November 28, 2023

Scrolling your social media feed or TV, you’re bound to see advertisements for apps that offer easy access to medications. Can you trust a telehealth pharmacy to get you access to the new weight loss sensation, Ozempic? You could get hair loss medications from Hims or Keeps. You could get acne creams from Curology. Is it convenient? Is it high quality? Is it expensive?

As a dermatologist and researcher on telemedicine for over a decade, I am both excited by and concerned about this recent trend of direct-to-consumer (DTC) telemedicine platforms. You can schedule a visit with a doctor and get the medication you need more easily, which is attractive for both straightforward problems (e.g. birth control), and for stigmatizing problems (e.g. STIs).

On the plus side, these start-ups have recognized that patients are not getting access to medicines and treatment, and new models can break down barriers. Especially during the pandemic, when in-person care came with exposure risks, telemedicine was essential to bridge gaps. However, some barriers are good, and we need to make sure we only get necessary medications and that medical care remains connected and not fragmented.

What if your primary doctor doesn’t know that you’re starting a new medicine, or if the DTC doctor doesn’t know about your medical history or allergies and you forgot to tell them? Many of these companies don’t ask all the appropriate questions, verify information or contact your primary doctor if there is a problem. It is also important to always have in-person local options, ideally someone who knows you, in case of any emergency.

Beyond the lack of connectivity and quality concerns, these DTC companies are not the cheapest way to get access — some charge steep monthly fees to sign up, while most of their profit models are based on the money generated by prescriptions. A DTC company advertising a visit to get a medication (e.g., “Get your Viagra privately without any of the hassle!”) probably makes most of their money on that prescription, and could be less inclined to appropriately advise you of risks, given their major conflict of interest. Should we equate a good doctor’s visit with getting what we expected to get, or should we evaluate visits based on objectively good care, whatever that ends up being? I’ve heard doctors complain that if all they wanted were good reviews, they just had to prescribe all the antibiotics and pain medications patients asked for, whether it was good for them or not.

Research shows that patients are desperate for access to care. Believe it or not, patients have even been anonymously posting photographs of their own genitals on Reddit forums to crowdsource treatment for sexually transmitted infections! If you read the forums, like our team did on dermatology Reddit, patients mention not having insurance, having to wait to see doctors, not having the time or ability to go in for an in-person consultation and sometimes medical mistrust.

Clearly, poor healthcare access remains a problem we cannot ignore. These companies do offer a glimpse into what a possible solution could be. But who are these doctors? And is this a cost-effective way to get care? Dermatology, for one, can be notoriously difficult to get into for an appointment, but when I see patients for hair loss, I consistently find that I can provide the same medications that companies like Hims and Keeps can for significantly less. Some might argue that the convenience of an app and the wellness-focused packaging creates value. But why pay more for fancy labels and question whether you could ever trust one of these companies to tell you not to go on a medicine they make most of their money from?

I remain concerned but cautiously optimistic about the future of DTC telemedicine companies. Traditional in-person medical care has plenty of flaws, and our goal should be to deliver high quality care, no matter what the method. Innovation is always needed, and I hope our regional and academic systems and private practices can expand ways to meet patients where they are, through telemedicine and beyond. 

We must continue to push the needle forward, but when it comes to health care, we cannot recklessly embrace the famously callous Silicon Valley mantra of “move fast and break things.” I recommend all patients remain cautious and continue to work closely with their local primary doctors if they are considering using one of these DTC companies or apps.

Jules Lipoff is a clinical associate professor (adjunct) at the Lewis Katz School of Medicine, Temple University. 

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