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[when opening a patients records] a pop-up would appear, asking about a patient’s level of pain. Then, a drop-down menu would list treatments ranging from a ref

[when opening a patients records] a pop-up would appear, asking about a patient’s level of pain. Then, a drop-down menu would list treatments ranging from a referral to a pain specialist to a prescription for an opioid painkiller. Click a button, and the program would create a treatment plan. From 2016 to spring 2019, the alert went off about 230 million times. The tool existed thanks to a secret deal. Its maker, a software company called Practice Fusion, was paid by a major opioid manufacturer to design it in an effort to boost prescriptions for addictive pain pills ... Its existence was revealed this week thanks to a government investigation. Holy shit

pintxo 7y ago
One doctors quote in the article says it all: > But, “if you want to model electronic health records as a for-profit system and not regulate them as such and force doctors to be on them, it’s almost inevitable that they’re going to be manipulated.”
- kangaroozach 7y ago
  If by manipulated he means continually improved through competitive pressure to on the whole deliver a better experience for less cost than the competition, then sure. All drugs are always on the table for doctors to choose from. It’s their responsibility to choose wisely and responsibly, even in the face of for profit nudges to behave a certain way.
  - pintxo 7y ago
    You might not have realized it, but doctors are just mere humans like everyone else. As such they are not magically immune to outside influence. Also, I believe our interpretation of the quote differs quite a lot from mine. I read the original quote as: the doctors get manipulated. This reading seems to be incompatible with your response.
  - Jamwinner 7y ago
    Its pretty clear thats not what he means at all. He means manipulated by having unneeded highlu addictive drugs pushed on people who don't need them, many times destroyinh their lives in the process. That manipulation. Why are you being purposefully dense?
banads 7y ago
I want to think this is bad, but the way it is described here doesn't really seem like a dark pattern to me. Maybe if "perscribe opiods" was the first or default selection, it would seem worse
- codeulike 7y ago
  It was built to be defensible/deniable. The fact that it was paid for by a pharma company is the problem. A doctors workflow shouldnt really be cladestinely influenced by a pharma company
  - banads 7y ago
    I agree that does seem to be the real problem. Though I'd really like to see the alert myself to see what kind of dark patterns they may have used to incline the user to select the opiod option
    - JshWright 7y ago
      Prescribing extended release opioids (which are known to be _highly_ addictive, even when used "appropriately") should never be the first choice for pain management. It should never have been presented as an equal option with non-pharmaceutical and non-opioid interventions.
    - mcguire 7y ago
      The existence of the alert itself is the dark pattern.
  - dreamcompiler 7y ago
    > A doctors workflow shouldnt really be cladestinely influenced by a pharma company Yet it has always have been so. Doctors are the gatekeepers of drug delivery, so big pharma has always pressured them. Doctors didn't push back (much) because they're too busy to keep up with pharmacology developments on their own, so the drug companies have offered such "education" as a helpful "service". (Said service always conveniently neglects to describe the benefits of older, still-useful drugs because they don't make any money.) The innovation of the 80s was the legalization of prescription drug advertising, which effected an additional pressure source for doctors to prescribe certain drugs: Their patients. Now this happens where the software doctors are forced to use puts even more pressure on doctors. People talk about the evils of big pharma all the time, but most have no idea how great the evil really is.
abdullahkhalids 7y ago
I see people here who don't seem to get why this is unethical. So let's be crystal clear. Doctors are simply opening a patient's record, for whatever reason. This patient may not even be sick or need any medication. The doctor has to deal with a pop-up, and if they interact with it, they get presented with various options. Both options mentioned in the news report are likely to increase opioid addiction. The problem is not in what order the options are presented, or what the default is. It is a problem that the treatment plan it creates was not created by the patient's primary doctor, but this is not the biggest problem. The problem is that a pop-up appears, forcing doctors to choose 230 million times between opioids or no opioids. The very existence of the pop-up is the problem.
- rectang 7y ago
  A large portion of the tech industry rests on the justification that users are to blame when unethical user interface design does what it's supposed to and shunts some statistically predictable fraction of users towards choices that are not in their best interest.
  - krageon 7y ago
    I think that nobody involved in any side of that argument (the people writing the justification and the people reading it) actually believe it is true. It's just some noise some person came up with to argue in bad faith why they should be allowed to keep doing bad things if it is good for their wallet.
    - kbenson 7y ago
      Never underestimate what someone will believe when they have a vested interest in believing it.
      - pixl97 7y ago
        "It is difficult to get a man to understand something, when his salary depends on his not understanding it"
mtgx 7y ago
People are going to go to prison for this, right? Or has all white crime been made legal in America? Because I can't tell anymore.
- alistairSH 7y ago
  Nope. As far as I can tell, the company was fined. That's it.
- ska 7y ago
  Or has all white crime been made legal in America? Can you think of a time when it was significantly more likely for something like this to end up with execs in jail?
  - ohithereyou 7y ago
    I can think of a time about 125 years ago that it was significantly more likely that execs of the company would end up with a bullet in their head or their loved ones kidnapped and ransomed for such shenanigans. (Note; This is obviously bad and I'm not advocating for it, but it's more than just "no jail time and you have to sell your third and fourth house to pay the fine".)
    - TeMPOraL 7y ago
      > "no jail time and you have to sell your third and fourth house to pay the fine" I might be too cynical, but I half-expect the company to have insurance to cover it.
      - ohithereyou 7y ago
        Most insurance policies exclude willful criminal acts perpetrated by the policy owner.
  - Barrin92 7y ago
    it's been a few thousand years, but maybe the Code of Hammurabi might be of assistance If a builder builds a house for someone, and does not construct it properly, and the house which he built falls in and kills its owner, then that builder shall be put to death.
eddywebs 7y ago
This qualifies for /r/assholedesign
- aqme28 7y ago
  More than that. This is unethical design. It's a design that probably killed people.
  - brianwawok 7y ago
    I think it's safe to remove probably. This went down a chain of people. CEO. VP. PM. Tech Lead. Developer. All of them made a choice to kill people for profit.
    - ohithereyou 7y ago
      I've said this before on HN and I'll say it again. Every C-level exec that was aware this happened and let it happen should be charged with a single count of involuntary manslaughter for every patient who had an opioid overdose that was prescribed pain medication by this system. This is not acceptable, and people's heads should roll.
      - sneak 7y ago
        Nobody forced anyone to put those drugs into their body.
        sonotathrowaway 7y ago
        Nope, they just lied about their addiction potential. Intentionally getting someone addicted to a drug can’t in any way be seen as forcing them to take it.
    - SkyBelow 7y ago
      Would this same logic apply to other jobs? For example, do people who brew beer make the choice to kill others? If the drunk drivers add a level of indirection that prevent blame, then why doesn't the same happen with the doctors in this case? Gun manufacturers? People who build cars that have a known higher fatality rate? People who build swimming pools (look up how many kids die to swimming pools a year)? People who sell unhealthy food? People who make tech/video games that result in less physical activity?
legulere 7y ago
I was also surprised quite a bit to find out that advertising is a thing in the programs of doctors in Germany. The regulating body sets as a rule that an ad-free version needs to be available as well. So there’s also a bit of fault on the doctors deciding to save few euros and taking the version with ads.
- TeMPOraL 7y ago
  This is just another pattern that's entirely predictable. Given a free ad-full version and a paid ad-free version, people will mostly pick the version with ads. There may be many reasons for it - through introspection of my own (old) Android purchasing habits, I can recognize at least: - not being rich enough to spend money on things I don't have a good reason to, - the perceived value of a piece of software being very small at the beginning, so paying up front is risky - the belief in my ability to ignore ads on the margin, which doesn't change the fact that ads work over time, and work at scale. Point being, this pattern is at this point perfectly predictable, so we can treat it as a law of nature - the same way gas molecules don't have to be dispersed throughout the room, they just tend to with very high probability. That's why I'm in favor of banning "free, ad-supported" as a business model, on the grounds of it being statistically harmful to the end-users and anticompetitive (if your competitor does it, you'll be forced to follow suit).
- fit2rule 7y ago
  In Germany, pharamceutial companies use young attractive women to pimp their products to doctors, and its not uncommon for doctors to be visited 7 or 8 times a month by these representatives. It should be noted also, that prostitution is legal in Germany.
tempsy 7y ago
Hard not to laugh at the co-founder's LinkedIn bio in light of all this: https://www.linkedin.com/in/matthewcdouglass/ https://www.linkedin.com/in/matthewcdouglass/ First line... "I dig: socially responsible company-building"
deleted 7y ago
[deleted]
mikehotel 7y ago
Leaving ethics aside, 230M alerts to prescribing doctors for $1M seems like a steal for pharma co. “Employees estimated internally that the drug company could add almost 3,000 patients and bolster opioid sales by as much as $11.3 million through the partnership. Under the contract, the drugmaker paid Practice Fusion almost $1 million”
bsanr2 7y ago
I hope everyone now understands why every seemingly-batshit conspiracy regarding the crack/cocaine epidemic exists: because there truly are people in this world who would absolutely stoop so low. And a reminder to the people realizing how bad a drug epidemic can be now that it's hit close to home: opioids primarily hit middle class families with the means to get prescription drugs at all, and have largely been treated in public discourse as a tragic public health crisis. No imagine how devastating a similar crisis would be to people with a fraction of the resources and who were constantly demonized in the media. We have to do better by each other so we can be better to ourselves.
ErikAugust 7y ago
A drug ad pop up in a health record? Do we have any more "dystopian sci-fi ideas" in the Backlog we want to implement today?
fzeroracer 7y ago
This is a perfect example of how free markets fail when profiteering is not aligned with the user in mind. Their sole purpose is to increase sales of their pain medication. The best way to do that is to advertise your drug to people who can push them, and even better if you can wear them down into making shitty decisions that involve them buying your drug. The free market can't fix this problem because it's hidden (intentionally) and because what the company wants is not what the user wants. The only recourse is legislation.
- deleted 7y ago
  [deleted]
- kangaroozach 7y ago
  Fascinating. So your saying the user must be aligned for the free market to work? How about employers choosing from a set of health insurance plans you can choose from? That’s a misalignment no? If I could get a coupon to buy my own insurance I may choose something better for me from an entire marketplace of plans. Instead I get stuck with the calculated decisions of people I don’t know trying to optimize their own profits while satisfying a set of people with very different needs and risk profiles than myself.

pintxo 7y ago

One doctors quote in the article says it all: > But, “if you want to model electronic health records as a for-profit system and not regulate them as such and force doctors to be on them, it’s almost inevitable that they’re going to be manipulated.”

kangaroozach 7y ago
If by manipulated he means continually improved through competitive pressure to on the whole deliver a better experience for less cost than the competition, then sure. All drugs are always on the table for doctors to choose from. It’s their responsibility to choose wisely and responsibly, even in the face of for profit nudges to behave a certain way.
- pintxo 7y ago
  You might not have realized it, but doctors are just mere humans like everyone else. As such they are not magically immune to outside influence. Also, I believe our interpretation of the quote differs quite a lot from mine. I read the original quote as: the doctors get manipulated. This reading seems to be incompatible with your response.
- Jamwinner 7y ago
  Its pretty clear thats not what he means at all. He means manipulated by having unneeded highlu addictive drugs pushed on people who don't need them, many times destroyinh their lives in the process. That manipulation. Why are you being purposefully dense?

banads 7y ago

I want to think this is bad, but the way it is described here doesn't really seem like a dark pattern to me. Maybe if "perscribe opiods" was the first or default selection, it would seem worse

codeulike 7y ago
It was built to be defensible/deniable. The fact that it was paid for by a pharma company is the problem. A doctors workflow shouldnt really be cladestinely influenced by a pharma company
- banads 7y ago
  I agree that does seem to be the real problem. Though I'd really like to see the alert myself to see what kind of dark patterns they may have used to incline the user to select the opiod option
  - JshWright 7y ago
    Prescribing extended release opioids (which are known to be _highly_ addictive, even when used "appropriately") should never be the first choice for pain management. It should never have been presented as an equal option with non-pharmaceutical and non-opioid interventions.
  - mcguire 7y ago
    The existence of the alert itself is the dark pattern.
- dreamcompiler 7y ago
  > A doctors workflow shouldnt really be cladestinely influenced by a pharma company Yet it has always have been so. Doctors are the gatekeepers of drug delivery, so big pharma has always pressured them. Doctors didn't push back (much) because they're too busy to keep up with pharmacology developments on their own, so the drug companies have offered such "education" as a helpful "service". (Said service always conveniently neglects to describe the benefits of older, still-useful drugs because they don't make any money.) The innovation of the 80s was the legalization of prescription drug advertising, which effected an additional pressure source for doctors to prescribe certain drugs: Their patients. Now this happens where the software doctors are forced to use puts even more pressure on doctors. People talk about the evils of big pharma all the time, but most have no idea how great the evil really is.

abdullahkhalids 7y ago

I see people here who don't seem to get why this is unethical. So let's be crystal clear. Doctors are simply opening a patient's record, for whatever reason. This patient may not even be sick or need any medication. The doctor has to deal with a pop-up, and if they interact with it, they get presented with various options. Both options mentioned in the news report are likely to increase opioid addiction. The problem is not in what order the options are presented, or what the default is. It is a problem that the treatment plan it creates was not created by the patient's primary doctor, but this is not the biggest problem. The problem is that a pop-up appears, forcing doctors to choose 230 million times between opioids or no opioids. The very existence of the pop-up is the problem.

rectang 7y ago
A large portion of the tech industry rests on the justification that users are to blame when unethical user interface design does what it's supposed to and shunts some statistically predictable fraction of users towards choices that are not in their best interest.
- krageon 7y ago
  I think that nobody involved in any side of that argument (the people writing the justification and the people reading it) actually believe it is true. It's just some noise some person came up with to argue in bad faith why they should be allowed to keep doing bad things if it is good for their wallet.
  - kbenson 7y ago
    Never underestimate what someone will believe when they have a vested interest in believing it.
    - pixl97 7y ago
      "It is difficult to get a man to understand something, when his salary depends on his not understanding it"

mtgx 7y ago

People are going to go to prison for this, right? Or has all white crime been made legal in America? Because I can't tell anymore.

alistairSH 7y ago
Nope. As far as I can tell, the company was fined. That's it.
ska 7y ago
Or has all white crime been made legal in America? Can you think of a time when it was significantly more likely for something like this to end up with execs in jail?
- ohithereyou 7y ago
  I can think of a time about 125 years ago that it was significantly more likely that execs of the company would end up with a bullet in their head or their loved ones kidnapped and ransomed for such shenanigans. (Note; This is obviously bad and I'm not advocating for it, but it's more than just "no jail time and you have to sell your third and fourth house to pay the fine".)
  - TeMPOraL 7y ago
    > "no jail time and you have to sell your third and fourth house to pay the fine" I might be too cynical, but I half-expect the company to have insurance to cover it.
    - ohithereyou 7y ago
      Most insurance policies exclude willful criminal acts perpetrated by the policy owner.
- Barrin92 7y ago
  it's been a few thousand years, but maybe the Code of Hammurabi might be of assistance If a builder builds a house for someone, and does not construct it properly, and the house which he built falls in and kills its owner, then that builder shall be put to death.

eddywebs 7y ago

This qualifies for /r/assholedesign

aqme28 7y ago
More than that. This is unethical design. It's a design that probably killed people.
- brianwawok 7y ago
  I think it's safe to remove probably. This went down a chain of people. CEO. VP. PM. Tech Lead. Developer. All of them made a choice to kill people for profit.
  - ohithereyou 7y ago
    I've said this before on HN and I'll say it again. Every C-level exec that was aware this happened and let it happen should be charged with a single count of involuntary manslaughter for every patient who had an opioid overdose that was prescribed pain medication by this system. This is not acceptable, and people's heads should roll.
    - sneak 7y ago
      Nobody forced anyone to put those drugs into their body.
      - sonotathrowaway 7y ago
        Nope, they just lied about their addiction potential. Intentionally getting someone addicted to a drug can’t in any way be seen as forcing them to take it.
  - SkyBelow 7y ago
    Would this same logic apply to other jobs? For example, do people who brew beer make the choice to kill others? If the drunk drivers add a level of indirection that prevent blame, then why doesn't the same happen with the doctors in this case? Gun manufacturers? People who build cars that have a known higher fatality rate? People who build swimming pools (look up how many kids die to swimming pools a year)? People who sell unhealthy food? People who make tech/video games that result in less physical activity?

legulere 7y ago

I was also surprised quite a bit to find out that advertising is a thing in the programs of doctors in Germany. The regulating body sets as a rule that an ad-free version needs to be available as well. So there’s also a bit of fault on the doctors deciding to save few euros and taking the version with ads.

TeMPOraL 7y ago
This is just another pattern that's entirely predictable. Given a free ad-full version and a paid ad-free version, people will mostly pick the version with ads. There may be many reasons for it - through introspection of my own (old) Android purchasing habits, I can recognize at least: - not being rich enough to spend money on things I don't have a good reason to, - the perceived value of a piece of software being very small at the beginning, so paying up front is risky - the belief in my ability to ignore ads on the margin, which doesn't change the fact that ads work over time, and work at scale. Point being, this pattern is at this point perfectly predictable, so we can treat it as a law of nature - the same way gas molecules don't have to be dispersed throughout the room, they just tend to with very high probability. That's why I'm in favor of banning "free, ad-supported" as a business model, on the grounds of it being statistically harmful to the end-users and anticompetitive (if your competitor does it, you'll be forced to follow suit).
fit2rule 7y ago
In Germany, pharamceutial companies use young attractive women to pimp their products to doctors, and its not uncommon for doctors to be visited 7 or 8 times a month by these representatives. It should be noted also, that prostitution is legal in Germany.

tempsy 7y ago

Hard not to laugh at the co-founder's LinkedIn bio in light of all this: https://www.linkedin.com/in/matthewcdouglass/ https://www.linkedin.com/in/matthewcdouglass/ First line... "I dig: socially responsible company-building"

deleted 7y ago

[deleted]

mikehotel 7y ago

Leaving ethics aside, 230M alerts to prescribing doctors for $1M seems like a steal for pharma co. “Employees estimated internally that the drug company could add almost 3,000 patients and bolster opioid sales by as much as $11.3 million through the partnership. Under the contract, the drugmaker paid Practice Fusion almost $1 million”

bsanr2 7y ago

I hope everyone now understands why every seemingly-batshit conspiracy regarding the crack/cocaine epidemic exists: because there truly are people in this world who would absolutely stoop so low. And a reminder to the people realizing how bad a drug epidemic can be now that it's hit close to home: opioids primarily hit middle class families with the means to get prescription drugs at all, and have largely been treated in public discourse as a tragic public health crisis. No imagine how devastating a similar crisis would be to people with a fraction of the resources and who were constantly demonized in the media. We have to do better by each other so we can be better to ourselves.

ErikAugust 7y ago

A drug ad pop up in a health record? Do we have any more "dystopian sci-fi ideas" in the Backlog we want to implement today?

fzeroracer 7y ago

This is a perfect example of how free markets fail when profiteering is not aligned with the user in mind. Their sole purpose is to increase sales of their pain medication. The best way to do that is to advertise your drug to people who can push them, and even better if you can wear them down into making shitty decisions that involve them buying your drug. The free market can't fix this problem because it's hidden (intentionally) and because what the company wants is not what the user wants. The only recourse is legislation.

deleted 7y ago
[deleted]
kangaroozach 7y ago
Fascinating. So your saying the user must be aligned for the free market to work? How about employers choosing from a set of health insurance plans you can choose from? That’s a misalignment no? If I could get a coupon to buy my own insurance I may choose something better for me from an entire marketplace of plans. Instead I get stuck with the calculated decisions of people I don’t know trying to optimize their own profits while satisfying a set of people with very different needs and risk profiles than myself.