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Comment by abdullahkhalids | Hacker News Reader

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 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.

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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.

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

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

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.

As software continues to become a structural part of society that becomes more and more evident.

Civil engineers cracked the problem mostly by been able to say know and know that they had top-cover.

...but then programmers wouldn't be able to assert innocence and powerlessness. They might have to make decisions that would limit their income or result in consequences.

True but it’s a lot easier to say no as a civil engineer with both legal and professional bodies backing you than currently.

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.

>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)

>Even still it's not clear why that's an issue.

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.

This is called Clinical Decision Support and there are many good implementations of it; the probably comes when you use a CDS framework to implement non-clinical decisions, e.g. to promote opioid prescriptions via a kickback deal as Practice Fusion did.

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...

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