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It's hard to put into words how angry I am about this. These sorts of things don't happen by accident. I don't understand how someone gets asked to build this "

It's hard to put into words how angry I am about this. These sorts of things don't happen by accident. I don't understand how someone gets asked to build this "feature" and they don't just quit on the spot...

tempsy 7y ago
These alerts were probably configured on some admin panel that was already built and didn’t require an engineer to be involved.
- JshWright 7y ago
  That's certainly possible, but it's not likely (in my experience working with CDS features). These sorts of alerts are pulling data from all sorts of different places, and there's generally at least some engineering effort involved in setting up new "categories" of alerts like this.
  - tempsy 7y ago
    it doesn’t sound like it was a new category...just some new piece of logic that would trigger “prescribe opioids!” when the doctor typed something in why would you think these sham alerts rely on actual data that was “new”? these were probably as simple as some if statement that said “if patient over X age and in pain and lives in Y state then show alert”
    - hermitdev 7y ago
      The sad thibg about this whole opioid epidemic is that people such as myself, who actually suffer from chronic pain can't get relief. Not that opioids would help me, wrong kind of pain. I suffer from nerve pain which requires a whole other class of drugs, but the docs dont want to prescribe anything anymore, even non opioids. It fucking sucks, degrades my quality of life and ability to carry out day to day tasks.
    - JshWright 7y ago
      My guess is it's the "in pain" part that would require some engineering effort to expose as an option inside the CDS dashboard (assuming such a dashboard existed). Obviously none of us know how this was implemented, and it's possible PF had a slick CDS design tool that was super powerful and made these sorts of things easy. That's never been my experience though...
bb611 7y ago
Working in the Bay Area, I'm sure I've had more colleagues who would implement this than would not. That's even though I've specifically chosen to work at companies that emphasize the importance of social good in their business. Most people come to work for a paycheck, and the perceived cost to them of shaking up that paycheck (even just to get a new job) is very high.
- toomuchtodo 7y ago
  How do you make the cost for them lower to make the right decision? Or make the amount of pain higher for making the immoral one?
onetimemanytime 7y ago
>>I don't understand how someone gets asked to build this "feature" and they don't just quit on the spot... Shall we go down the list of horrible and unethical things engineers have built over millennia, so we settle this once in for all? If you quit, someone else will do it
- firstplacelast 7y ago
  And this is why drug traffickers should not be punished. If they don't do it, someone else will. It is the people on the receiving ends, the ones that take the kickbacks and the ones that take the drugs, that should be punished.
- sitkack 7y ago
  We don't know how many quit to get to the worker that implemented this. The thing is, it doesn't stop with the first person that quits, it goes forward with the first person that says "yes".
astura 7y ago
Because when an engineer gets a big list of the alerts he or she must implement some aren't labeled "*illegal kickback scheme to get doctors to prescribe medically unnecessary medication for profit," it looks like any other requirement. Making things look legit to others outside of the scheme is important to successfully pulling off the scheme. Even if an individual engineer suspected the opioid recommendation alerts were medically unnecessary, medically unnecessary tests and treatments are very common [1], so it wouldn't exactly stand out as "probaby an illegal kickback scheme." [1] https://www.propublica.org/article/unnecessary-medical-care-is-more-common-than-you-think https://www.propublica.org/article/unnecessary-medical-care-...
- JumpCrisscross 7y ago
  > Because when an engineer gets a big list Let’s not be naive. The list is big. But elements are incriminating. If you implement them, you are morally—and eventually, legally—responsible.
- kerkeslager 7y ago
  As a software engineer: a lot of what I do is understanding the context of what I'm doing. When I'm writing code, I'm trying to grok how the business users think about the business objects and business logic. I get a story that says, "As a user, when I press the H key I want a horn to play." And I go into the planning meeting and ask, "Is this like a bike horn?" And they say yeah! And I ask, okay, so when I press the key, do you want the horn to sound on key down, or key up? And they say, "How about it starts playing on key down, and stops playing on key up?" And then I say, "do you want different volumes, for let's say when they are on their bike and just want to politely let someone know they are there, versus when they're about to get hit by a truck?" And they say, "yes, eventually, but being able to play the horn at different notes is a higher priority." And then I ask, "wait, why is that useful for a bike horn?" And then they explain that they're going to be playing the horn as part of an orchestra. And then by the end of the conversation I realize the horn I'm implementing is a French horn midi keyboard, not a bicycle horn traffic signal, and the requirements are completely different. I don't really buy this idea that people are just writing single, isolated requirements out of context.
W-Stool 7y ago
Money. Most of the shady practices going on in the world today and a thousand years ago end up being about money. Even the software engineers who implemented this ghastly thing - they needed the job and the money the job pays so "OK, yeah, I'll do it".
ummonk 7y ago
How about A/B testing for increases in usage, ads-clicks, subscription signups, and lack of subscription cancellations? How about PR consisting pretty much of finding favorable journalists who will provide positive pre-vetted coverage of feature launches? How about VC-fueled price-dumping to squash competition and build a monopoly? How about paying phone manufacturers, browsers, etc. to become preloaded apps or default search engines? The impacts aren't nearly as harmful in tech as in pharmaceuticals, but there are a lot of practices in our industry which we all accept as normal procedure but would seem very ethically questionable to an outsider.

tempsy 7y ago

These alerts were probably configured on some admin panel that was already built and didn’t require an engineer to be involved.

JshWright 7y ago
That's certainly possible, but it's not likely (in my experience working with CDS features). These sorts of alerts are pulling data from all sorts of different places, and there's generally at least some engineering effort involved in setting up new "categories" of alerts like this.
- tempsy 7y ago
  it doesn’t sound like it was a new category...just some new piece of logic that would trigger “prescribe opioids!” when the doctor typed something in why would you think these sham alerts rely on actual data that was “new”? these were probably as simple as some if statement that said “if patient over X age and in pain and lives in Y state then show alert”
  - hermitdev 7y ago
    The sad thibg about this whole opioid epidemic is that people such as myself, who actually suffer from chronic pain can't get relief. Not that opioids would help me, wrong kind of pain. I suffer from nerve pain which requires a whole other class of drugs, but the docs dont want to prescribe anything anymore, even non opioids. It fucking sucks, degrades my quality of life and ability to carry out day to day tasks.
  - JshWright 7y ago
    My guess is it's the "in pain" part that would require some engineering effort to expose as an option inside the CDS dashboard (assuming such a dashboard existed). Obviously none of us know how this was implemented, and it's possible PF had a slick CDS design tool that was super powerful and made these sorts of things easy. That's never been my experience though...

bb611 7y ago

Working in the Bay Area, I'm sure I've had more colleagues who would implement this than would not. That's even though I've specifically chosen to work at companies that emphasize the importance of social good in their business. Most people come to work for a paycheck, and the perceived cost to them of shaking up that paycheck (even just to get a new job) is very high.

toomuchtodo 7y ago
How do you make the cost for them lower to make the right decision? Or make the amount of pain higher for making the immoral one?

onetimemanytime 7y ago

>>I don't understand how someone gets asked to build this "feature" and they don't just quit on the spot... Shall we go down the list of horrible and unethical things engineers have built over millennia, so we settle this once in for all? If you quit, someone else will do it

firstplacelast 7y ago
And this is why drug traffickers should not be punished. If they don't do it, someone else will. It is the people on the receiving ends, the ones that take the kickbacks and the ones that take the drugs, that should be punished.
sitkack 7y ago
We don't know how many quit to get to the worker that implemented this. The thing is, it doesn't stop with the first person that quits, it goes forward with the first person that says "yes".

astura 7y ago

Because when an engineer gets a big list of the alerts he or she must implement some aren't labeled "*illegal kickback scheme to get doctors to prescribe medically unnecessary medication for profit," it looks like any other requirement. Making things look legit to others outside of the scheme is important to successfully pulling off the scheme. Even if an individual engineer suspected the opioid recommendation alerts were medically unnecessary, medically unnecessary tests and treatments are very common [1], so it wouldn't exactly stand out as "probaby an illegal kickback scheme." [1] https://www.propublica.org/article/unnecessary-medical-care-is-more-common-than-you-think https://www.propublica.org/article/unnecessary-medical-care-...

JumpCrisscross 7y ago
> Because when an engineer gets a big list Let’s not be naive. The list is big. But elements are incriminating. If you implement them, you are morally—and eventually, legally—responsible.
kerkeslager 7y ago
As a software engineer: a lot of what I do is understanding the context of what I'm doing. When I'm writing code, I'm trying to grok how the business users think about the business objects and business logic. I get a story that says, "As a user, when I press the H key I want a horn to play." And I go into the planning meeting and ask, "Is this like a bike horn?" And they say yeah! And I ask, okay, so when I press the key, do you want the horn to sound on key down, or key up? And they say, "How about it starts playing on key down, and stops playing on key up?" And then I say, "do you want different volumes, for let's say when they are on their bike and just want to politely let someone know they are there, versus when they're about to get hit by a truck?" And they say, "yes, eventually, but being able to play the horn at different notes is a higher priority." And then I ask, "wait, why is that useful for a bike horn?" And then they explain that they're going to be playing the horn as part of an orchestra. And then by the end of the conversation I realize the horn I'm implementing is a French horn midi keyboard, not a bicycle horn traffic signal, and the requirements are completely different. I don't really buy this idea that people are just writing single, isolated requirements out of context.

W-Stool 7y ago

Money. Most of the shady practices going on in the world today and a thousand years ago end up being about money. Even the software engineers who implemented this ghastly thing - they needed the job and the money the job pays so "OK, yeah, I'll do it".

ummonk 7y ago

How about A/B testing for increases in usage, ads-clicks, subscription signups, and lack of subscription cancellations? How about PR consisting pretty much of finding favorable journalists who will provide positive pre-vetted coverage of feature launches? How about VC-fueled price-dumping to squash competition and build a monopoly? How about paying phone manufacturers, browsers, etc. to become preloaded apps or default search engines? The impacts aren't nearly as harmful in tech as in pharmaceuticals, but there are a lot of practices in our industry which we all accept as normal procedure but would seem very ethically questionable to an outsider.