The Expert Podcast

For many years, telemedicine was pitched as the new wave of health care service where you can actually get a lot of health care resources or consultation without having to go in person to a medical facility. Telehealth, telemedicine—whatever you want to call it—actually became very popular during the pandemic when people didn't want to go anyplace in person, especially a medical facility. One of the areas where telehealth or telemedicine was thought to have big potential was in the mental health arena.

Because mental health, almost by definition, doesn’t actually require physical exams like taking blood, checking temperature, or monitoring heartbeat, it is by nature a more conversational process. So, many online companies popped up offering mental health treatment online. The problem is, a lot of these companies grew too big for their britches—they expanded too fast. As a result, there were problems, and this Wall Street Journal article talks about some of them, which may now be leaving a bad taste in the mouth of people who tried to access these services.

A couple of examples featured in the article are Cerebral and Done Global. The short story is that they raised hundreds of millions of dollars in venture capital money, had some high-profile spokespeople, and launched with high expectations. In fact, one company had a valuation of $5 billion within just a couple of years after starting. But they got into trouble because they started prescribing drugs that may have been overprescribed or abused.

They were also talking about profitability because of prescribing these drugs. Now, they’re under investigation for possibly prescribing too much—so much, in fact, that two large prescription providers, Walmart and CVS, will no longer fill their prescriptions because they don’t consider them legitimate or responsible enough to be dispensing such medications.

In one case, a major company was run by a former Facebook product manager with no medical training. They advertised on social media, and the same thing happened—Walmart and CVS stopped filling their prescriptions. Many of these companies were thought to be disruptors, meaning they wanted to do things in a more efficient and different way.

One good quote from the article came from an internal insider at one of these companies, saying, "It’s one thing to be disruptive, but there’s a reason that medicine is encumbered by regulations—they’re dealing with people’s lives." One of the companies said they aimed to provide "low-threshold access" to medication. But medication might actually need "high-threshold access" because it’s important to make sure there are no side effects or other problems before prescribing certain drugs.

Another company mentioned is Talkspace. You’ve seen those ads—it’s therapy, consultation, and counseling by telehealth to work through anxiety and family or relationship problems. It’s easy to sign up for, but a lot of customers found it a bit off-putting. In one case, a therapist appeared unprofessional—switching between rooms, ending up on a couch with a kitchen in the background, and people walking behind them. That’s not really private.

In another instance, a therapist was a passenger in a car and stopped for gas during a session. The customer could hear the driver get out and could see the gas pumps. It didn’t feel like a place where the therapist could listen intently. So, these consultations weren’t happening in secure, quiet environments—without distractions—the way they usually ask patients to do.

Part of the reason for this is the increased demand during the pandemic, which lowered the bar for training for some therapists, counselors, and even other medical personnel. So while there’s big potential for telehealth and telemedicine, the fast growth may have created some problems that need to be worked through before it becomes a more mainstream and accepted way to obtain health care remotely.