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Hims and Roman target erectile dysfunction, which can signal health issues

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startups young patients erectile dysfunctionErectile dysfunction can be the first sign of troubling health problems like heart disease.Shayanne Gal/Business Insider

  • New telemedicine companies like Hims and Roman have sprung up, offering online prescriptions for Viagra and other erectile dysfunction medications. 
  • That erectile dysfunction can be a sign of other, more worrying health problems, particularly in younger men, is well-established among physicians. 
  • One doctor worries about losing the “window of opportunity” to tackle health problems like heart conditions if men are getting care online rather than in a doctor’s office. 
  • Roman’s CEO, a Hims medical consultant and others say that online medical platforms can play an important role in getting men help. 

Most people associate erectile dysfunction with the silver-haired men in Viagra commercials.

Yet Zachariah Reitano was just 17 years old when he experienced it for the first time. Confused and frustrated, he knew something was wrong.

He was right. It’s well-established among doctors that erectile dysfunction can be the first sign of a more troubling health problem, especially in younger men.

Later diagnosed with a heart condition, Reitano compares erectile dysfunction to “the check engine light in your car going off.” 

“It’s a sign that something is wrong, but you don’t exactly know what,” he wrote in a blog post. Unfortunately, many men ignore that sign because of the embarrassment and stigma that surrounds the condition, he says, and doctors often don’t raise the subject during checkups. 

Reitano’s experience led him to start the men’s health company Roman, which prescribes and delivers medications like Viagra and its lower-cost generic, called sildenafil. Roman is one of a slew of new companies like Hims and others shaking up the traditional model of healthcare by offering this kind of online service targeted specifically at erectile dysfunction. 

These new companies paint erectile dysfunction as a problem among younger, not-yet-greying men, but one for which there is help. 

That raises two key questions. How can these online companies care for patients who could have serious underlying health conditions like Reitano? And are these companies over-hyping how common erectile dysfunction is in younger men?

Read more: Trendy startup Hims wants to shake up men’s health by prescribing generic Viagra online and is nearing a $1 billion valuation. But a move to relax guidelines has raised concerns among some of its doctor partners.

Roman and its telemedicine peers, though, say they can direct patients to get appropriate care, even if it’s not through their own companies. They also say they’re combating the stigma associated with impotence by talking about the condition openly and making care accessible in a discrete, affordable way. 

 

 

A ‘window of opportunity’

At its most basic, an erection happens because of blood flowing to the penis. Trouble getting an erection could mean that something is getting in the way.

Because that part of a man’s body contains very small blood vessels, erection problems could be the first sign of heart disease or other problems with blood circulation. Erectile dysfunction also has plenty of other potential causes, including common medications, psychological factors and health-related behaviors like drinking and not exercising. 

Not every young man with erectile dysfunction is going to have an underlying heart problem, urologist Dr. Hossein Sadeghi-Nejad told Business Insider, “but certainly some of them do.” Sadeghi-Nejad serves as president of the Sexual Medicine Society of North America, which promotes high standards in treating human sexual dysfunction, and co-authored the American Urological Association’s erectile dysfunction guidelines.

The AUA guidelines recommend a physical exam, which can’t be done online. 

“I think to lose that window of opportunity to address the bigger problem would be a pity,” Sadeghi-Nejad said. 

Without an in-person exam, some physical causes of erectile dysfunction could be missed, he said, giving as an example the handful of times in a year when he’s had patients who turn out to have a tumor in their testicles.  

Roman CEO Reitano knows from firsthand experience that a Viagra prescription won’t solve an underlying health problem. But Roman can help patients find out about the connection, including by strongly recommending that patients get in-person tests, and then walking them through the results and next steps for free, Reitano said. 

When Roman began working in erectile dysfunction, it found that many of its members smoked, a risk factor for erectile dysfunction. So the company next expanded into products that help them quit, Reitano said, and now sells the prescription smoking cessation aid bupropion as well as nicotine gum.

“I come to this as a patient,” he told Business Insider. “We treat our patient for life.”

If Roman’s physicians can’t treat a patient, they refer him to nearby health centers and physicians, something that it has done for thousands of patients, Reitano said. 

Read more: A startup aims to help the 18 million US men diagnosed with erectile dysfunction pay attention to their ‘check-engine light’

These online companies all patch patients through to doctors, but they have different approaches and styles. 

Rival Hims’ website reads at first like an e-commerce experience, greeting potential patients with the different categories of medical products they can shop—hair, sex, skin, or vitals—and then glossy product images. After a patient adds Viagra or another prescription product to his online cart, he gets directed to a medical consult. 

See also: We tried to buy generic Viagra online from Hims and failed — here’s how it went down

Online telemedicine services like Hims are a powerful opportunity to “find people who do have medical problems, and get them to doctors that can help them,” according to Dr. Peter Stahl, a Hims medical consultant and the director of male reproductive and sexual medicine at NewYork-Presbyterian Hospital/Columbia University Medical Center. As part of his role at Hims, Stahl came up with advice for Hims’ doctor partners that they can look at if they have questions.

According to those recommendations, one goal of care is to identify health conditions that can underlie erectile dysfunction, he said, which might include diabetes, testosterone deficiency, high cholesterol and vascular disease. Hims’ doctor partners “routinely” recommend patients see a specialist, rather than writing them a prescription, if they decide that is the best course of treatment, the company said in a statement. 

Lemonaid Health is another telemedicine company offering erectile dysfunction medications. The start-up says it is more of an online doctor’s office, and aims to care for the patient as a whole. A patient who clicks on Lemonaid’s various medicines and treatments gets directed to set up a doctor consultation, which might include answering online questions or a live video interaction. 

On a page about erectile dysfunction, the company points out that it can be the first sign of things like heart conditions, cardiovascular disease and diabetes, and says that it offers an optional lab test to look into those possibilities.

Lemonaid also offers a service to quit smoking with the smoking cessation aid Chantix or Zyban, and one to manage patients’ cholesterol, which might include a statin prescription. Both health problems are linked to erectile dysfunction. 

“When we do turn away patients, we think of other opportunities to help,” Dr. Davis Liu, chief clinical officer of Lemonaid, told Business Insider. The company also plans to launch services for depression and anxiety, high blood pressure and diabetes this year. 

40% under age 40

Viagra has been sold for about 20 years, and recently became available as an inexpensive generic drug. In its prime, the brand-name product — brought to market by Pfizer — brought in more than a billion dollars a year for the drug giant.

Back then, the type of older man frequently featured in Pfizer’s ads was a prime demographic, or roughly ages 40 and over, a 2006 article from the peer-reviewed medical journal PLOS Medicine found. 

But new online startups offering erectile dysfunction medications have men under age 40 in their sights, and cite a popular statistic: that erectile dysfunction affects up to 40% of men by that age. 

That statistic comes from one of the most important studies to measure the prevalence of erectile dysfunction, the “Massachusetts Male Aging Study,” which randomly selected men between ages 40 and 70 to participate.

As part of the study, researchers gave men a questionnaire to “characterize erectile potency.” They found that 52% of men reported some level of erectile dysfunction, ranging from minimal to moderate to complete impotence, and that age was strongly connected to the condition. Complete erectile dysfunction was more infrequent, according to the study, ranging from around 5% in the 40-year-old set to 15% by age 70. 

The study found that at age 40, about 40% of men had some level of erectile dysfunction, but didn’t look at younger men. 

Still, that figure isn’t a good estimate for the proportion of men who need erectile dysfunction drugs, urologist Sadeghi-Nejad told Business Insider. While up to 40% of men may have at some point experienced trouble getting or maintaining an erection by age 40, he draws a distinction between chronic erectile dysfunction and occasional experiences with it. 

In other words, not every guy who has experienced erectile dysfunction is bothered enough by it to see a doctor, or to take a medication for it. Online companies offering easier access to generic Viagra and other erectile dysfunction medications could change that, he noted. 

Erectile dysfunction research often excludes younger men, according to a 2017 study by Italian researchers. One exception was a large study published in 2004, which found that erectile dysfunction affected 8% of men in their 20s and 11% of men in their 30s. 

Hims and Lemonaid told Business Insider that the 40% figure is accurate, citing its use in peer-reviewed medical journals and the evidence-based medical resource UpToDate. Roman’s Reitano said in a statement that the “vast majority” of the start-up’s members are older than age 40, with an average age of 46. 

Hims has been dubbed the “millennial erectile dysfunction company” because its splashy advertising appears designed for men in their 20s and 30s, including through use of a color dubbed “millennial pink” and tongue-in-cheek eggplant emojis. The startup treats men starting at age 25 and going up to age 65. 

Hims consultant Stahl calls promoting awareness of erectile dysfunction in this population an important step forward.

Young men are a large part of his in-person practice at Columbia, he said. The condition is less common in men in their 30s and 40s than in older men, but those who do have it are “excellent candidates for treatment,” he said.

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The 3 Best Canadian Tech Stocks I Would Buy With $3,000 for 2021

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The majority of the Canadian tech stocks went through the roof in 2020 and delivered outsized returns. However, tech stocks witnessed sharp selling in the past 10 days, reflecting valuation concerns and expected normalization in demand. 

As these high-growth tech stocks shed some of their gains, I believe it’s time to accumulate them at current price levels to outperform the broader markets by a significant margin in 2021. Let’s dive into three tech stocks that have witnessed a pullback and are looking attractive bets. 

Lightspeed POS

Lightspeed POS (TSX:LSPD)(NYSE:LSPD) stock witnessed strong selling and is down about 33% in the last 10 days. I believe the selloff in Lightspeed presents an excellent opportunity for investors to invest in a high-growth and fundamentally strong company. 

Lightspeed witnessed an acceleration in demand for its digital products and services amid the pandemic. However, with the easing of lockdown measures and economic reopening, the demand for its products and services could normalize. Further, it faces tough year-over-year comparisons. 

Despite the normalization in demand, I believe the ongoing shift toward the omnichannel payment platform could continue to drive Lightspeed’s revenues and customer base. Besides, its accretive acquisitions, growing scale, and geographic expansion are likely to accelerate its growth and support the uptrend in its stock. Lightspeed stock is also expected to benefit from its growing average revenue per user, innovation, and up-selling initiatives.     

Shopify 

Like Lightspeed, Shopify (TSX:SHOP)(NYSE:SHOP) stock has also witnessed increased selling and has corrected by about 22% in the past 10 days. Notably, during the most recent quarter, Shopify said that it expects the vaccination and reopening of the economy to drive some of the consumer spending back to offline retail and services. Further, Shopify expects the pace of shift toward the e-commerce platform to return to the normal levels in 2021, which accelerated in 2020.

Despite the normalization in the pace of growth, a strong secular shift towards online commerce could continue to bring ample growth opportunities for Shopify, and the recent correction in its stock can be seen as a good buying opportunity. 

Shopify’s initiatives to ramp up its fulfillment network, international expansion and growing adoption of its payment platform are likely to drive strong growth in revenues and GMVs. Moreover, its strong new sales and marketing channels bode well for future growth. I remain upbeat on Shopify’s growth prospects and expect the company to continue to multiply investors’ wealth with each passing year. 

Docebo 

Docebo (TSX:DCBO)(NASDAQ:DCBO) stock is down about 21% in the last 10 days despite sustained momentum in its base business. The enterprise learning platform provider’s key performance metrics remain strong, implying that investors should capitalize on its low stock price and start accumulating its stock at the current levels. 

Docebo’s annual recurring revenue or ARR (a measure of future revenues) continues to grow at a brisk pace. Its ARR is expected to mark 55-57% growth in Q4. Meanwhile, its top line could increase by 48-52% during the same period. The company’s average contract value is growing at a healthy rate and is likely to increase by 22-24% during Q4. 

With the continued expansion of its customer base, geographical expansion, innovation, and opportunistic acquisitions, Docebo could deliver strong returns in 2021 and beyond.

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Manitoba to invest $6.5 million in new systems

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WINNIPEG – The province of Manitoba is investing $6.5 million over three years to replace technical systems used in healthcare facilities, including replacing current voice dictation and transcription services with more modern systems and upgrading the Provincial Health Contact Centre (PHCC)’s triage, call-recording and telephone systems, Health and Seniors Care Minister Heather Stefanson (pictured) announced.

“Our government is investing in the proper maintenance of information and communications technology to ensure digital health information can be safely stored and shared as needed,” said Stefanson. “These systems will ensure healthcare facilities can continue to provide high-quality services and allow Manitobans to get faster access to healthcare resources and information.”

Dictation, transcription and voice-recognition services are used by healthcare providers to write reports. There are currently approximately 80 healthcare sites across Manitoba using some combination of dictation, transcription and voice-recognition services. Many of these systems are nearing the end of their usable lifespans.

“Across our health system, radiologists and nuclear medicine physicians use voice-dictation services to help create diagnostic reports when reading imaging studies like ultrasound, nuclear medicine studies, X-rays, angiography, MRI and CT scans,” said Dr. Marco Essig, provincial specialty lead, diagnostic imaging, Shared Health. “Enhanced dictation and voice-recognition services will enable us to work more efficiently and provide healthcare providers with quicker access to these reports that support the diagnoses and treatment of Manitobans every day.”

The project will replace telephone-based dictation and transcription with voice-recognition functions, upgrade voice-recognition services for diagnostic imaging and enhance voice-recognition tools for mobile devices.

“Investing in more modern voice-transcription services will help our health-care workers do the administrative part of their jobs more quickly and effectively so they can get back to the most important part of their work – providing top-level healthcare and protecting Manitobans,” said Stefanson. “The transition to the new system will be made seamlessly so that services disruptions, which can lead to patient care safety risks, will not occur.”

The new systems will be compatible with other existing systems, will decrease turnaround times to improve patient care and will be standardized across the province to reduce ongoing costs and allow regional facilities to share resources as needed, Stefanson added.

The PHCC is a one-stop shop for incoming and outgoing citizen contact and supports programs such as Health Links–Info Santé, TeleCARE TeleSOINS and After-Hours Physician Access, as well as after-hours support services to public health, medical officers of health, home care and Manitoba Families.

The current vendor that supplies communications support to the PHCC is no longer providing service, making it an opportune time to invest in an upgraded system that will provide better service to Manitobans, the minister said, adding the project will provide the required systems and network infrastructure to continue providing essential services now and for the near future.

“The PHCC makes more than 650,000 customer service calls to Manitobans per year to a broad spectrum of clients with varied health issues. This reduces the need for people to visit a physician, urgent care or emergency departments,” said Stefanson. “The upgrade will also allow Manitobans in many communities to continue accessing the support they need from their home or local health centre, reducing the need for unnecessary travel.”

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Telus and UHN deliver services to the marginalized

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Telus’s Health for Good program has launched the latest of its specially equipped vans to provide medical services to the homeless and underserved, this time to the population of Toronto’s west end. The project relies not only on the hardware and software – the vans and technology – but on the care delivered by trained and socially sensitive medical professionals.

For the Toronto project, those professionals are working at the University Health Network’s Social Medicine program and the Parkdale Queen West Community Health Centre. The city’s Parkdale community, in the west end, has a high concentration of homeless and marginalized people.

First launched in 2014, Telus’s Health for Good program has delivered mobile clinics to 13 Canadian cities, from Victoria to Halifax. Originally designed to deliver primary care, the program pivoted to meet the needs of patients in the COVID-19 pandemic, said Nimtaz Kanji, Calgary-based director of Telus Social Purpose Programs.

Angela Robertson of the Parkdale Queen West Community Health Centre (CHC) asserted that marginalized people are particularly susceptible to the spread of COVID-19, as they don’t have access to the basic precautions that prevent its spread.

The clinic is located near a Pizza Pizza franchise; homeless people shelter under its overhang on the weekends, she said. Some have encampments under nearby bridges.

“The public health guidelines and requirements call for things that individuals who are homeless don’t have,” Robertson said. “If the response calls for isolation, that suggests people have places to isolate in.”

And in the shelter system, pre-COVID, the environment was very congregate, with many people in the same physical space, said Robertson. Some homeless persons, in order to keep themselves safe, have created encampments, and the city has opened up some hotel rooms across the city to create spaces for physical distancing.

Even proper hand-washing and hygiene becomes a challenge for the homeless.

“COVID calls for individuals to practice constant hand-washing. Oftentimes, individuals who are homeless use public washroom facilities that may be in restaurants or coffee shops, and many of those spaces are now closed. So there are limitations to accessing those facilities. It’s not like they’re in a community where there are public hand-washing facilities for people who are homeless.”

The mobile health clinic allows the CHC to take “pop-up testing” into communities where there is high positivity and where additional COVID testing is needed. The CHC can take testing into congregate sites and congregate housing to provide more testing, Robertson said.

“The other piece that we will use the van to do is, when the vaccine supply gets back online, and when the health system gets to doing community vaccinations … we hope that we can be part of that effort.”

COVID has contributed to a spike in cases of Toronto’s other pandemic: opioid overdoses. Some community members are reluctant to seek care because of the stigma attached to substance abuse; and COVID has a one-two punch for users.

The first rule of substance abuse is, don’t use alone; always be with someone who can respond to a potential overdose, ideally someone who can administer Nalaxone to reverse the effects of the overdose, Robertson said. “It’s substance abuse 101,” and the need for social distancing makes this impossible.

Secondly, COVID has affected the supply chain of street drugs. As a result, they’re being mixed increasingly with “toxic” impurities like Fentanyl that can be deadly.

The van itself is a Mercedes Sprinter, modified by architectural firm éKM architecture et aménagement and builder Zone Technologie, both based in Montréal. According to Car and Driver magazine, the Sprinter line – with 21 cargo models and 10 passenger versions – is “considered by many to be the king of cargo and passenger vans.”

Kanji said the platform was chosen for its reputation for reliability and robustness.

While the configuration is customized for each mobile clinic, it generally consists of two sections: A practitioner’s workstation and a more spacious and private examination room, so patients can receive treatment with privacy and dignity, Kanji said. The Parkdale clinic is 92 square feet.

“While the layouts vary across regions, they typically include an examination table and health practitioners’ workstation, including equipment necessary to provide primary healthcare,” the Telus vice-president of provider solutions wrote in an e-mail interview. The Parkdale Queen West mobile clinic is designed for primary medical services, including wound care, mobile COVID-19 testing and vaccination efforts, harm reduction services, mental healthcare and counseling.

The clinic equipped with an electronic medical record (EMR) from TELUS Health and TELUS LTE Wi-Fi network technology.

Practitioners will be able to collect and store patient data, examine a patient’s results over time, and provide better continuity of care to those marginalized citizens who often would have had undocumented medical histories.

The EMR system is Telus Health’s PS Suite (formerly Practice Solutions). It is an easy-to-use, customizable solution for general and specialty practices that captures, organizes, and displays patient information in a user-friendly way. The solution allows for the electronic management of patient charts and scheduling, receipt of labs and hospital reports directly into the EMR, and personalization of workflows with customizable templates, toolbars, and encounter assistants.

But like others tested for COVID, it’s a 24-48 hour wait for results. Pop-up or not, how does the mobile team get results to patients who have no fixed address?

The CHC set up a centre for testing in a tent at the Waterfront Community Centre. Swabs are sent to the lab. “We are responsible for connecting back with community members and their results,” Robertson said.

“This is the value of having Parkdale Queen West being in front of the testing, because many of the community members who are homeless we know through our other services, and there is some trust in folks either coming to us to make arrangements to collect their results, or we know where they are.”

This is a key element of the program, said Kanji – leveraging community trust. In Vancouver downtown east side, for example, where there is a high concentration of marginalized members of the indigenous community, nurse practitioners are accompanied by native elders in a partnership with the Kilala Lelum Health Centre.

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