Cerebral: A Mindless Strategy

The Covid-19 pandemic provided an opening for unprincipled opportunists, seeking financial fortune under the guise of healthcare, to flourish. No where was this better manifested recently than in the company Cerebral, an online start-up in Silicon Valley, touted as an option for those unable to access mental health care. The founder was Kyle Robertson, a businessman with no medical training or background. Robertson was able to secure financial backing from major investors, some of whom were placed on the board of his company.

I became aware of Cerebral early in 2022 when ads began appearing and/or being shared in some of the physician FB groups to which I belong. The company was reaching out to many physicians, regardless of specialty, to remotely “supervise” nurse practitioners. 

To members of Physicians for Patient Protection(PPP), of which I am a member, this “supervision model” is a huge red flag for companies who seek to buy physician licenses to cover their a**es for liability purposes because they are using non-physician practitioners(NPPs), specifically nurse practitioners, to practice medicine and increase profits. Members put out the word to be wary of Cerebral because they recognized this predatory model–it never bodes well for physicians. The ad below is from Indeed.

Take note…Psychiatry is “preferred but not required”. One physician to four NPs who are not directly supervised. This is not a job opportunity, it is a disaster waiting to happen. Physicians have got to stop allowing companies like this to use and abuse their medical licenses.

The significant lack of oversight and regulation in online medical services has enabled the corporate practice of medicine(CPOM) to thrive. The mental health online services also made it easier to take advantage of a population that is inherently vulnerable to begin with. Cerebral was never about the care, it was about the potential to profit, in my opinion. When profits were threatened because of decreasing subscriptions to Cerebral, a decision was made to target patients with ADHD to prescribe more stimulants such as Adderall. Medical standards were tossed to the wayside. The discipline and practice of medicine is tightly regulated for good reason, because the health and safety of the public is paramount. However, the pandemic led to a lowering of the standard when the regulations designed to keep the public safe were lifted by the government so that patients could have access to medications and treatments previously unattainable online. Schedule 2 controlled substances such as Adderall had required an in-person visit with a physician or other licensed health care professional. After the lift, any “provider” could write for these substances without necessarily being a physician and in-person visits were no longer required. It does not take a rocket scientist to understand that in a country rife with substance abuse, the now easy access to this particular drug would inevitably lead to a snowballing of prescriptions and revenue for Cerebral would explode. And that is exactly what occurred, with Cerebral’s worth reaching $4.8 billion dollars.

Cerebral’s ultimate goal, like many so-called health care companies, was to make a profit. Patients were secondary. Adderall is not a benign drug, it can be extremely dangerous if not prescribed or used appropriately. When I read some of the ads for Cerebral, it became apparent to me that their clinicians were most likely diagnosing people with ADHD, carte blanche, just to sell the medication. I also noted something else…Cerebral was using nurse practitioners(NPs) almost exclusively to prescribe–another red flag indicating the CPOM. According to at least one article, most were Family Nurse Practitioners working outside their scope. I do not believe for one second this was happenstance. It is my contention that Cerebral not only used NPs because they were cheaper, but also because many were unlikely to question the business model or algorithms put forth by the company to sell stimulants such as Adderall. Cerebral became a glorified pill mill. When then vice-president of product and engineering, Matthew Truebe, raised concerns about the prescription practices, he was terminated. Truebe is not a medical professional, yet he was concerned, as were some nurses(https://www.businessinsider.com/telehealth-startup-cerebral-prescribed-psych-meds-2022-6?fbclid=IwAR1ZK4yIA76afYy5hgtaMBBDLUhTQmQTttd1PZCnpm11bW4kKAnjE-oMnns). Reportedly, internal documents reveal that at least two thousand incident reports were filed by employees. Cerebral had a Chief Medical Officer, David Mou, MD, MBA, who is also president of the company. I find it difficult to believe that he was not aware of these issues and if he wasn’t, he should have been.

“Cerebral’s chief medical officer, David Mou, said in March that the company began auditing charts to promote clinical safety and quality. “We use data science to figure out how we can encourage our clinicians to follow basically these evidence-based clinical guidelines,” he said. “And we do audit charts on a regular basis to ensure that the care is as evidence-based as possible.””

To his credit, Dr. Mou created a department of Clinical Quality and another for Clinical Safety, with both departments being led by psychiatrists. However, I am unimpressed by his taking action to audit because this should have been done all along. He has worked for Cerebral since February 2021. Why were the audits only begun in March 2022–when there had been multiple complaints? This just doesn’t pass the smell test.

Corporations like Cerebral would never be successful without the sanctioning of healthcare professionals who facilitate their entry into medicine. We have to stop being the Trojan Horse for the corporate practice of medicine, it is destroying our profession and worse, harming patients.

In the end, the only safe place to put a Trojan horse is outside your walls. — Robert Harris

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