is inherently less likely to lead to human infectious drug resistant bacteria.

And none of that has any impact on whether or not we should limit antibiotic overuse in humans.

Doctors certainly aren’t under-prescribing antibiotics if you look at the data.