The wellness profiteers of virtual health care

“Talk to a health-care specialist online,” says the bolded text at the top of the page. Scroll the list of virtual health services on Maple’s website and you’ll find a mix of different types of care: medical specialties like endocrinology; vaguely defined lifestyle services like “health and wellness coaching;” alternative health services like functional medicine.

In Maple’s FAQ for functional medicine, the answers are slippery and don’t clarify that practitioners aren’t medical doctors and can’t write prescriptions, instead saying they “prefer to use natural remedies whenever possible” and “may recommend conventional medicine” but “prefer to use alternative medicine first.” Providers are “hand-selected” by Maple to work as independent consultants, connecting with patients on its platform and giving the company a share of the payment.

Maple is not the only virtual health company offering standard medical care alongside nonessential or fringe services. Examples include the cannabis prescription services offered by Telemed MD and Tia Health, and the live cell banking service available on Gotodoctor.ca. One of the doctors on Gotodoctor.ca’s roster specializes in “cosmetics,” which is not a recognized medical specialty.

Virtual health companies’ blending of standard medical care with unscientific services, like those promising a “personalized analysis of your whole being,” offers a glimpse of Canada’s future health marketplace: an eclectic, sometimes ill-defined menu of “customized” services from which consumers select what (hopefully) meets their health needs. Maple has long promoted itself as a solution for Canadians “forced to go into crowded walk-in clinics or the emergency room for routine primary care,” but what it offers is similarly stop-gap – a menu of episodic services with little continuity.

The growth of the virtual health industry is driven in large part by the decline of primary care. And since people who don’t have a trusted provider’s guidance are more vulnerable to wellness scams, we should scrutinize virtual care that blurs the lines between evidence-based and unproven and consider whose interests are being served.

The virtual health industry is dominated by large corporations, many of whom sell nonessential or unproven treatments in addition to necessary medical care. Gotodoctor.ca is the “preferred virtual care provider” of its pharmacy partner, Rexall Health, which is itself owned by American pharmaceutical giant McKesson. Rexall Health also sells virtual care, including an undefined “holistic nutritionist” service. Another major pharmacy chain, Shoppers Drug Mart (owned by Loblaws), is an investor in Maple and also sells virtual care, including prescription cannabis and cosmetic services. Its online store, Wellwise by Shoppers, sells essential items like mobility aids alongside questionable products such as an “energy power bracelet” that claims to use “far infrared rays” to make “body cellars vibrate in resonance.”

It’s understandable that pharmaceutical companies would want to tap into the lucrative wellness market, but snake-oil products are harmful and offering them on a platform alongside essential health care legitimizes their use. Even nonessential services that aren’t typically thought of as alternative health (such as cannabis or skincare) can present a problem as newer or less evidence-based industries can attract unscrupulous providers; consumers, on the other hand, need a high level of knowledge to separate fact from fiction.

Profits from nonessential services are reliably higher than low-cost primary-care mainstays like immunization, cancer screening, routine blood tests and treatment of common infections. So, as large pharmaceutical companies become increasingly involved in health-care delivery, we must monitor corporate focus on providing accessible, affordable essential care versus higher profit, nonessential services.

Being a savvy consumer who can sift through false promises takes on new importance in a health-care system structured as a private marketplace rather than an essential public service. Traditionally, patients built trusted relationships with primary-care providers who advised them on health and lifestyle decisions, often in collaboration with a network of specialized providers. But the virtual health marketplace grew out of the walk-in model of medicine, fragmented and lacking continuity between providers. Episodic walk-in care is associated with higher rates of misdiagnosis, duplicated testing and delayed treatment, which is why it’s widely understood to be worse for health than a longstanding relationship with a primary-care provider.

Neoliberal ideology has downloaded responsibility for health from the state to the citizen

Feeling stressed about an illness and frustration with the medical system can increase susceptibility to wellness scams, so it’s worth asking how responsible virtual health companies are for such harms when they profit both from walk-in care and alternative health services.

If alternative health seems at home in our evolving system, it’s because the political and cultural groundswell for personalized wellness consumerism has been rising for decades, perhaps now close to its pinnacle.

“Health consumer” as a notion originated in the 1960s, used by the patients’ rights movement to indicate empowerment in a paternalistic and often dehumanizing medical system. The framing of health as an individual rather than institutional pursuit sparked interest in the alternative health movement that rejected medical authority and preached total self-determination. As alternative health boomed in the 1970s, its views seeped into the mainstream, popularizing the notion that modern “toxins” create illness and that the body can be purified by “natural” products. The health consumer became to some degree a wellness seeker, trying to attain an “ancestral” state of perfect health through correct living and buying.

The politics of the past few decades have further developed the health consumer’s role. As described by author Colleen Derkatch in Why Wellness Sells, neoliberal ideology has downloaded responsibility for health from the state to the citizen. Health has become one’s personal duty to maintain even while major health determinants like wages, insurance, access to food and safe housing are often out of individual control. This has given rise to a “civic-moral imperative” to become a “good health citizen” who monitors and maintains oneself to avoid burdening the system at-large. Now, health consumers don’t only have the right to pursue individual wellness, they have the concomitant moral responsibility as health citizens to be (and stay) well.

As the meaning of “health consumer” transformed over the past six decades, the wellness industry has flourished, selling a dream of self-reliance and self-healing. With virtual health care becoming a commonplace reality in Canada, the profitability of wellness culture can reach still greater heights.

But inherent to this success is the continued deterioration of public health care and disenfranchisement of patients, now a growing client base for wellness fraudsters. And when fringe health services are sold via virtual clinics, the pharmaceutical companies that own them also profit, a new model for 21st century wellness consumerism.

We’re at a crossroads entering the era of virtual health care. Is it better to create a highly varied health marketplace for consumers to navigate or establish a public right to essential health care that is evidenced-based and easily accessible?

It’s time to decide how much we want our system grounded in expectations of good health citizenship rather than the improvement of health determinants like poverty. We can build primary-care infrastructure that does more than enrich wellness profiteers, it can be the foundation for societal health, strong and broad to support us all.