Platform Heals? Ethical Issues in Direct-to-consumer Telepharmacies

Ben Wills - The Hastings Center

ELSIconversations - February 26, 2021

Healthcare is in the middle of a dramatic revolution. Hims, Hers, Roman, Nurx, LemonAid, and The Pill Club are start-ups seeking to “disrupt” conventional pathways to healthcare by replacing both in-person appointments and trips to the pharmacy with telemedicine visits and integrated mail-order pharmacies under one brand. By tackling the morass of state and national regulations concerning telemedicine and pharmacies, they make seeing a provider and getting medication something that can be done from the couch. What could be wrong with streamlined, lower-cost access to medical care? As it turns out, plenty. Ease of access comes with costs: many companies don’t take insurance, for example, “smart” medical history forms often don’t handle patients well, little opportunity is made to foster a provider-patient relationship, and wellness products of dubious benefit are sold alongside established medications. At a more abstract level, some company marketing practices seem to medicalize natural variation. This paper articulates ethical implications of a business model that lies at the intersection of platform-based e-commerce, wellness, and telemedicine. Despite superficial similarities between reproductive telemedicine companies, this analysis shows that the specificities of marketing, decisions about which products and medications to sell, and company structure – aspects which are still in flux as this industry learns and identifies best practices – critically impact the possibility of providing ethical, quality tele-healthcare.