181–190 of 269 posts
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.
People are using their government influence to rob citizens blind for their self-enrichment. The war on drugs was used to enrich police forces and suppliers while the opioid problem was for the benefit of the pharmacy and insurance companies.
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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…
This tool was probably built by several teams of developers working somewhat isolated. Someone built a system that allows for treatments to be suggested for certain ailments, another team did the UI, another testing, then there was probably completely separate team of people in charge of determining what to suggest for as treatments. This treatment team was very likely not staffed by developers at all.
Which of these groups are responsible here? Do I need to be pushing back with every dialog option I create with data from a database? Ask my PO, "what are we going to do to ensure that nobody puts dangerous options in the db?" I'm being serious, if you're blaming the developers for this, then you should make suggestions that are appropriate for the real environment most of us work in; that is: we're often a very small cog in a very large machine with no view of the big picture.
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.
Of course. I wouldn't really ever consider engineers to be to blame - they could whistleblow of course, but the people that inked the deal and brought it to the engineers should be held responsible.
If we can't hold the tech industry responsible for this, what hope do we have holding them responsible for murkier issues like privacy/data collection?
edit: by "developers" in my parent post, I meant "the EHR company"
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>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…
As in you don't understand the need for the anti-kickback statute?
I am not hear to defend it, but I happened to be an attorney on a Qui Tam case (i.e. whistle blower case, which are some of the judgments in the US) revolving around anti-kickback and stark laws.
In short "Russian money" was being funneled into the US to set up pharmacies in Russian immigrant neighborhoods, the engaged in some real bad behavior (patients didn't pick up Rx, they would still bill medicare, then they would relabel and fill future Rx with the already paid med and get a 2nd payment for the meds...other acts included cash payments to doctors to send patients their way). They also engaged in what I felt was not "bad" behavior, they would deliver meds and give the patients a "goody bag" with things from the old country (caviar, hometown news papers, etc...). One pharmacist noticed their supervisor the acts violated the law, and he was fired in retaliation (he is the whistle blower). Before the lawsuit CVS bought the Russian backed chain for well over $100M.
I myself never thought the free goody bag was so outrageous and even think that it is good customer service, but its still unlawful. The law has nothing to do with the type of Rx, or really the Rx at all, its about the unlawful bribe/rebate.
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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 pres…
Of course my partner understand how her patients got that way and doesn't blame them. Exactly as you said. It's terrible.
This is one of the most comically evil things I've ever heard of. I bet you the person who designed this feature is on hacker news as we speak. If you are and you see this I hope you get run over by a bus today.
Even small apps have dozens of developers. I'm sure this one had many more than that. Is the problem the implementation of popup, the content, or something else? If this was a system that recommended treatments based on symptom, is the guilty party the person who wrote the query, "SELECT treatment FROM symptom_treatments WHERE symptom_id = ?" Or the person who put the result of that query onto a page? Or is it the person(s) who suggested opioid as a treatment for symptom_id 7?
I feel like you're making the problem comically simple to justify getting on your ethical high horse. Yeah, a group of people decided to pull this shit, but there's a very small chance that this decision was made by one engineer that frequents HN. Most likely it was made by senior executives who passed down bits and pieces to various teams to get the outcome they wanted.
[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 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.
- 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).
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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…
Yes and no. I'm not sure who and where sells true junk food; the usual culprit - McD, KFC - sell food that's unhealthy in the long run, but it's also cheap, tasty and quick to get, making it desirable in many different situation.
(Also, frankly, I think McDonald's may be better for you than equivalents from a "normal" restaurant. Large fast food chains are ridiculously optimized, but they have standards to meet and an individual location doesn't have the freedom to screw with it. Meanwhile in a random restaurant, I always have to worry how cheap they get with the ingredients and their process, and whether e.g. the meat I'm getting was actually grilled, or was just microwaved and then decorated with grill marks. I don't know anyone currently working on the "back end" of a typical restaurant, but from second-hand reports I keep hearing, I'm not reassured about quality.)
And "videogames" as a product category is too broad for this consideration. On one end of the spectrum you have beautiful, engaging videogames designed by passionate creators who absolutely build what they'd like to play. On the other end, you have the bottom-feeding Zynga-like garbage that's essentially gambling in disguise, designed from grounds-up to screw players over.
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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?
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".)
I might be too cynical, but I half-expect the company to have insurance to cover it.
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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.