The Dark Side of Digital Health?

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Words | Angelica Owczarek

Hers is a US based telehealth service aiming to address women’s common health needs. Telehealth provides the exchange of healthcare services and education between patients and a digitally accessible health professional. But is there a dark side to digital health?

Hers boasts to its customers about gaining a sense of control over their health by using their products for specifically women’s skin, hair and sexual health concerns: their offerings ranging from shampoo to birth control. At first glance – the website does not appear to be a medical service. It features a minimalistic design, a “trendy millennial” aesthetic seen in the likes of brands such as Glossier. The marketing strategy features little text, non-offensive pastel colours and diverse, minimally made-up women. Medications are plainly packaged. A pastel picture collage aesthetically surrounds short, punchy marketing buzzwords whilst a link takes you to a page about the company’s purpose. The web designer definitely had a field day. Because I sure forgot it was a medical service. Is it beautiful? Yes. Does it pose itself as a credible medical service? No.

Hers is not a stranger to Instagram, in fact it is the platform where their marketing strategies received the most backlash. Among their social media posts and advertisements, they have marketed medication propranolol for performance anxiety; to calm nerves before a big date or presentation, and the worst of all-to stop anxiety from “standing in the way of you manifesting your badassery”. Luckily, this laughable marketing attempt for a serious medication didn’t have their aesthetic-loving consumers fooled. The statement has since been taken down from the Hers website, consumers taking to Instagram in anger. 

A comment from user sleepyhousehealing states “Bizarre. I needed a prescription for this and it was for temporary relief of PPA. Advertising drugs as a one-size fits all solution is some dystopian future shit. This episode of Black Mirror sucks.” 

Many users mentioned how Hers’ marketing pathologises normal experiences of anxiety, helloitssita stating “Holy. Shit. This is actual bonkers. I am so disgusted and disturbed, this isn’t ethical. Everyone has pre date jitters, some level of anxiety is normal. We all experience it. But to think with all the cute packaging and the right marketing that this is ok is so wrong. Why call it Hers? Trying to push strong medication with serious known side effects onto people who don’t know better with cute packaging. Have you thought about girls who think pre date jitters are something to medicate then they have a drink on said date, they could pass out and god knows what. This is negligent as hell to say the least.” 

Propranolol is a beta blocker, primarily used in the treatment of high blood pressure to prevent strokes, heart attacks and kidney problems. The way Hers uses a combination of techniques such as emojis, simplistic language and plain packaging to market the drug on their Instagram page begs the question of whether this should be subject to the same laws and regulations as a medication product claim advertisement. According to the US Food and Drug Administration (FDA), “A product claim ad names a drug, says what condition it treats, and talks about both its benefits and its risks. An ad must present the benefits and risks of a prescription drug in a balanced fashion. Balance depends on both the information in the ad itself and how the information is presented.” Hers does not provide a fair balance of information about the drug’s risks and benefits. Under the FDA, presenting a medication’s risks in “small type size”, positioned “far from where the benefits are discussed” is considered an unfair balance of information. In Hers case, the risks of the medication are not presented in the post, relying on the patient to source the information externally on their website. 

It fails to mention that Propranolol is not FDA approved for the treatment of “performance anxiety”, let alone anxiety, and is used off label to treat such conditions. Moreover, consumers are not presented with the FDA’s required “brief summary” including additional risk information. Does it matter if it is just an Instagram post? In Australia, the Therapeutic Goods Administration (TGA) prohibits the advertising of medication directly to consumers. As non-US consumers have access to Hers marketing, at the very least, they have a responsibility to inform consumers of the risks of their medications. Hers has issued a public apology on their Instagram page about pushing propranolol, particularly for the quote about being “nervous about your big date”. They stated that they have “permanently removed that ad and are working with our medical team to ensure that all copy is safe and accurate for the consumer moving forward”. However, a user comment from missmeganwhite reveals, “THIS IS BULLSHIT I JUST GOT THE SAME SPONSORED AD BUT INSTEAD OF FIRST DATE IT WAS “work presentation” JUST STOP“. Hers’ treatment for “performance anxiety” is no longer boasted on their front page, standing beside their golden skin, hair and sexual health treatments. Instead, it is just a few extra clicks away.

The issue with telehealth services is that online doctors cannot observe a patient outside of an online interaction. A patient’s actions, speech, mannerisms or appearance could go unnoticed before diagnosis. Doctors may have trouble handling patients with complex medical history or needs digitally, and it may be easier for consumers to skip side effect warnings. As consumers are required to pay for their medication and subscription to Hers before consulting with an online doctor, this begs the question whether this is an ethical way to provide a medical service especially if a consumer only requires short term treatment. For example, if propranolol is supposed to be for a “one-off” anxiety-inducing event, why do consumers need to subscribe to receive 5 pills every month?

Following in the footsteps of Hers, Kin Fertility is an Australian-based telehealth service providing access to birth control and fertility testing. The company uses similar visual marketing that lessens the seriousness of the health service. Unlike Hers however, Kin Fertility adheres to Australian TGA guidelines as no medications are mentioned or promoted specifically. You are only able to see the brands of pills they carry and their prices. They have a similar business model, and you still pay for subscription upfront, however you undertake a medical questionnaire first. Emojis are used in the questionnaire as well as casual slang terms. You are unable to proceed in the questionnaire and pay for subscription to Kin if you indicate you have never tried the pill. Kin recommends the consumer to see a doctor in person, which enables them to be seen by a health provider that can ensure full duty of care in person.

Yet, there is a place for telehealth services. They create accessibility to medicine where it is unavailable. Rural women benefit from access to a doctor itself, as well as a doctor willing to prescribe contraception. It creates accessibility for people living with mental or physical disabilities, empowers marginalised groups to seek treatment, caters towards busy professionals with little time, or provides the convenient option to receive the medication you know you are happy with.

From an ethical standpoint, telehealth services need to provide duty of care to their consumers. With social media being a two-way street, luckily, consumers are pushing companies in the right direction.

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