This appeared last week:
‘Pill mills’ or the future of medicine? The rise of the telehealth industry
January 21, 2023
It’s not easy for Laney Robson to get her two children, aged 5 and 11, to a doctor. Based just outside the Hunter Valley in NSW, she could brave the “diabolical” wait at the local emergency department or face being told “it’s weeks and weeks wait before we can take you on” by an unfamiliar GP clinic. So Robson started using InstantScripts, an online business that charges $19 per prescription, for scripts to treat minor ailments like her children’s eye and chest infections.
“Everything else we do in our lives is becoming more and more online, I just don’t see the difference between banking online and this sort of stuff,” Robson says. “Certainly for people in rural areas, we’re very fortunate to be able to access something like this.”
Telehealth has been one of the big winners in Australian business from the COVID-19 pandemic. A new wave of startups offering online access to treatments from acne creams to erectile dysfunction medication and weight loss drugs emerged raising well over $100 million collectively from venture capital firms and other investors who see a potential gold rush for startups to capture a slice of the $200 billion this country spends on health each year.
These well-funded startups have been advertising aggressively on late night television, social media and public transport in a bid to ingratiate themselves with customers young and old.
At the forefront of this trend is Eucalyptus, which operates brands such as Pilot, Kin, Juniper and Software that offer men’s health, pregnancy, women’s health and skincare products respectively. There’s also Mosh, a men’s health brand. There are a host of platforms that let you speak to a doctor to get a prescription for all manner of ailments, the largest of which is InstantScripts which Robson was drawn to. And some major players are also getting into the space. The ASX-listed health insurer nib bought a majority stake in Midnight Health, a stable of brands similar to but much smaller than Eucalyptus, last year.
While investors in telehealth startups have high hopes for the industry, and patients are thrilled with the convenience they offer, some health experts and industry groups are deeply concerned. Rather than just changing how healthcare is delivered, they fear that basic tenets of medicine are being disrupted.
Pharmacy Guild president Trent Twomey says there are “cowboys” operating in telehealth and accuses them of “reducing the provision of healthcare to an algorithm” under a doctor’s supervision.
The Royal Australian College of General Practitioners is aggrieved too. The telehealth industry is pursuing “a business opportunity versus a health care opportunity,” says its president, Dr Nicole Higgins.
Of course, the business and care models of both GPs and pharmacists (which are pushing to do more prescriptions themselves, setting up a separate clash with GPs) are being put under pressure by telehealth companies.
But with Australians’ wellbeing on the line, along with medical professionals’ livelihoods, and a share of the hundreds of billions this country spends on health each year, it will be a long battle.
From marketing to medicine
The idea of telehealth is not new and in theory the level of care and speed is no different to an in-person consultation. But technology and the pandemic have driven it to new levels of speed and popularity.
“McDonald’s is also a very convenient service, but it’s not necessarily one that’s very healthy in the long term”
RACGP president Nicole Higgins
Figures from the Centre for Online Health at the University of Queensland show that there were 122 million telehealth consultations from the start of the pandemic to the third quarter of 2022. The figure shows how Australians have flocked to telehealth, but would be far higher if it included the new start-ups, who bill customers directly and do not use Medicare.
The biggest player is likely Eucalyptus, which has its roots in marketing rather than medicine. In a 2019 pitch deck designed to secure early investors, the company styled itself after e-commerce companies selling razors and shoes.
“We were just well-placed, luckily, to build infrastructure when the shift to telehealth really happened,” says its chief executive and co-founder, Tim Doyle, a former marketing whiz at online mattress company Koala.
By 2020 the company had shifted to put health at its core, hiring more doctors and giving them final say over all medical calls at the company. And its ambitions are only growing, with a focus on trying to tackle the chronic and wildly expensive problem of obesity.
For companies like Eucalyptus, patient-doctor consultations are necessary but not the moneymaker. By contrast, for InstantScripts and other firms like it such as Qoctor, the reverse is true. They are selling consultations and prescriptions.
While some of the new telehealth companies use video or voice calls for all patients, others rely overwhelmingly on text-based consultations. More than 70 per cent in Eucalyptus’ case.
These begin with a patient selecting the kind of treatment they want. InstantScripts allows the patient to specify down to the exact dosage of, for example, Azotet (a cholesterol medication). Other firms, such as The Hairy Pill, which treats hair loss, do not advertise their medical ingredients because of government restrictions but have slogans such as “One pill. One solution” and before and after photos showing potential results.
Once a patient has selected the kind of treatment they want, a form appears asking questions. Some companies use lengthy forms, asking dozens of questions about a patient, their medical history, and their issues. Other providers probe far less and, if a potential patient wants a particular medication, the answers to questions such as “Are you having trouble achieving an erection?” are obvious.
“The same concerns could be levelled against... in person doctors, [claiming] they’re influenced by drug companies, that they’re trying to do medicine in 10 minute blocks and things like that.”
Telehealth Associate Professor Liam Caffery, University of Queensland
The new providers get through the results from their patients quickly. Some roster their doctors in five-minute increments. Others expect them to assess six to 10 patients an hour.
If the patient is approved by the doctor, the prescription medications come fast. Eucalyptus’ brands have partner pharmacies that ship pills to patients, while InstantScripts says about 95 per cent of its patients are sent the script electronically and get it from their local chemist.
Higgins, the president of the general practitioner’s association, has a dim view of these companies, though she understands the convenience.
“We also know that McDonald’s is also a very convenient service, but it’s not necessarily one that’s very healthy in the long term,” Higgins says.
She points out that telehealth providers cannot carry out physical checks of a patient and can employ doctors to do prescribing work who are licensed but have not trained specifically as GPs. She says telehealth providers tend not to know patients’ families like GPs do. And Higgins worries about care being “fragmented”, with no GP knowing every medication a patient is taking or following up if medicines are not being used.
The Medical Board of Australia, which oversees doctors, appears to agree. Late last year it handed the GPs a win, condemning the fastest way of getting a prescription online: filling out an online questionnaire that a doctor signs off without ever having spoken to the patient.
“Consultations enable a doctor to ask follow-up questions that help identify the best treatment for a patient,” a board spokeswoman said. “A text-based health questionnaire completed by a patient and read by a doctor at a different time is not a doctor-patient consultation.”
“Prescribing is not a tick and flick exercise – it relies on a doctor’s skill and judgement,” the spokeswoman said. For now, the new rule is a draft only but it could be made permanent later this year.
There are many more pages here:
As is clear, from this well researched article, we have has all sorts of services, with all sorts of business models, spring up in the last few years and especially since COVID.
I suspect there has not been a careful review of the clinical safely and quality of these systems and now that COVID has largely settled surely now is the time to lay out appropriate ‘ground rules’ and evaluate carefully where we are and what needs to change…before the chicken really does “fly the coup”.
It will be interesting to see what
the poll this week makes of it all! It is clear the Medical Board is starting to take an interest and that change is around the corner....
David.
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