Why is this interesting? - Friday, April 12

On DTC, prescription drugs, and regulation

Colin here. If you have consumed any media in the past few years, you’ve no doubt been hit by advertising from direct to consumer (DTC) brands. They’re all over podcasts, subways, and, most recently, TV. Two that you’ve likely seen recently are Hers (and Hims) and Roman, who are trying to reinvent the way generic prescription drugs are marketed and sold.

Both companies have grown quickly and together raised roughly $300 million in venture funding in just two years. In periods of growth, companies tend to stretch to the limit and often weak links snap. In the case of these two, unfortunately the weak link seems to be pretty essential: a remote doctor assessing and writing prescriptions. Per a Times story from last week on “Restaurant-Menu Medicine”:

“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.”

Why is this interesting?

To me there are a ton of questions here. Are people getting prescriptions that they shouldn’t be getting? Is the system being gamed? Is there a growth-at-all-costs mentality to justify huge valuations? Should prescription medication, with all its potential dangers, be yet another ecommerce transaction?

On one hand, the value proposition is clear. A sleek, streamlined way to get medicine discreetly: the same way someone would shop for electronics or makeup. But there is a lot more at play. The Times went through the ordering process a number of times and found it to be uneven at best (on one occasion the doctor offered credentials and on another they didn’t) and at worst out of line with state laws (the Times found someone who was able to get a prescription in Ohio without meeting the state’s legal prescription standards). While pure efficiency is nice in many categories, laws like the one in Ohio which requires doctors “communicate with patients in real time, through audio or video” exist specifically to ensure prescriptions come with some care.

The companies argue they aren’t health providers and, for legal purposes, the doctors don’t actually work for them. But just as Uber tried to position itself as market-based intermediary with nothing to do with the drivers, I suspect as this practice continues and spreads we will see an analog to what happened with the regulation and oversight of ride sharing. (CJN)

Fish of the Day:

I spent the last two days catch and release fly fishing in Missoula, Montana with my friend Nick and an amazing guide named Chris Stroup of Montana Cutthroat Guide Service. We’ve been going out with Chris for six years now and he’s great. He finds fish no matter the time or weather. Look him up if you find yourself around Montana and want to go fly fishing. I caught this beauty towards the end of our second day. (NRB)

Quick Links:

  • Speaking of overprescribing, urgent care clinics have a big problem as well. “Of 2.7 million urgent care center visits, 39% resulted in antibiotic prescriptions. Not far behind, 36.4% of 58,206 retail clinic visits resulted in prescriptions. Meanwhile, 13.8% of 4.8 million emergency department (ED) visits and 7.1% of 148.5 million medical office visits resulted in written prescriptions.” (NRB)

  • Jack Dorsey remains tone-deaf and annoying, per usual. (CJN)

  • A wonderful interview with John Morford, who is a very important hotel designer responsible for the likes of the Park Hyatt Tokyo, Park Hyatt Seoul, and the Grand Hyatt in Hong Kong. This is an old-ish interview, and he doesn’t do many. But it is a very soulful and thoughtful discussion on creating spaces. I had the good fortune of meeting him in Hong Kong on a random evening a few years back, and I think he was taken aback to be recognized. (CJN)

Thanks for reading,

Noah (NRB) & Colin (CJN)