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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

#161

Post by vkou »

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--who might get six months of work in before realizing that they are working for the baddies, and also deciding to either quit or die a little inside.

They have another option. Organize and push back.

But when FAMG employees organize to push back on unethical behaviour that they are asked to be complicit in, much of HN tends to accuse them of all sorts of nasty things.

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

#162

Post by stevula »

bryanrasmussen wrote: post #39
icoder wrote: post #29

Earlier quoted context omitted.

As I understand it, a developer could implement this without any knowledge of the secret deal: when opening a patients records a pop-up should appear. That's basically what the physicians would know after a using it for while too.

Sure, not every developer who worked on the application needs to know what would cause the modal to appear and what possible messages it might have. But I think it likely that somewhere there was a developer who knew what that there was a query | logic function checking the patients pain relievers status etc. and a developer knowing that in the database the text came back with hey you should give this guy some oxy. A…

Probably a developer somewhere in the process would have figured it out, but it’s possible they just built some abstraction for showing rx recommendations when certain conditions are met. The specific medications and conditions could be controlled through a CRM or admin interface without the knowledge of devs as to what actually goes in.

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

#163

Post by TAForObvReasons »

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.

> It is difficult to get a man to understand something, when his salary depends on his not understanding it.

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

#164

Post by Scoundreller »

rscho wrote: post #134
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…

Epic is far, far away from what us MDs imagine when someone mentions the benefits of EHRs. For starters, if one could make an EHR that just only attempts to also help practitioners in the trenches instead of just the billing dept. that would be stellar! So 'the value EPIC brings' is huge... for anyone but care providers, thank you very much.

Sounds like you have a billing department problem.

I think one big issue is that the US subsidized EHRs for a while. So non-US non-billing-focussed EHRs never really developed.

Now those US EHRs are getting dumped on the rest of world, with all of that carefully developed billing tech disabled out-of-the-box.

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

#165

Post by tbyehl »

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)

Some of a competing EMR is PowerBuilder. Hopefully not the one you made ;-)

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

#166

Post by [deleted] »

SkyBelow wrote: post #153
brianwawok wrote: post #116

Earlier quoted context omitted.

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.

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 wh…

[deleted]

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

#167

Post by alexandercrohde »

dfsegoat wrote: post #81

A murder trial for an MD who was over-prescribing opioids just started in my city [1]. How are the developers of this software not being criminally charged? It literally seems like the same thing and if nothing else, they made it easier for doctors to potentially kill people and face charges themselves. 1 - https://www.pressdemocrat.com/news/10643995-181/murder-trial...

I think punishing the engineer would be much less practical than the CEO. There will always be an engineer (perhaps a remote contractor) who will build this.

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

#168

Post by treis »

dreamcompiler wrote: post #131
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

> 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 conveni…

> Doctors didn't push back

Doctors, or at least some, are their partners in crime:

>Opioid manufacturers are paying U.S. doctors huge sums of money for speaking, consulting, and other services—and the more opioids a doctor prescribes, the more money he or she gets paid by those same manufacturers, according to a new analysis from Harvard T.H. Chan School of Public Health, Harvard Medical School (HMS), and CNN.

>The study found that, in 2014 and 2015, opioid manufacturers paid hundreds of doctors sums in the six figures, while thousands more were paid over $25,000.

>“I don’t know if the money is causing the prescribing or the prescribing led to the money, but in either case, it’s potentially a vicious cycle. It’s cementing the idea for these physicians that prescribing this many opioids is creating value,” said Michael Barnett, assistant professor of health policy and management at Harvard Chan School, in a CNN.com article. Barnett co-authored the study with Anupam Jena of HMS.

https://www.hsph.harvard.edu/news/hsph-in-the-news/opioids-d...

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

#169

Post by asdfgionio1234 »

SkyBelow wrote: post #153
brianwawok wrote: post #116

Earlier quoted context omitted.

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.

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 wh…

If I brew beer, odds are I also drink beer.

If I manufacture guns, odds are I also own guns.

If I make sports cars, odds are I also like to drive sports cars.

People who build swimming pools swim. People who sell junk food buy junk food. People who make video games play video games.

The people in your examples are all selling things they probably want to be able to buy. Perhaps you disagree with their decisions, but they are acting out of a good-faith belief that the things they make are good.

No one wants to have someone try to get them hooked on opioids.

Follow the Golden Rule.

(Maybe the junk food and video games examples are different, since some foods and games are deliberately addictive.)

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

#170

Post by WorldMaker »

mcguire wrote: post #122
rectang wrote: post #77

Earlier quoted context omitted.

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.

More reasons to push for Professional Ethics Boards with teeth and/or unions with ethics rules.
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