It was a shock in 2017 when the iPhone X arrived with a beautiful, near full-screen display, marred by a weird black notch.

Bezel-free displays are difficult for phone makers to pull off, because the front-facing camera has to be housed somewhere. In Apple's case, it's housed in the notch.

Apple audaciously leaned into the notch, telling the public it embraced what was clearly a design compromise and aggressively marketing the iPhone X as a full-screen display.

Such is the luxe power of the iPhone that Android phone makers actually copied the notch into their own full-screen designs. The OnePlus 6 had a notch, as did the Huawei P20 Pro, and the LG G7 ThinQ.

But one massive Chinese phone manufacturer called Oppo has broken away from the pack and come up with its own solution.

Read more: A massive Chinese phone company that outsmarted Apple in China and India is now heading to the West

Oppo officially launched in the UK last month, finally introducing its high-end Find X flagship to the British market for £799 ($1,000).

Business Insider had about ten minutes with the Find X, and found it fairly obviously inspired by the iPhone X and its successors. The name, the Find X's OLED display, and software features like Portrait Mode all showed Apple-like touches.

But there was one feature that was distinctly un-Apple, and that was the Find X's solution to the notch.

Oppo's solution was to put the front-facing camera in a motorised pop-out section that automatically opens when you press the camera button. The camera isn't just for photos and selfies, but for 3D facial recognition and O-Moji, Oppo's take on Apple's Animoji.

Here's the pop-out camera in action — watch the top of the phone:

The camera appears on its own shelf, and disappears again as soon as you click away from the camera. The movement is surprisingly subtle and evidently designed to be as smooth and unobtrusive as possible.

Here it is from behind, courtesy of YouTuber Marques Brownlee:

And here's how it looks as you're taking a photo:

The popped-out camera is subtle, but you can see it at the top of the phone. Shona Ghosh/Business Insider

It's hard to tell how hardy this motorised gimmick is. The phone isn't waterproof, so it isn't clear what would happen if any liquid fell into the slight gap between the camera array and the main smartphone body. Likewise, it's hard to tell whether the mechanism might break if any dust or particles get caught up in it.

With so little time with the Find X, we couldn't test the pop-up camera's durability by, for example, dropping it from a height.

And a final practical consideration: how do you buy a protective smartphone cover if the phone keeps changing size?

Marques Brownlee/YouTube/Shona Ghosh

In an in-depth review of the phone, TechRadar noted the mechanism takes a full second to unfurl and that might slow over time.

"The sliding drawer also has a tendency to collect pocket lint and dust, which we assume isn't particularly healthy for the handset when it slides back in," the reviewers wrote. "When extended, it also feels a little spongey, offering moderate resistance but a little wobble when handled."

The pop-out camera is certainly eye-catching. At the very least might help Oppo stand out in the crowded UK market, where the iPhone reigns king. While Oppo dominates in Asia, along with its sister companies Vivo and OnePlus, it's still relatively unknown in the West.

Cute as the pop-out is, we're struggling to see it ending the reign of the notch in 2019.

Galaxy S10 E: A dual-lens system, with one likely for regular photos, and the other for zoomed shots. Single selfie camera.

Galaxy S10: A triple-lens system, with one likely for regular photos, the other for zoomed shots, and another for ultra-wide angle shots. Single selfie camera.

Galaxy S10 Plus: A triple-lens system, with one likely for regular photos, the other for zoomed shots, and another for ultra-wide angle shots. Dual-lens selfie camera, with one for normal selfies and the other for ultra-wide angle selfies.

Galaxy S10 X: A four-lens camera system, with one likely for regular photos, the other for zoomed shots, and another for ultra-wide-angle shots. (It's unclear what the fourth lens could be used for. It's pure speculation, but the fourth lens could be purely complimentary for portrait mode enhancements.) Dual-lens selfie camera, with one for normal selfies and the other for ultra-wide angle selfies.

Actor Terry Crews said the National Enquirer's publisher, American Media Inc (AMI), tried to "silence" him with fake stories as Jeff Bezos publicly accuses the publisher of trying to blackmail him.

Crews said on Twitter that AMI tried to silence him as he attempted to sue a Hollywood agent who he claimed groped him and the agency's talent agency "by fabricating stories of me with prostitutes."

Crews accused Adam Venit of groping him at an industry party in 2016, and filed a police report with the Los Angeles Police Department. Crews told the Senate Judiciary Committee in 2018: "The assault lasted only minutes, but what he was effectively telling me while he held my genitals in his hand was that he held the power. That he was in control."

Crews said on Friday that AMI tried to silence him and that they "even went so far as creating fake receipts" but that he "called their bluff by releasing their threats online."

Crews first made the allegations against the company in 2017, when he shared an email that he said was from Radar Online, which is owned by AMI. He said that the day after he spoke about his allegations the publication emailed him about a story about him hiring two prostitutes in Monte Carlo in 2015.

Read more:Read all the emails Jeff Bezos says the National Enquirer sent to 'blackmail' him

"It never went 2 press because it was a lie," Crews then said. "This was not a coincidence. I told u they were coming 4 me. I also told you I am ready."

This was Crews' tweet in 2017:

Crews shared the allegations again on Friday after Jeff Bezos, the founder of Amazon and the owner of The Washington Post, accused AMI of "extortion" and said it was threatening to leak naked photos of him unless he stopped his investigation into how the photos leaked to the National Enquirer.

Terry Crews attends Esquire's Annual Mavericks of Hollywood in Los Angeles. Getty

In a blog post on Medium, Bezos said: "Rather than capitulate to extortion and blackmail, I've decided to publish exactly what they sent me, despite the personal cost and embarrassment they threaten."

And reporters including Ronan Farrow have since come forward to say that AMI had threatened them to stop reporting on the company's relationship with President Donald Trump. Farrow tweeted that he and at least one other journalist "fielded similar 'stop digging or we'll ruin you' blackmail efforts from AMI."

Read more: Jeff Bezos alleges ties between Saudi Arabia and National Enquirer's publisher, David Pecker, and it could all relate to the murder of journalist Jamal Khashoggi

AMI said its board would investigate the claims made by Bezos, but said it had "acted lawfully."

"American Media believes fervently that it acted lawfully in the reporting of the story of Mr. Bezos," AMI said in a statement on Friday morning.

Jeff Bezos. Cliff Owen/AP Images

"Further, at the time of the recent allegations made by Mr. Bezos, it was in good faith negotiations to resolve all matters with him. Nonetheless, in light of the nature of the allegations published by Mr. Bezos, the Board has convened and determined that it should promptly and thoroughly investigate the claims. Upon completion of that investigation, the Board will take whatever appropriate action is necessary."

AMI and representatives for Terry Crews could not immediately be reached for comment.

While other carriers pile on the for-sale frills, Southwest Airlines has stayed true to its roots.

But with demand for tickets set to pale in comparison to last year, JPMorgan is brainstorming ways that the discount carrier could get its cut of the billions of dollars that flyers pay every year for things like checked bags, changed reservations, and premium seats.

In a recent note to clients, analyst Jamie Baker began to "opine on the feasibility and potential profitability of seat monetization at Southwest." However, the bank would like to "strenuously emphasize" that it's aware of no such plans.

On Southwest's fourth-quarter earnings call in January, CEO Gary Kelly said that new revenue sources were "under construction," according to Bloomberg, which first reported on the JPMorgan note.

Bags will likely be off the table — "that's not what we do," Kelly said — but seat monetization could fill a lot of gaps, JPMorgan explains.

"Southwest could easily add $0.10 to $1.00 in annual EPS by monetizing up to four rows of each aircraft," writes Baer. "Essentially, offering a paid opt-out to the need to queue in advance, thereby guaranteeing last on/first off status for travelers (along with dedicated bin space)."

That would check four boxes for the airline, which currently has a Business Select option for earlier boarding, but has maintained an all-coach cabin for decades: "ease of execution, ease of passenger understanding, profits, and the broader preservation of the existing Southwest experience," says Baker.

Instead of boarding first, JPMorgan has an idea that basically reverses the common concept of priority seating.

Up to four rows of the aircraft would be reserved for premium tickets, potentially business travelers, guaranteeing access to perks like first-off exiting and overhead storage.

Read more: Southwest Airlines' Companion Pass is the holy grail of travel rewards — I used mine for 3-for-1 flights with my wife and baby

"Simply put, this would negate the need to queue ahead of boarding time - a process that we believe initially wastes travelers' time in exchange for reducing Southwest headcount," writes Baker.

It likely wouldn't cost Southwest much to implement, Baker estimates, and would save flight crews time if the new class included exit rows, as passengers who are prohibited by law from those seats likely wouldn't be buying premium tickets.

But will this theory ever be put into practice?

"We have no idea," says Baker. "While we can offer no unique insight as to what the company may be pondering, we do believe we understand what the new reservation system is capable of, as well as what passengers might potentially respond enthusiastically to - particularly business travelers."

Trump has historically been highly critical of Bezos, Amazon, and the Washington Post. On Twitter, Trump also took aim at the Bezos-owned "lobbyist newspaper."

Source: Business Insider

Amazon Go's cashierless technology has been widely touted as the future of retail.

But one former Walmart executive says the technology, while impressive, has too many limitations to succeed in grocery stores, department stores, and other retailers with stores that are generally larger than a gas station.

"The Amazon Go store is just a fairy tale for retailers that actually want to make money," said Joel Larson, a former Walmart senior manager who was head of checkout innovation at the company until October.

Amazon did not respond to a request for comment on this story.

Amazon Go uses computer vision powered by hundreds of cameras to track what shoppers remove from shelves. The technology enables shoppers to enter a store, grab what they need, and leave without encountering a cashier or even swiping a credit card.

Read more: Ex-Walmart exec says theft helped kill Walmart's cashierless checkout technology

When Larson left Walmart, he joined Innowi, a company that makes handheld mobile checkout devices. In an interview with Business Insider (and later in an article posted to LinkedIn), Larson outlined several reasons why he thinks Amazon Go's technology won't be widely adopted by most retailers.

Amazon did not respond to a request for comment on this story.

Walmart

1.Accuracy problems. The accuracy of computer vision technology declines in environments with too many similar-looking items, according to Larson. Larson estimated that Amazon Go stores feature roughly 1,000 items. Grocery stores, by comparison, carry roughly 80,000 different products, and big-box retailers such as Walmart carry more than 300,000 products.

Computer-vision technology can have a hard time differentiating between similar products such as two different sizes of Cheerios boxes, Larson said. The probability of inaccuracies increases with a higher number of overall items, especially when many of those items look similar to one another, he said.

2. Expensive, heavy hardware. Computer-vision technology involves hundreds — if not thousands — of cameras that would be costly to purchase and maintain for a big-box retailer, Larson said. And existing stores may need to make structural changes to their ceilings to support the weight of the cameras, he said.

3. Heat generation. "Thousands of cameras put off a lot of heat," Larson said. "Will the AC systems in today's stores support all of that heat being generated? Probably not."

4. Labor costs. Computer vision technology doesn't necessarily result in labor cost savings, despite the fact that it eliminates the need for cashiers, Larson said. The technology is usually supported by humans who review video footage in real time to help resolve issues when the software can't distinguish between similar items.

Target shoppers using the retailer's app aren't always getting the best deal.

An investigation by KARE11 news, an NBC affiliate in Minneapolis, Minnesota, found that prices varied in Target's app based on whether a customer was inside or outside of a Target store. Business Insider confirmed the practice in its own test.

The app uses geo-fencing and location data to make the determination of where a customer is. When in the store, all prices listed in the app resemble the prices listed in the store. Outside of the store is a different story. That is where Target must compete with other online stores and the rest of the world, and the prices there mimic those of Target.com.

Comparing prices for more than 20 items on the app when inside and outside the store, Business Insider found the price changed on nearly half of them. In almost all cases, the prices were higher when we checked the price on the app while inside the store.

Price changes ranged from $0.10 to more than $7, but most were less than a dollar. The largest gap was on a Fisher-Price children's toy, the price of which fell by $7.49 after we left the store.

Read more: The clever tricks Target uses to get you to keep spending money

In a statement to Business Insider, a Target representative did not say that the company would bring parity to its online prices and in-store prices, but that it's "committed to providing value to our guests and that includes being priced competitively online and in our stores, and as a result, pricing and promotions may vary."

"We appreciate the feedback we recently received on our approach to pricing within the Target app. The app is designed to help guests plan, shop and save whether they are shopping in store or on the go," the statement continued.

Target has also said it released an update to make pricing clearer in-app.

"We've made a number of changes within our app to make it easier to understand pricing and our price match policy. Each product will now include a tag that indicates if the price is valid in store or at Target.com," a Target spokesman said. "In addition, every page that features a product and price will also directly link to our price match policy."

Target also reiterated its price-match policy, which customers can take advantage of anytime and anywhere. The policy also applies to goods that Target sells both online and in stores.

KARE11 repeated its experiment at Walmart, Macy's, and Best Buy and did not find any pricing differences.

Here's the full breakdown of Business Insider's comparison of prices on the app in store and outside of a Target store:

In 2015, the Honda HA-420 HondaJet entered production. It was the Japanese industrial giant's first foray into the world of aviation as a manufacturer. The HondaJet was the culmination of three decades of research and development led by Honda Aircraft Corporation CEO Michimasa Fujino.

Honda is a company known the world over for its engineering prowess. Pretty much everything the company produces is world class from hybrid supercars to lawn movers. Still, many were unsure if Honda was up to the task of building a jet from scratch.

Read more: I flew on Honda's $4.9 million private jet, and it's an absolute game-changer.

In the fall of 2017, Business Insider had the chance to experience the HondaJet first hand on a test flight over the Northeastern United States. It was magnificent. The HondaJet proved to be quick, comfortable, and chock full of innovative design features.

In 2018, Honda introduced an updated version of the plane called the HondaJet Elite. The name matches with the designation given to the company's luxury spec automobiles.

The Elite was initially sold alongside the original HondaJet but has now taken over as the only version of the plane in production.

Read more: We drove a $49,000 Honda Pilot to see if the new 2019 model is ready to take on Toyota and Ford. Here's the verdict.

This month, we made our way to down to Greensboro, North Carolina, home of the Honda Aircraft Corporation, for a test flight on board the HondaJet Elite.

The HondaJet Elite starts at $5.25 million, $350,000 more than the original HondaJet.

Here's a look at our flight on the Honda HA-420 HondaJet Elite:

Prior to Columbus's arrival in the Americas in 1492, the area boasted thriving indigenous populations totaling to more than 60 million people.

A little over a century later, that number had dropped close to 6 million.

European contact brought with it not only war and famine, but also diseases like smallpox that decimated local populations. Now, a new study published in the journal Quarternary Science Reviews shows that those deaths occurred on such a large scale that they led to a "Little Ice Age": an era of global cooling between the 16th and mid-19th century.

Researchers from University College London found that, after the rapid population decline, large swaths of vegetation and farmland were abandoned. The trees and flora that repopulated that unmanaged farmland started absorbing more carbon dioxide and keeping it locked in the soil, removing so much greenhouse gas from the atmosphere that the planet's average temperature dropped by 0.15 degrees Celsius.

Typically, experts look to the Industrial Revolution as the genesis of human-driven climate impacts. But this study shows that effects may have began some 250 years earlier.

"Humans altered the climate already before the burning of fossil fuels had started," the study's lead author, Alexander Koch, told Business Insider. "Fossil fuel burning then turned up the dial."

More than 50 million indigenous people perished by 1600

Not all scientists are convinced by Koch's explanation.

Amazon Games Studios is working on a massively multiplayer online roleplaying game called "New World," the largest project yet from the online retailer's largely unknown game development team.

Amazon Games Studios was established in 2012, but so far its releases have largely been limited to smartphones and Amazon devices. "New World" was one of three PC games announced by Amazon Game Studios in 2016, along with "Crucible," a "Fortnite"-style battle royale game, and "Breakaway," an online battle arena game that has since been cancelled.

Here's everything we know about "New World," Amazon's first major video game:

Imagine if you could get a prescription drug for a medical condition online without traveling to see a doctor, or even speaking with one.

That's the promise behind the trendy men's health startup Hims, which says its online platform is making medical care more available for men with stigmatized health issues such as impotence and hair loss.

You've probably seen the splashy ads featuring stylized eggplants and cacti (a winking nod to Hims' work in erectile dysfunction), and even the rapper Snoop Dogg. With these high-profile campaigns, the San Francisco telemedicine startup has vaulted to prominence, and is reportedly nearing a $1 billion valuation.

But Hims' approach triggered concerns among some doctors working with the company after the startup led an effort to expand the number of patients that physicians could treat with generic Viagra online, according to secret messages among clinicians and a person familiar with the matter.

The clinicians are employed by Hims' independent medical partner, an organization called Bailey Health. But the move prompted worries among some doctors that Hims might be pressuring them to write more prescriptions in a more lenient manner. Erectile dysfunction can also be a sign of more concerning health conditions, which might not be diagnosed or treated in an online visit, according to an outside expert.

This story is based on secret messages among clinicians and internal documents reviewed by Business Insider, as well as conversations with current and former Bailey Health doctors. Business Insider also spoke with Melissa Baird, Hims' chief product and operations officer, and Dr. Peter Stahl, a Hims medical consultant. Requests for comment from Bailey Health were not returned by two individuals there.

Hims said in a statement that "this narrative is patently false" and said that the level of patient care and safety on its platform was "best in class." Hims also emphasized the distinct and separate status of Bailey Health.

"Any claims that are made to the contrary are categorically false, and intentionally aim to undermine the credibility of safe, effective protocols set forth in telemedicine and the medical community at large," the statement said. "hims has always made clear to physicians that each physician must prescribe according to his or her own, independent clinical judgement and that the safety of patients is paramount. There are no penalties or negative repercussions of any kind for any physician based upon their prescribing rates."

The concerns raised at Hims provide a unique window into the issues that may crop up as more medical-care services move online and companies toe the line between e-commerce and medicine, serving patients who are also customers.

Many see these types of telemedicine companies as the future of healthcare, and investors have poured hundreds of millions of dollars into startups selling prescription products online, including birth-control pills, migraine medications, and contacts.

Startups raising private funds are typically under pressure from their venture investors to show significant growth. And the Silicon Valley mantra of "move fast and break things" presents issues in the healthcare industry, where people's health and well-being are on the line.

Read more: Investors are betting $660 million that companies that ship Viagra and hair loss pills to your door is the future of medicine

A disruptive model

Erectile dysfunction is a common problem, and brand-name Viagra is notoriously expensive. At about $50 a pill, it regularly brought in more than $1 billion in annual revenue, and one year it generated as much as $2.1 billion for Pfizer.

Hims burst onto the scene in late 2017 and quickly began selling the generic, cheaper form of Viagra when it became available. Led by founder and CEO Andrew Dudum, the startup also offers hair-loss products and creams, and gummy vitamins that don't require a prescription. The business has also expanded, with a push into women's health and a UK launch.

Dudum pitches Hims' online-only approach as a convenient, inexpensive, and destigmatizing route to medical care. People don't like going to the doctor, he has said, let alone for an uncomfortable or taboo condition.

Instead, customers detail their medical history and symptoms in a detailed online form, which is then reviewed by a doctor. If the physician gives the OK for a prescription, Hims mails the patient the pills in a nondescript package. The clinician can also refer a patient to see an in-person physician.

Under Hims' original protocols, doctors likely would not have prescribed to patients with certain risky health conditions, including diabetes and blood pressure outside a certain range. The new protocols allow doctors to prescribe to such patients but, because they are guidelines, do not require it.

Hims said its original erectile-dysfunction protocols were overly conservative and excluded men who could be helped safely online.

Baird told Business Insider that the move to relax standards, made in July 2018, had not substantively changed the percentage of patients treated, and she denied that it had prompted significant concerns among doctors.

"I wouldn't say it was out of the realm of normalcy for any fairly fundamental change within a company you do every day," Baird said. She compared it to a design change on a popular website.

"Facebook changes its UI. Everybody gets really upset for a couple of days," she said.

Yutong Yuan / BI Graphics

But objections to the more lenient guidelines persisted until at least late last year. Bailey Health doctors use the messaging tool Slack to communicate, and one clinician posted a poll asking about the new guidelines.

Multiple Bailey Health employees said the change "has made patient care deteriorate considerably" and asked to go back to the previous policy, according to the poll, which was obtained by Business Insider. Business Insider confirmed that two physicians who participated in the poll work for Hims' medical partner.

Business Insider began reporting this story in December, and has contacted 19 individuals for it. Some refused to speak with us. Business Insider is not identifying those who did in order to allow them to speak freely without fear of professional repercussions.

Participants in a separate group chat, which was private and not hosted on a company system, voiced serious worries about the protocol change and other company practices for months after the new policy went into effect. They also said Hims was pressuring doctors to write more prescriptions, including by monitoring individual doctors' prescribing, according to the group messages and a source familiar with the matter.

Baird said the company does not have the ability to track how many patients are being turned down for generic Viagra or other drugs by individual doctors. Bailey Health currently employs 140 US doctors, according to a Hims public-relations contact, and Baird said Hims tracks the rejection rate only on an aggregate basis across the company. The rates at which clinicians refer patients to in-person doctors, which Hims' Baird said was the same as the rejection rate, are "encrypted at the individual level," Hims said in a statement.

Hims told reporters last year that it rejects about 30% to 40% of patients seeking generic Viagra. But Baird told Business Insider in January that the company's rejection rate was never that high, instead citing a range of 10% to 20%.

Hims said in a later statement that rejection rates have fluctuated each week between 15% and 45% of customers, the result of the evolving treatment protocols, the increasing volume of users, and changing patient demographics. And Baird said in a later conversation that the effect on the rate after the guidelines were loosened last summer is "not even something we can evaluate."

Two other online healthcare companies said their rejection rates for erectile dysfunction are higher. Lemonaid Health said it often tells about 45% of patients to get care elsewhere. Roman said more than half of people who begin an online visit for erectile dysfunction are rejected but wouldn't give a precise figure.

Hims said its rejection rates shouldn't be compared to other companies.

Questions about new online models

Hims' subscription-based model has proven attractive to venture-capital investors such as Peter Thiel's Founders Fund, Joshua Kushner's Thrive Capital, and 8VC. Hims clocked in at a $500 million valuation last fall, according to PitchBook, and a funding round in the works could bring that figure to more than $1 billion, a Recode report said.

These new online models can help patients by making it easier for them to get care, but there are concerns about divorcing erectile-dysfunction consultations from the wider medical system, said Dr. Hossein Sadeghi-Nejad, a urologist and the president of the Sexual Medicine Society of North America, which promotes high standards in treating human sexual dysfunction.

Sadeghi-Nejad said he's not familiar with Hims specifically.

Because erectile dysfunction can be the first sign of other health conditions, treating it might include lifestyle changes, such as limiting or quitting alcohol, seeking counseling, using an erectile-dysfunction medication, using a medical device, or undergoing surgery.

For instance, Sadeghi-Nejad said medications that lower blood pressure, called beta blockers, can also cause erectile dysfunction. A cardiologist doing a full, in-person evaluation might adjust a patient's blood-pressure medication, rather than prescribe Viagra, he said.

"But if it's done as part of this whole prescribing system, what are the odds the doctor will say, 'Mr. Sadeghi, go see a cardiologist and then call me?'" he asked.

Yutong Yuan / BI Graphics

Viagra is taken before sexual activity to increase the blood flow that makes erections possible. Viagra, like all prescription drugs, has risks, but they are mostly considered limited. And Viagra isn't thought to have long-term side effects.

Concerns raised in a secret group chat

Hims had been selling generic Viagra, known as sildenafil, for just over half a year when a change was made. In mid-2018, Hims led an effort to change the guidelines for doctors working with the company to make it easier for them to prescribe the drug to more people.

Hims confirmed that its guidelines changed to make generic Viagra available to more people but said on Friday that it would only share the guidelines if this reporter signed a confidentiality agreement. The company said it could not provide specific information about the guidelines because it could "compromise the integrity of the telemedicine visit."

The original protocols for doctors who treat patients through Hims' platform recommended that the doctors avoid treating individuals with certain health conditions, including diabetes or blood pressure outside a certain range, according to Stahl. Both diabetes and heart problems can be linked to erectile dysfunction, and erectile dysfunction can be a sign of more harmful medical problems for individuals with those conditions.

That was no longer the case under the new protocols. Afterward, clinicians took to a secret, private group chat to voice their significant concern. Roughly 10 employees were included on the chat, with up to five actively participating, two participants confirmed to Business Insider.

The doctors work for Bailey Health, the independent medical partner of Hims. But to the secret-group-chat participants, the distinction didn't make much of a difference. This separate structure is common among health companies because many states outlaw businesses practicing medicine.

The participants were especially concerned about whether Hims was pressuring doctors to write more prescriptions in a more lenient way.

One doctor who works at Bailey Health and was included in the secret group messages acknowledged some pressure to write more prescriptions but said it comes as more of a suggestion. The company doesn't encourage unsafe practices or fire those who don't comply, the doctor said. Clinicians emphasized in interviews that they practiced according to their independent medical judgment.

And Bailey physicians are paid by the hour, not by the prescription, according to Hims and others.

"Doctors have no pressure to prescribe," Hims' Baird said.

An internal poll about the guidelines

If Bailey doctors were initially bothered by the protocol change, it was just the short-term confusion that can come with any organizational change, Baird told Business Insider.

Business Insider began reporting on Hims in December. In late December, a clinician set up a poll about this subject on Bailey Health's internal Slack messaging system. The survey asked whether the new guidelines for erectile dysfunction patients were clear, and appeared to be open to all Bailey Health clinicians.

None of the employees who participated said yes. Five said "no, they're not" clear and 10 said "it has made patient care deteriorate considerably in the past several months."

Meanwhile, 16 responded in support of the company going back to the prior policy. Clinicians could choose more than one answer, and there was some overlap between the groups. The above reflects the results as of the time Business Insider viewed them.

Baird also said the company would not interfere with prescribing decisions, including the duration of prescriptions given to patients. Hims has made longer-duration prescriptions of generic Viagra, including six-month and 12-month supplies, available for patients. Asked whether Hims ever urges doctors to prescribe these longer-duration supplies more, Baird said the company did not.

"Sometimes the urology advisers will chime in, and say you know, it's a little extra to be making them come back every three months," she said, calling longer-duration prescriptions more standard in in-person doctor's offices. "But Hims itself never says anything about the duration of prescription."

In an email sent to Bailey Health staff late last year, Baird reminded them that "our advisors" had said that six-month and 12-month prescriptions were allowed.

"I am not, in any way, critiquing or suggesting the longer duration prescriptions, but about 6 months ago we were around 25% 6 month prescriptions and now we are almost 0," she wrote. "That makes me think that perhaps some newer docs either aren't aware of the advisory board's suggestion or people have just fallen into habit -- as can happen when you are seeing a bazillion patients :)."

How the change was made

The process by which Hims changed the erectile-dysfunction protocols was another subject of controversy in the private doctor group chat viewed by Business Insider.

The initial guidelines had been formed when the company was much smaller, and they were perceived as being too stringent by Hims' vice president of medical affairs, Dr. Adrian Rawlinson, and by Hims' medical advisory board, Baird said. Rawlinson didn't immediately respond to a message seeking comment on his role in changing the guidelines.

Among the factors playing into the move was "the fact that we were just in a better place overall to be able to handle more patients," Baird said.

The protocols were changed by a group of physicians, including the medical board and Bailey doctors, in July 2018, she said.

Hims had just closed a $50 million fundraising round that summer and was already trying to raise more money. It took until late January to raise the most recent round, which amounted to $100 million, according to a Recode report.

Stahl, the director of male reproductive and sexual medicine at NewYork-Presbyterian Hospital/Columbia University Medical Center, said he was a hired consultant who provided recommendations to Hims, including on the erectile-dysfunction guidelines. He said he hadn't been involved in actually making the changes, which he said had been made by Bailey Health's advisory board.

Among his advice had been changes to approaches that appeared "medically incorrect," he said. Stahl also said it's not any riskier to prescribe Viagra to people with diabetes than to those who don't have it.

"I think that telemedicine is new, and I think the instinct to be conservative makes sense in certain scenarios," Stahl said. But that "can also serve as a barrier to appropriate and effective medical care, and can be an access barrier."

Stahl acknowledged that there was some pushback from Bailey Health clinicians after the guideline changes were announced, including about cardiovascular safety and patients with diabetes. Ultimately, physicians will use their medical judgment when deciding what to prescribe, he said.

Part of the reason for this controversy is that there aren't yet expert guidelines on how to treat erectile dysfunction online. The latest guidelines from the American Urological Association recommend a physical exam, which can't be done through a platform like Hims.

"There is not currently a consensus statement with regard to how to treat erectile dysfunction on a telemedicine platform," Stahl said. "Those meetings I'm sure will happen very shortly but they haven't happened yet. So you know, everyone is doing their own thing."

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Reddit CEO Steve Huffman delivers remarks on “Redesigning Reddit” during the third day of Web Summit in Altice Arena on November 08, 2017 in Lisbon, Portugal. (Horacio Villalobos-Corbis/Contributor)