Health-records software pushed opioids to doctors in secret deal with drugmaker
bloomberg.com
bloomberg.com
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 software company called Practice Fusion, was paid by a major opioid manufacturer to design it in an effort to boost prescriptions for addictive pain pills ...
Its existence was revealed this week thanks to a government investigation.
Holy shit
> 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.”
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.
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.
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 conveniently neglects to describe the benefits of older, still-useful drugs because they don't make any money.) The innovation of the 80s was the legalization of prescription drug advertising, which effected an additional pressure source for doctors to prescribe certain drugs: Their patients.
Now this happens where the software doctors are forced to use puts even more pressure on doctors. People talk about the evils of big pharma all the time, but most have no idea how great the evil really is.
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...
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.
This is a dark pattern. Pharmaceutical companies already have undue influence over what doctors prescribe. Embedding ads within a records system risks biasing both diagnosis and prescription.
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 is not in what order the options are presented, or what the default is. It is a problem that the treatment plan it creates was not created by the patient's primary doctor, but this is not the biggest problem. The problem is that a pop-up appears, forcing doctors to choose 230 million times between opioids or no opioids.
The very existence of the pop-up is the problem.
Civil engineers cracked the problem mostly by been able to say know and know that they had top-cover.
It’s a trade off and it wasn’t something that happened over night it took centuries of disasters for civil engineering to become the way it is, software outside of academia is a minnow by comparison.
We may get there but it’ll take a successive series of software disasters to get to it sadly.
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.
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)
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.
To see the list of CQMs that ONC certification requires (which are often used as inputs to CDS systems) you can look here: https://ecqi.healthit.gov/system/files/EP-EC-MeasuresTable-2...
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?
I might be too cynical, but I half-expect the company to have insurance to cover it.
If a builder builds a house for someone, and does not construct it properly, and the house which he built falls in and kills its owner, then that builder shall be put to death.
Time to get software engineer's family members hooked on opioids!
His crime was essentially using investors funds improperly, all ended paid back in full, many made decent profits.
I think history will judge him a lot less harshly than the current media cycle did.
Big pharma do this stuff for breakfast weekly and no one says a word nor been thrown in jail for years for it.
I think you'll find the likelihood of going to jail for any crime is inversely proportional to the amount of money the accused has in the bank.
This went down a chain of people. CEO. VP. PM. Tech Lead. Developer.
All of them made a choice to kill people for profit.
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.
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 who sell unhealthy food? People who make tech/video games that result in less physical activity?
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.)
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.
Now, the C levels probably aren't the same, but they are the same in that they aren't the same across industries.
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 vendor.
The software can not force people to ingest pills.
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.
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.
Of course my partner understand how her patients got that way and doesn't blame them. Exactly as you said. It's terrible.
I honestly feel the US healthcare system is a complete joke. I am losing respect for doctors because they are a part of it.
This is a bit off topic, but I recently changed my health plan. I was on a state plan before. I asked the insurance rep what happens when I go to the ER on a state plan in another state. She said, "well if its in an emergency you are fine, but if its not then you will be responsible for 60%" or something crazy. How the hell can I decide what is an emergency? I am not a medical professional. It is complete bullshit to put that on a individual but this is what they want. The insurance company will blame you and say it was not emergency to save money.
Prices should be ‘regulated’ by REAL price transparency and consumer choice! The prices will self regulate based on the market.
AND insurance can be privately bought to protect against the chance that you get stuck with something expensive. Just like insurance against your house burning, car crashing, or dealer getting a blackjack.
The idea that regulating the price through government will lead to more efficient system with lower costs and better outcomes is a fallacy. Even NASA is being outdone by private space exploration. Government regulation simply can not compete with a truly free market where consumers have access to information, prices, and can make decisions for themselves.
CHOICE is what is required to optimize the solution. Regulation is mostly a fallacy. Regulation is required for certain protections, but not a reliable means to get the system to deliver the optimal outcomes and the lowest costs.
- 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).
It should be noted also, that prostitution is legal in Germany.
First line... "I dig: socially responsible company-building"
“Employees estimated internally that the drug company could add almost 3,000 patients and bolster opioid sales by as much as $11.3 million through the partnership. Under the contract, the drugmaker paid Practice Fusion almost $1 million”
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.
Their sole purpose is to increase sales of their pain medication. The best way to do that is to advertise your drug to people who can push them, and even better if you can wear them down into making shitty decisions that involve them buying your drug.
The free market can't fix this problem because it's hidden (intentionally) and because what the company wants is not what the user wants. The only recourse is legislation.
How about employers choosing from a set of health insurance plans you can choose from? That’s a misalignment no?
If I could get a coupon to buy my own insurance I may choose something better for me from an entire marketplace of plans. Instead I get stuck with the calculated decisions of people I don’t know trying to optimize their own profits while satisfying a set of people with very different needs and risk profiles than myself.
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...
The person who ended up pushing opioids as a treatment for ∀y is very likely not an engineer.
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"
I thought we have some of the most expensive doctors in the world, why can’t we get paid ehr software? The ceo responsible for this mess is Tom Langan. Why we are not able to put him in jail for a year is still a mystery. This is pure evil.
One should be increasingly wary of using free software for crucial applications and sensitive data. Being HIPAA compliant isn't enough.
There's a regulatory body called POC3 (https://www.poc3.org) for communication device (and software) providers who make money from pharmaceutical ads to lay down ethical guidelines. Hopefully a body like this should be formed for partnerships between pharmaceutical companies and EHR (& similar) software products too.
IMO the medical industry could use more free as in freedom software, and that may be an alternative way to prevent things like this.
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 about myself. I am in no way a saint, I don't claim to know what I would've done in the same situation but I think it's for the benefit of software development to acknowledge that we do make ethical decisions when we build things and that the solution to something as complicated and diverse as ethics is not to just ignore it.
It would be one thing of some product manager came to them and said, "since a large opioid manufacturer has paid us a lot of money, we're going to implement this feature in order to increase unnecessary opioid prescriptions" but I would be surprised if that happened. "We're going to implement this feature to help doctors pick the right treatment for a patient's pain."
Someone here is evil and deserves what's coming, but I don't know that it necessarily would have been readily obvious to those implementing it. In fact, it would likely have been preferable to conceal the true nature of it lest any of them have any moral qualms or objections.
I'm not trying to negate your question, either. I think it's a good question to ask and consider.
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 for another thread.
This could very easily have been presented and sold to a team in a way that does not make it immediately seem like something evil.
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.
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!
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.
Now we know that was a terrible idea with devastating consequences. But we didn't know better and truly thought we were doing right by our patients. It's hard to imagine a programmer without medical training could be blamed.
Though, I think we agree that you cannot make an ethical decision on which action you should take unless you have any idea of what the consequences of your actions will be.
The CDC itself stated in April of 2019:
"CDC Advises Against Misapplication of the Guideline for Prescribing Opioids for Chronic Pain Some policies, practices attributed to the Guideline are inconsistent with its recommendations"
Sadly the medical community is not getting that message due to this mater now becoming political.
https://www.cdc.gov/media/releases/2019/s0424-advises-misapp...
Providers are under the microscope for opioids now, so why risk it, it's not their pain. Medicine is a rough field.
Dr Mark Ibsen is one of the five stories. He lost everything for helping those with Chronic Pain. Five of his patients killed themselves when he was no longer able to prescribe. The medical board said he was over prescribing, that blood is on the boards hands. The arbitrator/judge in the case said that Mark did not do anything wrong, yet The System destroyed him.
Yes it is a rough field. I see it every single day in advocating for those that the Medical Establishment has forsaken.
There are bad doctors, there are bad people writing medical software as this thread explains. They need dealt with.
Practice Fusion knew that at the time. Internal emails released as part of the legal process make it clear that this feature was designed to get previously "opioid naive" patient (people not previously prescribed opioids) hooked on extended release opioids. This was specifically done to address the falling rates of ERO prescriptions, which the pharma company described as being due to "political reasons".
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.
The software developers are not protected by the "standard of care" shield. The software developers, like just about every other profession are held to a higher standard than MDs, namely "ordinary care" or "reasonable care".
Is a software company taking reasonable care to avoid harm when it builds a software feature that secretly encourages doctors to issue dangerous prescriptions? I don't know -- doesn't sound like it to me. Though there are probably a few plaintiff's attorneys willing to find out how a jury thinks about it.
It's probably also not great for patients with rare diseases, that physicians are penalized for trying to solve problems no physician has solved before.
I'm not sure the fine is "small" though (not that any fine could be sufficient), Practice Fusion was acquired last year for "only" $100M.
Another doctor gave my wife an opioid painkiller prescription upon hospital discharge after a normal childbirth, just in case she needed it. Also never filled or used.
In the past few years doctors and pharmacists have become more aware of the risks and now write fewer opioid prescriptions. But for a while it was totally out of control. (I don't think either doctor was using Practice Fusion.)
And avoid scheduling anything right before your surgeon takes time off (weekends, vacation).
https://med.stanford.edu/news/all-news/2018/12/opioid-prescr...
https://med.stanford.edu/news/all-news/2018/12/opioid-prescr...
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.
The necessity is a result of big pharma lobbying activity, there is generally no medical necessity for opioids.
Big pharma money ensures things like marijuana remain a class 1 narcotic at the federal level meaning there is no known medical uses of the "drug." This allows pharma regulatory capture for their opiates which makes doctors, pharma, pharmacies and insurance money, so it simply becomes the norm to prescribe patients these highly addictive and euphoria inducing painkillers. So long as the patient remains insured, can pay and claims they are in pain, the Doctor will give them their drugs.
One astonishing fact is nearly 90 of the top 100 opioid prescribing doctors are in Florida, and 85% of all oxycodone a highly addictive variety of opioid therapy is prescribed in Florida.
I don't think something like a short-term prescription for low dose codeine/acetaminophen cough syrup is really a big deal. Stuff like that can even be over the counter in a lot of developed countries.
https://www.oecd.org/health/health-systems/opioids.htm
It's not an American problem, its a "First World" problem.
It doesn’t stop everyone. But for those it doesn’t, they risk succumbing to the paracetamol or ibuprofen before the codeine.
They could separate them, but I don’t think it’s common.
Also, poppies are stupid easy to grow, but nobody seems to bother recreationally, suggesting that ease of access was never a root cause.
Spoiler alert: "Pharma Co. X" is Purdue. Shocking! /s
Practice fusion is an industry leader precisely because it makes delivering care compliant and cheap for doctors.
In any case, the user of EMR's are providers, not patients.
All EMR's suck though. (note: I made one)
We shouldn’t feed the illusion that old stacks are inherently bad and that new stacks will magically solve all problems.
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.
I certain wouldn’t advocate using VB for new code. All I am saying is that the real problem is not the stack.
All EMRs suck though.
The backend is most certainly not in anything close to Visual Basic.. (MUMPS - using Intersystems Cache as the object store implementation)
All of the good things I could tell you that I remember about Epic have zero relationship with the software they sell. And none of them could stop me from leaving, because the software was the job. It was all essentially gold spray paint on a turd.
If you want the ability to support some very unique functionality, they will find a way to help support it. In a business that is almost nothing but edge cases (almost all of healthcare is complex, which is why you need 8+ years of training), you need lots of custom software behavior to fit these needs. The UCSF switch from GE healthcare to Epic about a decade ago is the prime example of what value Epic. [1, 2].
[1]. https://www.wired.com/2015/03/how-technology-led-a-hospital-... [2]. https://www.forbes.com/sites/zinamoukheiber/2012/04/18/epic-...
Also, my previous comment was in response to no one liking Epic though, so certainly on topic.
[1]. https://health.ucsd.edu/news/releases/Pages/2015-05-06-uc-sa...
[2]. https://ucsdhn.org/providers/physician-network/advantages/te...
A doctor can't open up an office and tend to patients with pen and paper anymore, and they have to pay thousands of dollars a month to systems that are truly terrible to be compliant.
Which doctor is going to read 300 pages of documentation for one if his 16 30-minute appointments a day?
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.
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.
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.
You can build an ehr with google docs if it were legal. But it isn't.
When I worked in a small practice that had converted from paper to electronic records, we didn’t even bother scanning in all the legacy paper records. They just sat in the doctor’s basement at home until the required 7 years passed until they could be destroyed. I’m not sure what would happen if that same doctor had to switch EHRs. I would guess they’d just leave the records on the old system and keep paying for both.
34k/year. Yeah, that's a lot.
https://news.ycombinator.com/item?id=22165946&ref=hvper.com&...
Color me surprised that it's probably Purdue. Every asset that the Sackler family owns should be seized.
Perhaps we as an industry should just refuse to participate when the company clearly prioritizes profits over doing the right thing, or in this case killing patients.
[0a] Mint in June 2010: https://web.archive.org/web/20100628142953/http://www.mint.c...
[0b] PracticeFusion in Feb 2010 (though rendering required Flash at the time): https://web.archive.org/web/20100228002944/http://www.practi...
Executive team: https://web.archive.org/web/20131108114711/http://www.practi...
Board of directors: https://web.archive.org/web/20131022222205/http://www.practi...
They've removed all this information from their website.
I wonder how these people can sleep at night knowing what kind of crimes against innocent people they've (allegedly) committed.
Time for the software industry to wake up and realize it's not the advertising industry.
Seen that way, it's absolutely criminal for software to allow the highest bidder to inject arbitrary bias into this infrastructure. On the other hand, it's absolutely foolish for organizations, which in the paper days hand-grew their infrastructure, to not closely scrutinize the nervous system/potential-trojan-horse that they're taking off the shelf and installing right into their core.
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.
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 before realizing that they are working for the baddies, and also deciding to either quit or die a little inside.
I would do that job. I would take that money. I don't get a stupidly-inflated Valley salary with bonus RSUs, and I have bills to pay. I don't have a union that can protect me from nonsense. I know it's wrong. I would do it anyway, because I have been screwed by every company I have ever worked for, such that I learned that my ethics don't matter. Money matters.
I want my kids to get an education without student loans, if they want it. I want to drive a car that isn't older than they are. And I want to retire before I die. My ethics would only keep me from that. Apparently, the companies that aren't managed by money-grubbing sociopaths just don't hire where I live. So if you don't want stuff like this to happen, make it actually mean something to have ethical objections, even for people working outside of California.
I build software that has probably contributed in a material way to human suffering. For far less money than a Silicon Valley developer might get paid to make a mobile app for on-demand dog-walking. Everyone in my building does it. Everyone in the building across the street does it. Companies that don't hurt people as part of their business model aren't hiring here. People that have a problem with it--or at least those who can't hide that they do--don't get the jobs.
So if you are currently on a high horse, I hope you enjoy the view from up there. You haven't yet used your influence to help other workers--those with nigh-nonexistent power as an individual to influence the corporate employers that reluctantly hire them, and then reserve the right to fire at any time for any reason, or no reason.
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 to think you're the only one who sees it as shady.
You've identified a perverse incentive that requires punitive counter-incentive in response. Someone in your position will think twice about doing that job if by doing so, their freedom and ability to take care of their kids is put in jeopardy.
Of course, there needs to be punitive incentives at the top so that such that low-level employees are not pushed to act in ways that lead to results such as these.
As long as "at will" employment exists, then no contract terms exist, and no labor law can stick to the employer, so long as they are willing to lie whenever there is no contradictory evidence. If the employee gets fired for asserting their rights in the law, and the employer can say it was an "at will" termination, the employee has no effective recourse or remedy.
If you criminalize the work that I do, you are just getting me fired for no HR-disclosable reason (again), and the company will have that work done in another jurisdiction.
If you aren't putting c-level executives and/or board members in prison, and forcibly restructuring or dissolving corporations, you aren't doing anything to protect me, the worker. And if you are placing legal liability on me, personally, I definitely will not testify against my superiors. I know the feces roll downhill.
I was about to be incredulous, but I actually do believe that you would rather have me fired and put in prison, and my dependents thrown in the gutter, than to have a software workers' union or stronger federal labor laws that might possibly protect me from an arbitrary dismissal if I tell my boss "What you are asking me to do is unethical." Thanks for that.
> If you aren't putting c-level executives and/or board members in prison, and forcibly restructuring or dissolving corporations, you aren't doing anything to protect me, the worker.
Agreed.
> I was about to be incredulous, but I actually do believe that you would rather have me fired and put in prison, and my dependents thrown in the gutter, than to have a software workers' union or stronger federal labor laws that might possibly protect me from an arbitrary dismissal if I tell my boss "What you are asking me to do is unethical." Thanks for that.
On the contrary, I am in favor of unionization and stronger labor laws in IT.
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.
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?
Before anyone complains about burdensome regulations, these are the situations were respecting people's information prevents deaths an family tragedy.
You're not the customer...
What makes this instance so pernicious is that it was involved in what is now a national crisis, but it's not very different to what a flu vaccination manufacturer could do, and which would raise no eyebrows in the eyes of the public or the government.
Medicine is one of those fields where the discrepancy of what patients think it is and what it actually is is wide enough to cause outrage at every single thing.
I don't doubt that—but I also have a lot of trouble believing that the people who designed this tool didn't know exactly what they were incentivizing. A UI designed with the user's interests in mind simply would not have come out this way.
The degree to which we've normalized the creation of dark patterns is scary.
I think a quadrant based graph makes this more apparent and can influence public policy
Maybe a z-axis for margins
Can we totally kill that excuse for their monopoly?
We trusted the physician cartel for decades and they have made healthcare worse.
But the advantages are a microcosm of horror, too, like the ability to keep animals clamped in extremely constricted, filthy, stress inducing environments without the flesh literally rotting off their bones, while feeding them a diet (corn for cattle?!) which gives them ulcers.
My late wife's Journal was part of the 2015 FDA hearing about getting these restricted from doctors giving them out like candy. Alas all we got was yet more "Black Box" warnings that you and the doctors never see.
Karen ultimately killed herself from the Chronic Pain cause by the Levaquin and Cerebrospinal Leaks (CSF Leaks). Her saga is one of the five stories in the upcoming documentary Pain Warriors being released to distribution this spring.
I'm now up to 44 people that have told me that their own CSF Leak started after taking Levaquin, Cipro etc. Something that there is ZERO medical research on. The Leak doctors are aware of this as I spoke about it at their first ever CSF Leak conference.
Someone here will inevitably say "I took Cipro et.al just fine". Many people do take it may times until they have a reaction or they don't associate their new health problems with the delayed reaction months later.
Antibiotics in general are a good thing, however we must never assume they are safe in and of themselves without consequences.
I do think that even though there are dangerous drugs, there are costs to making the use more expensive or harder to get. All drugs have side effects and some are truly devastating and the best way to handle that risk/reward tolerance is talking to a provider and managing it. The same way some drugs create dependence, the lack of them also cause enormous pain, and their increased price also create inaccessibility.
There is definitely a rampant culture of consuming pharmacological products in the US: maybe there are things that are causing the US society to be so dependent on drugs that can be addressed.
The FDA itself says these should not be used until all other possibilities have been exhausted. Sadly the doctors are not getting the message and are giving them out like candy.
A lot of my childhood was spent in hospitals, and I've had a variety of antibiotics over the years. And anesthetics, I've become quite the connoisseur. I'm not allergic to anything, I've never had a reaction of any kind to any drug. Not even allergic to any foods. Bring on the shrimp and peanuts!
I was recently given Cipro. My entire back broke out in a rash. Not a devastating side effect, but after a lifetime of a variety of drugs of all sorts without any but the desired effect, it sure made me go "WTF? You sure this shit's safe?"
No, they are not safe.
I doubt the story of how that happened, the corruption and stupidity that enabled it, will ever make it out of the land of "conspiracy theorist ravings" ... but it should.