Drug Sites Upend Doctor-Patient Relations: ‘It’s Restaurant-Menu Medicine’ - The New York Times
On the sites, people self-diagnose and select the drug they want, then enter some personal health and credit card information. A doctor then assesses their choice, with no in-person consultation. If approved, the medicine arrives in the mail days or weeks later.
The sites invert the usual practice of medicine by turning the act of prescribing drugs into a service. Instead of doctors making diagnoses and then suggesting treatments, patients request drugs and physicians serve largely as gatekeepers.
Much like Uber, which argues that it is not a transportation company even as it connects drivers and passengers, the drug sites argue that they are tech platforms, not health providers. The sites connect consumers — and often process their payments — to doctors who may prescribe drugs and pharmacies that can ship the medications.
To comply with state laws, the doctors work for separate companies that cater to the sites. The doctors are typically paid for each health consultation, or by the hour, not the number of prescriptions written. The sites generate revenue for themselves by charging service or processing fees to consumers, the doctors or both.
The new wave of sites that market drugs directly to consumers began popping up several years ago, promising to streamline medical care with software.
Several gained traction with cheeky TV commercials, billboard ads and social media feeds featuring sexual imagery like cactuses. They use slick packaging, wrapping doses of Viagra in condom-size envelopes or sending chocolate along with birth control pills.
The premise is so attractive to investors that Hims and Ro have raised nearly $100 million each. They have also tapped experts for advice, including Dr. Joycelyn Elders, a former surgeon general who is a medical adviser to Ro, and men’s health specialists at leading hospitals.
Dr. Elders said she had signed on to advise Ro to promote accurate information about sexual health.
The Food and Drug Administration generally prohibits pharmaceutical companies from marketing medicines for unapproved uses, as they have not been federally vetted for safety and effectiveness. Over the last decade, Pfizer and Johnson & Johnson have each paid fines of more than $2 billion to settle government charges of illegally marketing unapproved drug uses.
Doctors are permitted to practice medicine as they see fit, including prescribing drugs for unapproved uses. Mr. Ip of Kick noted that doctors regularly prescribed propranolol to treat anxiety.