You’re SIMPly the best … at making money

13 minute read

Single-indication marketing platforms (SIMPs) are making some doctors unhappy with their for-profit, few-questions-asked style of medicine.

We got into a bit of trouble this week with Creative Careers in Medicine (CCIM) after reporting on their conference’s session on telehealth.

CCIM has some elements similar to Social Media And Critical Care – SMACC was a creative global medical event phenomenon that started in Australia, but is unfortunately no longer with us. CCIM is lateral, future-leaning, creative and fun, and it’s as much about the future of medicine in Australia as it is about careers in medicine.

But fun and creativity weren’t the vibe when we got to the session on telehealth last Sunday.

The session exposed a major and widening rift between what’s happening at the big new single-indication marketing platforms – can we call them SIMPs? – such as Eucalyptus and Mosh, and what doctors think is actually best for patients and the system.

Not long into the CCIM session on telehealth which was sponsored by a private telehealth group – a doctor in the audience stood up and called out the panel for pushing the large privately funded platforms which, in the view of the doctor, were rapidly fragmenting good care models and damaging both the system and, likely, patients.

TMR reported the exchange on Monday. Soon after, in a move that seemed indicative of the division and tension in the room, another audience member posted on social media that the session was positive and productive and that our story was a beat-up.

This person failed to declare in their post that they have worked with organisations that have had deep interests in and work with the burgeoning SIMP businesses.

This feedback also contained some deliberate conflation between telehealth meaning “a phone call with your regular GP” and telehealth meaning “a few questions and a text chat and your Ozempic is in the post”. That’s why we’re calling the second type of operators SIMPs, for clarity.

TMR also received some feedback from other people in the audience, one who told us that our news story was too negative and did not represent the session or the conference in a good light. They said having media in the room might stifle meaningful discussion among audience members.

Our position is that the division that occurred in the room, and after, reflects an important issue for general practice and the health system more widely that would otherwise not be aired beyond the couple of hundred people.

Our reporting of the session was straight and maybe even a bit tame – possibly because we were pressured, just a little, by the CCIM organisers not to do the story at all.

When we said we were doing it, they requested edits on certain pieces of information – such as which panellists had worked or did work for which SIMPs – which we declined to do because the information was material to the issues in the story.

What’s clear is that at least some of the doctors in the audience believed that the aim of the session, at least in part, was to flatter SIMPs and show them in a good light.

The moderator of the panel, Dr Amandeep Hansra (also the founder of CCIM) and the two doctors interviewed on the panel had all worked for or were still working for either Mosh or Eucalyptus, and the panel was sponsored by private telehealth platform Doctors on Demand. So, technically at least, it was a panel with potential conflict.

Dr Hansra’s logic for including GPs who had worked or were working for these platforms was that this was a creative careers conference and the two GPs were communicating pros and cons for any GP thinking of working at one of these businesses.

Dr Hansra was obviously aware of potentially negative attitudes, because at one point she told the audience that the two panellists were being “brave” by coming on stage to talk about their experiences. She wasn’t wrong.

For the record, TMR has interviewed both panellists about their careers in the past and it is not our view that either doctor went on the panel with any intention to spruik Big Telehealth.

Both are creative and committed younger GPs with interesting career stories, who feel their experiences are relevant to GPs doubting whether they want to spend all their days in a windowless room doing 15-minute consults. Both had good points to make about developing a more fulfilling career as a GP.

But the point being made by the dissenter in the room can’t be dismissed on these grounds.

The balance the panel should have had (a non-SIMP person to speak out against them) was provided only by the doctor who spoke up from the audience.

That doctor later explained her position in a post on a private chat group that was later deleted at the request of the group’s moderator on the grounds that it might cause distress to the panellists.

TMR has not seen that first post, but the doctor later reposted it or a version of it, which ran in part:

“My feeling is that DoD/Mosh/Euc [Doctors on Demand, Mosh and Eucalyptus] were, by association, being platformed [at the session] as authorities and somehow valid arbiters of a go-forward approach at a time when fragmentation and discontinuity are real and present threats.

“… As far as it can be observed, Euc/Mosh strategies centre around driving profit margin out of insecurities and post rationalising their model. This is not a first principles approach.

“… The quip that ‘you’re not worse doctors for working here’ (at Mosh) was unsettling … The conflation of what is essentially a fast and loose dispensary with good quality general practice care should concern everyone. It blurs the lines between comprehensive primary care and a model that could be likened to a fast-food version of medicine, prioritising convenience well over quality and thoroughness.

“… The rise of platforms enabling patients to effectively dictate their treatment, including essentially self-prescribing chronic medication, like Ozempic, is a perverse inversion of medical practice.”

After reposting the comments the moderator disabled the chat group entirely which, among other things, meant that no further discussion could occur about the topic or the comment.

Our point here is not to butt in to private doctor discussions. This post succinctly expresses a doctor’s reservations around a significant phenomenon in medicine and we wonder why ongoing discussion on the topic was curtailed.

Our point here is not to butt in to private doctor discussions. The post (reprinted with the author’s permission) expresses neatly a doctor’s reservations around a significant phenomenon in medicine.

For decades the pharma industry has practised highly sophisticated marketing techniques, one of which involves the enrolment of senior and influential doctors in the cause of marketing a new drug.

Key opinion leaders (KOLs) are seen as the trusted gatekeepers for doctors downstream as to whether a pharma’s claims about a new drug can be trusted. KOLs are also often paid by pharma to be on their clinical boards.

The relationship between KOLs and pharma these days is very strictly regulated for transparency of potential conflict. Regardless, there is technically conflict in what they are doing if they are being paid by a pharma.

Transparency looks like a big problem with the situation in which a doctor might be talking favourably about one of these new telehealth platforms. If you’re a KOL and you have potential conflicts, those conflicts must be declared up front and in black and white so doctors downstream can make a fair judgement of the opinions on offer.

This is not happening in the case of SIMPs.

So far in the big telehealth debate we definitely seem to have high-profile and influential doctors for hire.

What are they hired for?

Is it for their deep expertise in delivering healthcare digitally and making sure everything in the system is connected properly so the patient is protected?

Or are some of doctors being recruited for their influence and celebrity as mouthpieces for the claim that these platforms are important future part of healthcare?

This issue is starting to divide the doctor community.

The specific argument many GPs are making about the platforms is that they do not properly, or at all, seek to integrate the treatments they are providing back into the normal frame of that patient’s care, so there exist serious continuity of care and safety issues.

Some of what the panel and the moderator pushed at the CCIM audience, conflicted or not, was thought provoking.

Some points they made included:

  • These platform players probably aren’t going away – the opportunity of big bucks is just too big. The genie is very likely out of the bottle here from a government point of view. So how do we live with them in the system?
  • Big demand from patients for these platforms exists for a reason. The platforms would have it that their clients are getting something from them that they are not getting from GPs, otherwise they wouldn’t be going there en masse and spending a lot of their own money. The question is, what are they getting and is it actually good for patients or good for profit? Also, should patients as consumers be allowed to get anything they want in healthcare type products and services, or might this end up crippling an already very strained system? Would it have been a good idea to first ask the public if it was OK to up-schedule opioids out of OTC?
  • If GPs like the ones in the room (and the big colleges) exclude themselves from being involved with these private plays, then through lack of proper clinical governance and common sense, they may well end up harming some patients, so well trained doctors being involved with them is important for the sector and patients. Dr Hansra actually told the audience that without help from properly trained GPs these platforms could end up killing a patient.

One former employee of one of the platforms told TMR that demand had arisen because patients can’t get the help they want for the single-indication problem they are trying to solve. It’s the “meeting a need” point made by the panel above.

When asked why GPs weren’t servicing the need, this person said it was mostly because GPs just don’t have the time to do it the way the platforms can.

That sounded like a trotted-out marketing line.

And there lies a lot of the problem with what happened at CCIM. You might have a good point to make but in what context of conflict are you trying to make it?

The other line we get from the platforms is that you can’t get to see a GP and they are all about access and equity – hey, we’re at your fingertips on your phone!

This is a rubbish argument. You largely can still see a GP, certainly if you wait a day or so (excluding some rural and remote regions where there are obviously access problems). And given that all these platforms charge about $400 per month for a weight loss drug and their online support, while Ozempic off label from your GP will only cost you about $190 per month including gap fee, access and equity are clearly not the problem.

The most prominent single issue being addressed by these platforms is weight loss.

Do GPs not engage their patients properly on weight loss? Or do a lot of patients just want Ozempic and don’t believe their GP is going to give it to them?

One thing is for certain: the platforms don’t engage at all effectively with their “Ozempic subscribers”, in terms of managing the long-term comorbidities associated with obesity, if indeed they are even effectively treating an obese patient for weight loss. They can’t: their business model is volume, and the volume is all sales of Ozempic (or equivalents). And they don’t generally connect their care with the normal framework of care a patient might be operating in, so all those other problems a patient likely has if they are obese are potentially not in the frame of their care.

Some doctors also think that if these privately funded for-profit monoliths continue to grow, they will eventually erode business margins in the already distressed general practice sector.

That’s certainly possible, though there is no evidence of it happening … so far.

All these platforms are growing fast, exploiting loopholes in a health system designed around universal access to healthcare via Medicare – not around digital marketing platforms prepared to go anywhere any which way, selling products seamlessly and seductively to patients and saying they’re good for us.

There are giant holes in legislation and regulation because governments haven’t had time to catch up. Our system is still fundamentally designed around doctors playing to the Medicare model, not tech entrepreneurs preying on patient insecurity.

Talking to prominent online commentator on digital health Michelle O’Brien about the problem this week (Ms O’Brien works for us part time) she summed up a lot of what is going on as follows:

“All this platform stuff is fine if it’s my banking, a new type of taxi service or how I start watching TV. But this is healthcare and healthcare is a very different proposition. Unfortunately so far the government is looking clueless and toothless in the face of these emerging private platform health plays, who are exploiting every legal loophole they can, just as companies like Uber and AirBnB did in other markets.

“If general practice starts to break down as a result of what these marketing platforms are doing, the blame is going to clearly lie at the feet of governments that have already seen the carnage in other markets from letting technology platforms dominate a consumer ecosystem but are moving way too slowly to stop them doing what they’ve done in other markets in healthcare.

“The other problems we have here is that consumers can’t be treated the same in healthcare as they have been in other markets. It can’t be about ‘consumers need to get what consumers want’, which is what a lot of these emerging platforms say is so modern and revolutionary about their approach to healthcare.

“Consumers can be like Labradors. If you put enough easy to access Ozempic in front of them, they are going to eat it until some of them die.

“The government needs to get in front of this problem and quickly or it’s going to blow up in their faces and significantly damage our whole healthcare system.”

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