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Health-records software pushed opioids to doctors in secret deal with drugmaker

bloomberg.com

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Re: Health-records software pushed opioids to doctors in secret deal with drugmaker

#121

Post by ska »

mtgx wrote: post #59
codeulike wrote: post #5

[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 s…

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.

  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?

Re: Health-records software pushed opioids to doctors in secret deal with drugmaker

#122

Post by mcguire »

rectang wrote: post #77
abdullahkhalids wrote: post #50

Earlier quoted context omitted.

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…

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.

Or management, those Snidely Whiplash types who create unethical requirements for innocent programmers to implement.

Re: Health-records software pushed opioids to doctors in secret deal with drugmaker

#123

Post by mcguire »

banads wrote: post #36
codeulike wrote: post #33

Earlier quoted context omitted.

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

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

The existence of the alert itself is the dark pattern.

Re: Health-records software pushed opioids to doctors in secret deal with drugmaker

#124

Post by noelsusman »

conanbatt wrote: post #44
to11mtm wrote: post #42

Earlier quoted context omitted.

Also, I've never heard a good thing about Epic...

It's made in Visual Basic, and it literally cannot interact with its own versions. Hospitals have different versions of the same system in the same building and cant exchange information. All EMR's suck though. (note: I made one)

It's written in MUMPS.

Re: Health-records software pushed opioids to doctors in secret deal with drugmaker

#125

Post by somurzakov »

nradov wrote: post #102
dkarras wrote: post #90

As a non-American I'm also curious about the mass necessity of opioid painkillers to begin with. From what I hear, people are prescribed opioids post surgery etc. which is bonkers to me as a foreigner. I'm a middle aged person and I have never seen anyone using opioid painkillers anywhere in my life. They give stuff to you when you are having surgery, and when you are in hospital's care, but something very extraordin…

In 2007 an oral surgeon gave me a prescription for opioid painkillers after a wisdom tooth extraction, just in case I needed it for pain. The pain wasn't very bad and I never filled the prescription, but in retrospect giving me that prescription in the first place was just crazy! Another doctor gave my wife an opioid painkiller prescription upon hospital discharge after a normal childbirth, just in case she needed it…

this is to prevent you from going to the ER and getting an enormous bill. sometimes after tooth extraction a condition called "dry socket" can develop and it will cause enormous pain. opioids solve that until your next regular visit to a doctor. otherwise you could feel terrible pain and go to ER in the night with all the consequences

https://en.wikipedia.org/wiki/Alveolar_osteitis

Re: Health-records software pushed opioids to doctors in secret deal with drugmaker

#126

Post by horsawlarway »

aqme28 wrote: post #95
eddywebs wrote: post #67

Earlier quoted context omitted.

This qualifies for /r/assholedesign

More than that. This is unethical design. It's a design that probably killed people.

I'd argue it's actually MUCH worse than simply killing people (which is already pretty staggeringly bad).

The constant push to privatize and let market forces drive medical interactions is CRUSHING trust in the system.

Let's take an example patient, Sally.

Sally goes to see her doctor, she's got some minor knee pain, but nothing serious. As a result of this profit motivated system, her doctor is likely to try to prescribe her expensive pain killers.

She doesn't really think she needs them, but she gets the prescription anyways since she trusted her doctor. Now Sally is actually lucky - no addiction issues, no real problems with the meds. She just decides to stop paying for them after a while since she didn't really think she needed them. AND SHE WAS RIGHT.

Now she's got a nagging thought in the back of her head - Why did my doctor ask me to buy this thing? I didn't need it.

Next time Sally hits the doctors office she's got her kids in tow and the doctor recommends several vaccines. Not super expensive, but not cheap. Normally she'd just trust the doc and say sure. But last time she was burned and paid for something she didn't need.

So this time she decides to do some googling and hits a whole host of anti-vax propaganda. Things that say kids don't need them, they're expensive and risky.

So she opts out.

----

We see this happen everywhere in medicine right now. Things like:

- The dentist that "finds" a cavity at the last minute to fill even though everything has been fine, and the patient doesn't normally have cavities.

- The physician that runs a whole slew of expensive tests for a simple issue

- The dermatologist who wants to do a biopsy on the mole that's been fine for years and doesn't look any different.

Each interaction like this - Where the patient feels more like a walking wallet than a person - they erode trust. Rightfully so, in my opinion.

The end result is whole swathes of disillusioned people who no longer trust the medical system. The consequences become staggering for society as a whole when this trust is gone.

---

I don't think it's any accident AT ALL that the most common group to believe the anti-vax rhetoric is the upper middle class. They're the patients most likely to have disposable income that can be targeted with schemes like this. And while those people are horribly wrong, their gut instinct is SPOT ON. They're being targeted financially and it's bullshit.

Re: Health-records software pushed opioids to doctors in secret deal with drugmaker

#127

Post by conanbatt »

JshWright wrote: post #85
skwb wrote: post #82

Earlier quoted context omitted.

It's very du joure to talk bad about Epic (and certainly not without reason re: HHS healthcare interoperability proposed rules) but they have been a huge success from a business perspective. The reason why they provide EHR support for the majority of large healthcare system hospitals is that they provide a lot of flexibility to implimentation. If you want the ability to support some very unique functionality, they wi…

They're in a very different market from Practice Fusion though. There aren't many small/independent practices rolling out Epic deployments...

When small practices get bought or acquired by hospitals they typically switch to epic.

Re: Health-records software pushed opioids to doctors in secret deal with drugmaker

#128

Post by jaclaz »

idiot900 wrote: post #14
pimmen wrote: post #4

I think this creates an interesting discussion on the part of the designers and programmers. Did they understand that what they were building was going to increase opioid dependence? Did they ask about it? And, the most interesting question of all: If they found out that was the case did they try to justify building it to themselves in some way? Full disclaimer: I have built software that I had ethical reservations a…

I'm a doctor. During medical school and residency, I was taught in good faith that "only as much as necessary" opioid was OK to give and wouldn't create dependence - it was only an "excess" of opioid that would cause a problem. So under the banner of reducing the suffering of our patients, and a mandate to reduce patient-reported pain scores, opioids flowed relatively freely. Now we know that was a terrible idea with…

> It's hard to imagine a programmer without medical training could be blamed.

Sure, but I would have expected that there would have been some perplexities by the actual doctors when they were presented these popups at each patient data access.

Re: Health-records software pushed opioids to doctors in secret deal with drugmaker

#129

Post by mcguire »

nkrisc wrote: post #114
ryandrake wrote: post #96

Earlier quoted context omitted.

I’ve never been a big fan of the “I don’t know what my software does—I just move JSON around” excuse. As professionals, we need to be aware of the intended use of the things we make, and that includes weighing the ethical implications. We also need a professional ethical vow with teeth like the Hippocratic Oath that allows tech professionals to push back against demands to write unethical software, but that’s a topic…

I don't disagree. But my point was that it's not always clear what the implications are. Sometimes it's more obvious, sometime it's not. We also don't know what the "intended" use of this feature that was presented to the people who made it was. They could very well have been deceived as to it's true nature. This could very easily have been presented and sold to a team in a way that does not make it immediately seem…

The bottom line is that developers and designers are not professionals, who would have to accept responsibility for their products. It is in the best interests of developers and designers not to be professionals and not to accept responsibility in cases like this.

A standard argument for this state of affairs is that it is in the best interest of society to allow developers and designers this freedom from responsibility, because of all the shiny new products. In which case you have to accept incidents like this---you can't make an omelette without breaking a few eggs.

Re: Health-records software pushed opioids to doctors in secret deal with drugmaker

#130

Post by mcguire »

vharuck wrote: post #113
logfromblammo wrote: post #98

They put pop-up stealth advertisements, targeted at your doctor, into your electronic medical record, so that he or she would get you addicted to painkillers. Software developers did this. For drug money. That's just terrible, isn't it? They shouldn't have done that. But even if the developers had ethical concerns, they had no recourse but to quit, and be replaced by someone else--who might get six months of work in…

>But even if the developers had ethical concerns, they had no recourse but to quit, and be replaced by someone else I'm not saying that everyone who touched the software should be indicted, but there were options beyond quitting. They could've told the customers, the news outlets, or the government. Of course, when you're surrounded by people doing the same thing and nobody else is speaking up, it's not unreasonable…

Whistleblowing is likely worse than quitting.
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