Health-records software pushed opioids to doctors in secret deal with drugmaker • Hacker News Board

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

#171

Post by jfarmer » Thu, Jan 30, 2020, 8:57 PM UTC

nkrisc wrote: post #6

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…

To be fair to the developers and designers: how exactly would they know that the inclusion of "opioid prescription" as an item in that list would help fuel a an opioid epidemic? Hindsight is 20/20, but would you expect them at the time to think, "If we include this as an option in this list, it will contribute to a nationwide epidemic of opioid abuse and countless deaths"? Honestly, I think it's a stretch, especially…

> If we include this as an option in this list, it will contribute to a nationwide epidemic of opioid abuse and countless deaths?

Give. me. a. break!

At a minimum they should ask, "What are the potential downsides? How extreme are they? How can we determine how likely those potential downsides are?"

I'd expect every junior PM to ask _that_ series of questions about any product decision in any market.

There's a reason clinical trials have protocols for early termination. Not understanding that early termination is a thing when building a social app is one thing, but they're building EMR software!

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

#172

Post by rscho » Thu, Jan 30, 2020, 8:57 PM UTC

Scoundreller wrote: post #164

rscho wrote: post #134

Earlier quoted context omitted.

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.

Sounds like I have a problem with anything making my job more painful.

The actual problem has nothing to do with nation-focused issues. With healthcare liberalization came competition, and therefore search for the cheapest solution. Problem is, in healthcare we have slaves (called residents) and what's cheaper than an educated slave? So actually, even european EHRs follow the 'for-billing' model because it's far easier to just dump the work on the residents.

EHRs are the whip with which we 'encourage' human healthcare providers.

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

#173

Post by bsanr2 » Thu, Jan 30, 2020, 8:59 PM UTC

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…

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.

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

#174

Post by munk-a » Thu, Jan 30, 2020, 9:05 PM UTC

treis wrote: post #168

dreamcompiler wrote: post #131

Earlier quoted context omitted.

> 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 s…

Some Doctors are absolutely devoid of morals and ethics, just like some teachers, some developers... some everything's - I think it's misleading at best to pull out a study as refutation that involved hundreds of doctors in a country of 300 million.

My entirely anecdotal experience has been that most Doctors aren't in it for the ferrari, but instead are trying to help improve people's lives.

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

#175

Post by kbenson » Thu, Jan 30, 2020, 9:16 PM UTC

krageon wrote: post #84

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.

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.

Never underestimate what someone will believe when they have a vested interest in believing it.

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

#176

Post by kohtatsu » Thu, Jan 30, 2020, 9:18 PM UTC

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.

Would you consider the girls who filed documents for the SS innocent?

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

#177

Post by treis » Thu, Jan 30, 2020, 9:20 PM UTC

throwaway_tech wrote: post #106

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…

>The very existence of the pop-up is the problem. Ethically yes, but legally, the issue may be more related to the payment, which I am guessing is a violation of the anti-kickback statute.

Even still it's not clear why that's an issue. Let's say that I've come up with a drug that treats a relatively unknown disease detectable through blood tests. So I go to Practice Fusion and pay them to develop a pop up that triggers when it sees a blood test indicative of the disease my drug cures. It seems like a win for everyone.

The only real difference I see is that opioids are on the balance probably harmful to patients. But that's an issue with the drugs and their recommended usage, not with the creation of the alert (assuming its recommendations followed accepted practice)

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

#178

Post by WorldMaker » Thu, Jan 30, 2020, 9:23 PM UTC

lawn wrote: post #101

kingkawn wrote: post #87

Who’d a thought that drug dealing was so lucrative?

There's a certain irony on how the U.S. has spent billions on the war on drugs, yet they still have a gigantic drug dealing problem, right under their nose.

It's not that ironic when you realize that some of it is causal: restricting the supply of dealers makes the remaining dealers more bold (and gives them more incentive to pay lobbying costs to encourage the government to keep the supply restricted).

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

#179

Post by mywittyname » Thu, Jan 30, 2020, 9:29 PM UTC

alexandercrohde wrote: post #167

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.

Also, you can be involved in the development of such things and not really be aware of what's going on. Like, you could be the front-end developer that presents the options returned from an API, or the back-end developer that just returns options from the DB and maintains the CRUD site for people to assign treatment X for ailment Y.

The person who ended up pushing opioids as a treatment for ∀y is very likely not an engineer.

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

#180

Post by cj » Thu, Jan 30, 2020, 9:35 PM UTC

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…

Worse, I went in for a consultation prior to having my wisdom tooth removed.

I was on the fence whether to have the procedure done or not. The doctor used the fact that I would be prescribed “really good painkillers” as an incentive for me to schedule the procedure.