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

#241

Post by logfromblammo » Fri, Jan 31, 2020, 4:12 PM UTC

the_decider wrote: post #213

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…

Those engineers that drafted gas-chamber blueprints had kids to feed too. You’re no better than they are.

Not going to argue. That's absolutely correct.

And let me tell you, it's really great for the self-esteem, too.

As long as people keep giving tax cuts to the rich and undermining labor law, it's only going to get worse. Kids are still in cages. Presidents are still corrupt. And I'm too much a coward to withdraw my support of the system for your benefit, just because I don't want my family to be insecure about food and shelter again. I don't want to move yet another 1100 miles for work. I want to feel like I matter, but I really don't.

If you feel like you have the choice to not do what I do, then you also have the power to help me have the same choice. Will you use it?

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

#242

Post by Ididntdothis » Fri, Jan 31, 2020, 4:41 PM UTC

slumdev wrote: post #235

Ididntdothis wrote: post #148

Earlier quoted context omitted.

Sure people do.

I think it's a matter of having the right tool for the job. If someone wanted to write a modern website in C++, I'd probably gripe about that. But Java, with either J2EE or Spring? No complaints here. VB just isn't appropriate anywhere anymore.

Every app has to start somewhere and will after a while be outdated. Whatever problems EPIC has are most likely not because of VB but because of bad management. I work in medical and I see almost every day management decisions that will lead to future software problems but nobody in leadership understands or wants to understand. Have a problem? Just throw the cheapest offshore team you can find at it. Repeat that a few times and you have a completely incoherent architecture. You will get this result with any stack.

I certain wouldn’t advocate using VB for new code. All I am saying is that the real problem is not the stack.

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

#243

Post by kube-system » Fri, Jan 31, 2020, 5:00 PM UTC

r_singh wrote: post #231

kube-system wrote: post #141

Earlier quoted context omitted.

Those 'just in case' scripts are usually combined medications that are short enough in duration that they don't pose much risk of dependency.

It’s a crafty way to pass on the responsibility of making the choice to the obviously oblivious “client”.

There's no accurate alternative. Different people often experience different pain responses to the same condition/procedure.

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

#244

Post by sonotathrowaway » Fri, Jan 31, 2020, 5:15 PM UTC

sneak wrote: post #240

ohithereyou wrote: post #140

Earlier quoted context omitted.

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.

Nobody forced anyone to put those drugs into their body.

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.

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

#245

Post by somurzakov » Fri, Jan 31, 2020, 6:04 PM UTC

nradov wrote: post #221

somurzakov wrote: post #125

Earlier quoted context omitted.

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

Thanks but I'm already familiar with the potential complications. The reality is that many people have become addicted following dental procedures. https://med.stanford.edu/news/all-news/2018/12/opioid-prescr...

if teenagers wanna get wasted, they will find plenty of junk on the streets. That's why kids should have parental oversight. You may fill the prescription with opioids - but you dont have to use them. I went to dentist couple times, and filled the opioid prescription once just in case, but never used them.

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

#246

Post by mlazos » Fri, Jan 31, 2020, 8:00 PM UTC

sneak wrote: post #239

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.

I don’t think that’s an accurate statement, and is a misattribution of responsibility. The responsibility ultimately rests with the person who puts the drug in their own body. You can make an argument that their physician is in a position of trust, and that some responsibility lies with their prescribing it. Extending it out to the workers of the vendor is as silly as extending it out to the workers of the keyboard v…

It’s definitely not like extending it to the keyboard manufacturer, that’s the reddest of red herrings. They intentionally signed off on a feature that encourages a physician (in a position of trust) to prescribe opioids. The keyboard or tools to build the software had absolutely nothing to do with this unethical decision. It was a ux design decision which they all certainly knew what its intention was (or they were incompetent af).

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

#247

Post by sneak » Fri, Jan 31, 2020, 8:24 PM UTC

mlazos wrote: post #246

sneak wrote: post #239

Earlier quoted context omitted.

I don’t think that’s an accurate statement, and is a misattribution of responsibility. The responsibility ultimately rests with the person who puts the drug in their own body. You can make an argument that their physician is in a position of trust, and that some responsibility lies with their prescribing it. Extending it out to the workers of the vendor is as silly as extending it out to the workers of the keyboard v…

It’s definitely not like extending it to the keyboard manufacturer, that’s the reddest of red herrings. They intentionally signed off on a feature that encourages a physician (in a position of trust) to prescribe opioids. The keyboard or tools to build the software had absolutely nothing to do with this unethical decision. It was a ux design decision which they all certainly knew what its intention was (or they were…

The software can’t write prescriptions.

The software can not force people to ingest pills.

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

#248

Post by mlazos » Fri, Jan 31, 2020, 8:39 PM UTC

sneak wrote: post #247

mlazos wrote: post #246

Earlier quoted context omitted.

It’s definitely not like extending it to the keyboard manufacturer, that’s the reddest of red herrings. They intentionally signed off on a feature that encourages a physician (in a position of trust) to prescribe opioids. The keyboard or tools to build the software had absolutely nothing to do with this unethical decision. It was a ux design decision which they all certainly knew what its intention was (or they were…

The software can’t write prescriptions. The software can not force people to ingest pills.

Your argument rationalizes literally every dark pattern in ux that has ever existed. No of course there isn't a gun to anyone's head here. That's not the point that anyone is arguing. The point is that it encourages someone in a position of trust to act against a patient's interest. They at least share blame with the physician. I'd say most of the blame, because if this feature didn't exist, the physician wouldn't act against the patient's self interest. The world isn't black and white, it's why manslaughter exists as a crime and why we don't just have murder.

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

#249

Post by sneak » Fri, Jan 31, 2020, 8:49 PM UTC

mlazos wrote: post #248

sneak wrote: post #247

Earlier quoted context omitted.

The software can’t write prescriptions. The software can not force people to ingest pills.

Your argument rationalizes literally every dark pattern in ux that has ever existed. No of course there isn't a gun to anyone's head here. That's not the point that anyone is arguing. The point is that it encourages someone in a position of trust to act against a patient's interest. They at least share blame with the physician. I'd say most of the blame, because if this feature didn't exist, the physician wouldn't ac…

Nobody is forced to write such software, either. Assigning responsibility for actions with clear boundaries does not “rationalize” anything.

It is important to remember that humans, regardless of their level of ignorance, are responsible for themselves and their own actions.

Encouraging people to make bad decisions isn’t the issue at all, even if the final result would not have happened without such encouragement.

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

#250

Post by pintxo » Fri, Jan 31, 2020, 9:43 PM UTC

kangaroozach wrote: post #229

pintxo wrote: post #11

Earlier quoted context omitted.

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.”

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.

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.