The Hollow Men of Hims

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)

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'd hazard the downvotes are due to the existing toxic relationship between legislation and the medical cartel.

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.)

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.

Healthcare is one of the most regulated industries in existence. You are fundamentally incorrect.

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.

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.

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.

How about supplements? Yeah…

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.

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.

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.

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.

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.

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.

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).

It’s no wonder someone with a mustache and green hat was pushed over the edge.

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.