D2C Healthcare: Doctor Sentiments

Part
01
of four
Part
01

Direct-To-Consumer Healthcare Service Perceptions

According to doctors, DTC (direct-to-consumer) home testing methods are mostly irrelevant tests that do more harm to consumers than good. They feel that patients need proper guidance from physicians rather than relying on these test results and that the tests are not considered to be accurately diagnostic for treatment decisions. Conversely, they note that DTC tests motivate physicians to learn more about genetics and help patients become more aware and engaged in their own health and wellness.

1. Irrelevant Testings with Dubious Results That Cause More Harm

  • DTC home testing kits for food allergies, offered by companies like EveryWell, test for Immunoglobulin G (IgG) as a marker.
  • However, clinical groups have advised against using IgG tests to evaluate food allergies because, according to physicians, the tests are "irrelevant for the laboratory work-up of food allergy or intolerance and should not be performed in cases of food-related complaints."
  • The reason for this response by doctors is due to the use of IgG because it stems from the body’s normal immune response to exposure to many substances, including food. High levels don’t indicate a problem; they simply point to foods a person recently has eaten.
  • Dr. Martha Hartz, an allergist, sad this about home allergy test: "It has no relevance to anything. It is just not a test that should be done."
  • According to Robert Wood, food allergy tests "are completely useless and do dramatic harm" because they make patients cut nutritious food from their diets which is unnecessary for healthy adults and children.

2. Motivate Physicians to Learn More About Genetic Tests

  • DTC kits make patients engaged and in-charge of their own health. People are more aware of their health and wellness and they discuss results and questions with their physicians.
  • According to the American Medical Association (AMA), physicians must discuss the risks and benefits of these tests with their patients.
  • Increasing popularity and interest among patients in DTC home testings using genetics motivates physicians to learn and be more informative as patients discuss concerns with them.
  • According to Dr. Margaux Lazarin, "as physicians, we don't get a lot of genetics training in medical school. The field is rapidly expanding—not just with direct-to-consumer products—and the increased interest will hopefully motivate physicians to learn more about genetics and its influence on the health of our patients as they bring questions and test results into our offices."

3. Patients Rely More on Tests Than Lifestyle Modifications Recommended By Physicians

  • People tend to rely more on results from home testing than physician's lifestyle recommendations. Dr. Lazarin stated, "I'm wary of how much emphasis patients put on tests, in general, even if it's something like cholesterol. They often put more weight on the test than the lifestyle modifications we recommend."
  • Patients are not usually informed about the limitation of DTC testing. The marketing of DTC health testing kits is often misleading and, in certain cases, there is no sufficient scientific evidence to support the test's claims.
  • Patients may get a result from a DTC test and believe they do not have a disease but physicians note that multiple other factors contribute to staying healthy. According to Dr. Stewart Decker, "People forget there are innumerable other factors that contribute to health or that could increase the risk of getting a disease. If a patient has a family history of breast cancer, that's an opportunity to have a conversation about risks. Now a patient with a family history of breast cancer might get this new test, think they are at low risk and never see anyone about it again."
  • According to the AMA, DTC lab tests "overstate the impact of particular findings, for which little or no evidence may be available, to support questionable recommendations such as those regarding nutritional choices."
  • Anneke Lucassen, president of the British Society for Genetic Medicine, states, "Finding a 'health risk' via these tests often does not mean a person will go on to develop the health problem in question, while 'reassuring' results might be unreliable." Lucassen goes further to state, "the BMJ paper warns genetic tests often prioritize 'breadth over detail,' citing a 23andMe test that checks for a few variants of Brca1 and 2, linked to breast and ovarian cancer risk when there are actually thousands."

4. Proper Guidance Is Compulsory to Interpret DTC Test Results

  • Physicians and experts feel that companies that provide DTC tests have an ethical responsibility to provide clear explanations about test results.
  • Dr. Lazarin says, "I think direct-to-consumer tests should connect consumers to genetic counselors to answer their questions. If someone has a high-risk test result, who is responsible for explaining that information? If I order a cholesterol test, I'm responsible for making sure the patient knows what their results mean."
  • According to Dr. Helen Stokes-Lampard, who chairs the Royal College of GPs, "Genetic testing shouldn't simply be done to satisfy a patient's curiosity about their health, as the results could have very real implications." She goes further to say that DTC test counseling "should be the direct responsibility of the companies that are being paid to perform the tests."
  • The reason for these kinds of responses from doctors is due to the complication in guidelines and test methods, and patient tendency to misinterpret results.
  • JAMA Viewpoints states that most DTC testing companies "offer these tests widely to the public without any reference to evidence-based guidelines or the appropriateness of testing in their advertisements."
  • It is evident from a survey in the Annals of Internal Medicine that most patients do not discuss DTC self-tested results with their doctors. Only 19% of patients shared their DTC results with their primary care physicians. Of those who did tell their physicians they had DTC testing, 35% said they were "very satisfied" with how that discussion went.

5. DTC Lab Test Results Should Not Direct Diagnostic/Treatment Decisions

  • DTC results should not be used as a substitute for physician guidance and diagnosis. Most doctors do not recommend DTC kits and think that these tests are useless and a waste of money.
  • The AMA states, "A positive result does not always indicate a clinical diagnosis. Instead, it may indicate an increased risk for developing a disease or condition. Similarly, a negative result is not indicative of the absence of disease risk. These concepts can be difficult for consumers to understand without a physician or genetic counselor to fully explain them."
  • Dr. Coyle, assistant professor of medicine and medical education, stated that "I wouldn’t recommend to patients that they do [DTC testing] if they asked."
  • Dr. Helen Wallace, director of GeneWatch UK, said, "We recommend that [patients] do not buy these tests, which are at best a waste of money."
  • The reason for this response is due to the high false-positive rates observed during recent studies. In one 2018 study in Genetics and Medicine, 49 patient samples tested for previously identified genetic variants found in raw DTC data, investigators found a 40% false-positive rate.
  • According to the AMA, DTC lab tests are "not set up with the appropriate sensitivity and specificity needed for population screening, which raises the potential for a high rate of false-positive results, and may not cover all risk factors for the condition. [These tests] avoid regulatory oversight, particularly when lacking health or medical claims."

Part
02
of four
Part
02

Direct-To-Consumer Healthcare Case Studies-Part 1

Quip and Warby Parker are examples of DTC healthcare companies providing revolutionary oral hygiene and prescription eyeglasses, respectively. Both companies are analyzed in detail in the following sections.

QUIP

Company Overview

Quip's DTC Products

  • Quip's set of electric toothbrush costs $25 for a plastic handle or $40 for a metallic handle and is refilled every three months for $5.
  • It also offers six-month digital reminders to all Quip members to visit dentists via a program dubbed 'Dental Connect.'
  • Quip also offers its members routine oral hygiene tips and tricks. It also runs a rewards program that pays $5 for inviting dentists to its platform.

Why They Chose To Provide These Services/Products

The Results of These Products

WARBY PARKER

Company Overview

Warby Parker Products

  • Warby Parker provides prescription eyeglasses available from $95, $145, and $195 with free shipping and free returns. Buyers can pick five eyeglasses to try at home and choose the one that best suits them.
  • It also sells sunglasses equipped with scratch-resistant lenses to block 100% UVA and UVB rays available for $95 and $145.
  • Warby Parker also offers gift cards and a range of accessories, including the Clean My Lenses Kit and Parker Case in Midnight for $15, while its Parker Pouch in Walnut sells for $20 and Parker Travel Case for $40.

Why They Chose To Provide These Services/Products

The Results of These Products

RESEARCH STRATEGY

A report by CB Insights featured a list of 14 direct-to-consumer (DTC) startups, which included Warby Parker, while a report by Modern Retail featured Quip as examples of DTC companies. Your research team then proceeded to uncover details regarding the types of products and services these companies offer, why they are offering the services and the results/impact of these services. In this regard, we examined business profiling vendors such as Crunchbase for details regarding their total funding amount and estimated annual revenues. Other details, specifically regarding these companies' products and services and the results of those services were retrieved from their respective websites with Warby Parker featuring a 2018 annual impact report with all its performance and success details. Overall, all details are profiled in the above sections under the respective company headlines.
Part
03
of four
Part
03

Direct-To-Consumer Healthcare Case Studies-Part 2

Hims and Roman are examples of DTC (direct-to-consumer) healthcare companies providing healthcare solutions addressing men's concerns such as erectile dysfunction, premature ejaculation, hair loss, among others. The following sections provide in-depth analyses of the two companies, including the products/services they sell, and the results or impact of those products/services.

HIMS

Company Overview

Hims Products and Services

  • Hims offers a broad collection of hair loss products. Its complete hair loss kit costs $44, while its non-prescription hair loss kit costs $30. Hims also offers several other hair products like shampoos, an edible kit, and conditioner costing $19, $28, and $22, respectively.
  • Hims skincare products include a complete anti-aging and a complete acne set costing $49 each. It also offers a morning glow vitamin C serum for $33 and a wrinkle goodnight cream, among other products for $24.
  • Hims also offers many erection dysfunction products, including sildenafil ($30), tadalafil ($240), viagra sildenafil ($425), stendra avanafil ($175), sertraline ($29), and a premature ejaculation kit and spray for $49 and $29, respectively.
  • Hims also provides a range of well-being vitamins such as sleep, immunity, and gummy heart vitamins for $19 each, biotin gummy vitamins for $16, and propranolol that can control physical anxiety symptoms for $25.

Why They Chose To Provide These Services/Products

  • CEO Andrew Dudum founded Hims following an incident where his sister called out that he had broken and dry skin.
  • So, Dudum's sister order him expensive products to solve the dry and broken skins, and Dudum quickly realized that men lacked access to dry and broken skin health products; therefore, he proceeded to create Hims to offer simple solutions to men's issues.
  • Therefore, Hims chose to provide more affordable access to men's prescriptions regarding hair loss, erectile dysfunction, premature ejaculation, and skin products through innovative products and medical advice, because these are common issues men fail to talk about.

The Results of These Products

ROMAN

Company Overview

Roman Products and Services

  • Roman offers a broad category of erectile dysfunction, hair loss, cold sores, genital herpes, premature ejaculation products at varying prices, and a ‘quit smoking’ kit called Zero, available for $129.
  • For erectile dysfunction, Roman offers sildenafil for $10/100mg (milligrams), generic viagra (sildenafil) for $34/100mg, branded viagra for $70/100mg, generic cialis (tadalafil) for $44/20mg, and branded cialis for $69/20mg.
  • For hair loss medication, Roman offers three packages, i.e., a 3-month supply of finasteride for $20/month or minoxidil for $16/month, or both for $35/month.
  • For cold sores and genital herpes, Roman offers valacyclovir available for $14/month per outbreaks or $42 for three months.
  • For premature ejaculation, Roman provides sertraline available for $24/month or $19/month for a 3-month kit, generic viagra (sildenafil) going for $34/100mg, generic cialis (tadalafil) for $44/20mg, and Roman endurance wipes for $27/month or $22/month for a 3-month kit.

Why They Chose To Provide These Services/Products

  • Roman was driven by several factors to launch these products. First, it found out that men are 50% less likely to visit a physician for over a two years.
  • Equally, Roman discovered that only 30% of men with erectile dysfunction seek medical attention.
  • The company further noted that 80% of viagra bought online is counterfeit.
  • The life expectancy of men is 76 versus 81 years for women because of several reasons, among them poor lifestyle choices.
  • Lastly, Roman discovered that one in seven men would be diagnosed with prostate cancer, and one in 39 will die from it.

The Results of These Products

RESEARCH METHODOLODY

In finding the two additional direct-to-consumer (DTC) healthcare companies profiled above, we started by checking the lists available in public, regarding DTC healthcare companies. On that note, we came across a Fitt Insider report dubbed, 'The DTC Healthcare Report,' with examples of several DTC healthcare companies disrupting the current healthcare landscape. From this list, we selected Hims and Roman, which have been profiled above. However, we did additional searches through business intelligence databases like Crunchbase to unearth details like funding amount, founding date, headquarters, and details on estimated annual revenues. Information about the products and services offered by both companies was uncovered from the individual websites, along with details why these companies chose to provide those services listed. For information regarding the results/impact of their services, we used a report by Forbes, GQ, and Fitt Insider, which contained an in-depth analysis of Hims and supplemented its findings with website data. For Roman, we used a more recent report by TechCrunch, which also included a full analysis of the performance of Roman.
Part
04
of four
Part
04

Direct-To-Consumer Healthcare Case Studies-Part 3

Viome and Nurx are examples of direct-to-consumer healthcare companies offering services in different categories, including gut health and sexual health, respectively. Full details on both companies are presented in the next sections.

Viome

Company Overview

Viome Products and Services

Why They Chose To Provide These Services/Products

The Results of These Products

Nurx

Company Overview

Nurx Products and Services

  • Nurx offers five critical sexual health services. It provides birth control pills for as low as $0 with insurance or $15 without. Other options include a patch, ring, or shot.
  • The company provides three different STI home test kits, the healthy woman kit ($190), the full control kit ($220), and the basics covered kit ($175) without insurance. However, with insurance, the kits cost $75 with a $12 medical consultation fee.
  • Emergency contraceptive pills are offered for free with insurance. For those without insurance, they cost $20. An additional fee of $12 medical consultation is charged as well.
  • Nurx provides HIV PrEP at convenient and affordable rates of $0, while its HPV at home screening kits cost $49 with insurance or $79 without, including a $12 medical consultation fee.
  • Its applications are available on both Google Play and App Store.

Why They Chose To Provide These Services/Products

  • Nurx decided to provide its services because it wanted to make it easier and innovative to access affordable healthcare medication and testing (STI).
  • The company created its business model to deliver choice by allowing individuals to make informed decisions about their bodies, to offer them control that allows them to plan ahead and look after themselves, and freedom that enables individuals to access affordable and readily available medication.
  • Nurx is primarily dedicated to making healthcare more accessible and easier for the masses by "reimagining the future of healthcare" for both patients and medical practitioners.

The Results of These Products

  • Nurx has over 3,872 positive reviews on its website, for its range of products from STI testing to HIV PrEP solutions.
  • Currently, Nurx serves more than 200,000 patients across the U.S. with high-quality care services and products.
  • Since its launch, Nurx has provided birth control kits to over 400,000 women.
  • Its new patient monthly growth rate is at 20% and its services and products are available to approximately 85% of the U.S. population.

RESEARCH METHODOLOGY

In finding the two additional direct-to-consumer (DTC) healthcare companies, we continued exploring the different pre-compiled lists of DTC healthcare companies provided by Forbes and Fin vs. Fin. These two sources featured the examples elaborated above, i.e., Viome and Nurx. After identifying these companies, we proceeded to search through their websites and profiles on Crunchbase for details regarding their services, their estimated revenues, funding information, etc. Details regarding why these companies are providing the products and services they do were retrieved from the 'about us' pages of these companies and online reviews published by reputable companies like Fitt Insider. Equally, information regarding the impact and results of their products was uncovered from the testimonials and review sections of these websites, along with DTC healthcare reports and reviews. For the case of Viome, we used data published by Forbes, PR Newswire, and Forex TV, while for Nurx, we also used data from a report published by PR Newswire and the company website. Overall, the details of two new DTC healthcare companies are provided in the above sections.
Sources
Sources

From Part 01
Quotes
  • "Yet physician groups have for years advised against using immunoglobulin G tests to evaluate for so-called food sensitivities or intolerances. And allergy experts told STAT that the test is useless at best and could even cause harm if it leads customers to unnecessarily cut nutritious foods from their diet."
  • "Patients who ask Dr. Robert Wood, an allergist at Johns Hopkins Children’s Center, whether they have a food sensitivity would never undergo an immunoglobulin G test. Immunoglobulin G tests 'are completely useless and do dramatic harm' because they may compel patients to unnecessarily avoid broad swaths of a healthy diet, Wood said."
  • "That’s because immunoglobulin G stems from the body’s normal immune response to exposure to many substances, including food. High levels don’t indicate a problem; they simply point to foods a person recently has eaten."
  • "The group noted that 'positive test results … are to be expected in normal, healthy adults and children,' and that the test 'increases the likelihood of false diagnoses … unnecessary dietary restrictions and decreased quality of life.'"
Quotes
  • "As physicians, we don't get a lot of genetics training in medical school. The field is rapidly expanding -- not just with direct-to-consumer products -- and the increased interest will hopefully motivate physicians to learn more about genetics and its influence in the health of our patients as they bring questions and test results into our offices."
  • "I'm wary of how much emphasis patients put on tests in general, even if it's something like cholesterol. They often put more weight on the test than the lifestyle modifications we recommend."
  • "There is potential with some of these tests to be used in prevention. Typically, patients with certain hereditary cancers are offered genetic testing after they have the diagnosis. With proper guidance, patients who are at risk could potentially have testing before the disease itself presents -- though this doesn't necessarily have to be direct-to-consumer testing specifically; physician-mediated testing could also play an important role. However, for patients whose physicians don't know about the tests, or with insurances that restrict coverage, or even with limited access to genetic counselors, the opportunity for highly motivated patients to have an opportunity for direct-to-consumer testing could be helpful in certain situations."
Quotes
  • "The geneticists said the tests could be wrongly reassuring - or lead to unnecessary worry."
  • "Finding a 'health risk' via these tests often does not mean a person will go on to develop the health problem in question, while 'reassuring' results might be unreliable."
  • "Dr Helen Wallace, director of GeneWatch UK, said: 'We recommend that you do not buy these tests, which are at best a waste of money.'Handing your DNA to a private company also raises privacy concerns for you and members of your family.'"
Quotes
  • "'I wouldn’t recommend to patients that they do [DTC testing], if they asked,' he said. 'I think we probably do need to be better about asking our patients whether they’re doing this on their own, to make sure that we help them interpret it correctly, that it’s a change in risk – not a diagnosis, and not an assurance they won’t get that disease process.'"
  • "High false-positive rates have been seen in recent studies that sought to confirm genotyping data from DTC genetic test results, according to Dr. Coyle. In one 2018 study in Genetics and Medicine (2018;20:1515-21) of 49 patient samples tested for previously identified genetic variants found in raw DTC data, investigators found a 40% false positive rate, which they said underscored the importance of clinical confirmation testing to assure proper patient care, he noted."
Quotes
  • "These and other DTC laboratory tests—often conducted without the involvement of a physician, with results reported directly to the patient—may lead patients to potentially harmful misunderstandings."
  • "A positive result does not always indicate a clinical diagnosis. Instead, it may indicate an increased risk for developing a disease or condition. Similarly, a negative result is not indicative of the absence of disease risk. These concepts can be difficult for consumers to understand without a physician or genetic counselor to fully explain them,” the AMA website says."
  • "'Moreover, advertisements tend to entice consumers by appealing to fears of contracting common disorders such as cardiac disease, stroke and various cancers. Most of these medical tests, however, are of low or negative value for a large segment of the consuming public.'"
  • "If your patient asks about DTC testing options, you should talk with them about the risks and benefits of these tests, along with the risks of interpreting such test results without input from you or another qualified health professional."