
Looks Can Kill: The Deadly Results of Flawed Design - ivank
https://www.propublica.org/article/looks-can-kill-the-deadly-results-of-flawed-design
======
rdtsc
[http://jalopnik.com/heres-the-problem-with-jeeps-recalled-
ge...](http://jalopnik.com/heres-the-problem-with-jeeps-recalled-gear-
shifter-1782364420)

That monostable shifter is just an incredible bad idea. It is baffling why
they do it that way. Was shifting a huge problem which needed to be solved in
automotive industry? Guessing someone wanted a promotion by claiming "I
redesigned the shifter".

I understand when GMail kept changing its interface every 6 months -- it would
correspond probably with year / mid-year reviews and ever designer probably
wanted to say "I redesigned blah blah". That is just email. But this is a car
and it can easily kill people. Why couldn't they just instead add more lights
to the dashboard, or rear view cameras or something of that sort.

~~~
ggchappell
I understand your point; but we should remember that the redesign of the
shifter did not happen in isolation.

Car designers have been tinkering with controls for decades. Sometimes the
addition of new ideas can be very helpful. For example, I had a Ford Taurus
back in the late 90s. Buttons that had a "positive" effect had a convex
portion; buttons with a "negative" effect were concave. Door locks, cruise
control, etc., all worked this way. It was very easy to operate that car
without looking, or in the dark.

Now add to that the computers-do-everything reality of the modern world.
Controls that used to be directly hooked to some mechanism no longer are;
software reads the control, and software initiates the desired effect. This
means that the form of controls is no longer dictated by the mechanisms they
relate to. Designers are free to design controls that users will find easy to
use and intuitive.

And so designers have tried all kinds of things. But, alas, some of them turn
out to be bad ideas. I don't say this _excuses_ the design flaws at issue
here, but I do think it does go a long way toward _explaining_ them.

[Meanwhile, I have a another Ford Taurus. No convex/concave buttons. I have no
idea why not. :-( ]

~~~
WalterBright
A classic in aircraft design are the levers that control the flaps have a
flap-shaped knob, and the control for the nose gear has a little tire for the
knob. This is all so the pilot knows what control his hands are on without
looking at it.

But as a cockpit designer told me once, everything that seems intuitively
obvious in cockpit design was paid for with blood.

~~~
unexistance
> But as a cockpit designer told me once, everything that seems intuitively
> obvious in cockpit design was paid for with blood.

pretty sure the same is true for a lot of other things that needed
improvement, EVEN if the designer(s) knows beforehand a possible failure MIGHT
results in human injury / death.

~~~
WalterBright
I'm of the opinion that user interfaces should not be patentable, specifically
so that when people find safer interfaces everyone else can copy them and
standardize on them, rather than trying to carefully avoid them.

------
neosat
Some comments here completely miss the key point of the article and instead go
down the route of whether the shifter itself should change or not.

The blunder (and yes, it is a blunder and not only in hindsight) in the
shifter is that it provides poor feedback to the human. While changing
technology may render some types of control not necessary, and thus correctly
invite new design thinking, the fundamental human need for feedback does not
change. In fact, when something that is so habitual to you changes, that is
precisely when the design should provide even more feedback because otherwise
you are likely to miss it. This is amplified if the consequences of not
comprehending ones actions are high - which clearly was the case here.

The designers here dropped the ball. There is no way early feedback through
rigorous testing on prototypes would have not identified this issue way before
it went into production.

~~~
bambax
> _Some comments here completely miss the key point of the article and instead
> go down the route of whether the shifter itself should change or not._

Well, the point of the article is "bad design can be dangerous", but there is
another point that can be discussed which is: why change what works?

Regarding the shifter, the traditional shifter is physically connected to the
gear box; in newer cars where everything happens via software, the physical
connection no longer exists, and so designers thought there was an opportunity
to redo it.

But, just because you can doesn't mean you should.

That said, your point about necessary feedback is extremely valid; it is
believed that the crash of the Air France flight 447 in 2009 is due in no
small part to insufficient feedback (either pilot could take back control of
the plane, without the other pilot knowing they didn't have control anymore).

~~~
marvin
It was actually worse than that in the Air France case -- if the rudder inputs
from the two pilots were different, they were averaged before being applied to
the physical control surfaces.

~~~
bambax
It could work both ways: either with one pilot in control or with both.

The averaging thing was not as stupid as it sounds when values are close.

It's completely crazy when both rudders were in the opposite direction at the
maximum (average of -100,+100 = 0), but it must have seemed an impossible case
to the designers...

------
pxlpshr
I have that shifter on my Jeep Grand Cherokee. It's been recalled but I
actually love it. Maybe I'm an outlier but it's not that dissimilar from
electronic shifters in BMWs and Mercedes. My girlfriend's Mercedes acts like a
turn signal on the steering column and it's 10x more confusing to operate. I
hate it. The primary safety difference is that it auto-parks itself when the
door is opened. Chrysler's recall adds the same self-parking functionality.

I don't agree that shifters should work the way they've always worked. They
warrant a redesign because long throwing shifters eat up a bunch of precious
center console space. An area where stuff is often over-packed by the driver
or co-pilot; phones, cups, coins, paperwork, keys, wallet. Most of this
demands short-term, easy access storage.

If better safety mechanisms were considered in the Chrysler, I doubt we'd be
talking about this shifter as a failure. Nobody is criticizing Mercedes'
exceptionally poor design – unless you read car enthusiast forums – because
they added better safety processes.

~~~
douche
An automatic gearshift doesn't belong in the center console, it belongs on the
steering column. I've driven Ford trucks and SUVs too long for me to think
otherwise.

~~~
frandroid
Get off your high mechanical horse. Most cars have a center console shifter
nowadays.

~~~
douche
haha, I know, and I don't like it...

If you're going to occupy the pumpkin, at least have a real, manual gearshift.

------
Artoemius
Every time I see an issue like this, I think of this Steve Jobs quote:

"Everything around you that you call life was made up by people that were no
smarter than you."

(That is, you can count on some things having been made by idiots.)

~~~
danso
Not just idiots, but sometimes committees of idiots. And often, committees of
smart folks who unintentionally create idiotic things.

~~~
TeMPOraL
Also consider that more often than not, making something useful is _not_ a
business goal.

------
ccvannorman
This angers me as a consumer of automobiles. I _abhor_ poor automobile design
and this takes the cake. This is also why I hate

a) air conditioning and radio controls that do not have clear positions for
their status, forcing me, the person _driving a big automobile in traffic_ ,
to divert my gaze to inspect them to ensure I have the correct setting

b) Tesla's monolith faceless screen which forces me to stare at it constantly,
taking my eyes off the road when I drive one

~~~
sokoloff
On the flipside of that, my LEAF has a big button in the middle called "Auto".
Hit that, and it's usually what I want (or damn close enough) if I'm at a time
when I can't glance at them.

Front defog is the only thing that I might need to look at in any kind of a
time-sensitive fashion. In my experience, setting defog on any other car is
harder than mashing the two buttons the are on in that area (defog and rear
defog).

I agree that if I want to manually set AC compressor on/off, fan speed 0-7,
face, face/feet, feet, feet/windshield, windshield-only, that it's harder on
the LEAF. Most times, I don't want that. I want either "defog" or "I'm a
little uncomfortable; please make me more comfortable".

------
cordite
This seems to be something the medical industry hits every month with
medications and materials. The human is prone to an incorrect interpretation
of the specifics and may take action or not take action improperly because of
that.

How to identify similarly spelled medications as different? Is the dosage or
dilution magnitudes apart without visibly distinct and obvious clues?

More information about how the medical world handles these kinds of issues is
at the Institution of Safe Medical Practices [1].

[1]:
[http://www.ismp.org/Newsletters/default.asp](http://www.ismp.org/Newsletters/default.asp)

~~~
jrowley
I heard recently of a patient that took some prescribed medication before her
surgery, but instead of taking 5 mg as prescribed she ended up taking 5 grams,
which induced a near fatal stroke. You could argue that better design could
have prevented this from happening.

Edit: The mistake was between mg and ml, so the person drank 5ml of a 5X
concentration drug. Either way a terrible, preventable result.

~~~
WalterBright
There was a famous airline accident where gallons of fuel was confused with
liters. The fix (obvious in hindsight) was to standardize on gallons.

~~~
sitharus
You're thinking of the Gimli Glider,
[https://en.m.wikipedia.org/wiki/Gimli_Glider](https://en.m.wikipedia.org/wiki/Gimli_Glider)

Boeing had just transitioned their FQIS from lbs to kgs (aircraft fuel is
always weighed, volume changes with temperature). The flight crew hadn't had
enough familiarisation and miscalculated.

All aircraft now calculate fuel usage in SI units.

~~~
sokoloff
> aircraft fuel is always weighed

Jet fuel is typically planned by weight. Avgas is typically planned by volume.
In general aviation, both are typically priced and sold by volume.

> All aircraft now calculate fuel usage in SI units.

All 3 of my aircraft track/calculate fuel usage in imperial units. Likewise,
everyone I know in US general aviation also still uses imperial units (lbs,
lbs/hr, gallons, gal/hr).

~~~
kwhitefoot
I wish people would stop saying imperial when they mean US Customary!

An imperial gallon is about 4.5 litre while a US Customary gallon is about 3.8
litre.

~~~
sokoloff
Fair point. Thanks for the correction!

------
AMWJ
I find it fascinating how many chat applications exist, and how success is
almost completely due to design. Most chat features you find in newer chat
apps, like Kik or Whatsapp existed since AIM. Yet users are very willing to
jump ship and grab onto an application with the same, perhaps fewer, feature
if it's more eye-catching, or intuitive. It's a nice reminder that part of
innovation in the tech industry is UI, and if you innovate a new interface for
an existing service, it can be as ground-breaking as any other innovation in
the industry.

~~~
digi_owl
No, i think the jump was technical.

AIM and similar gen IM protocols expected that you were using a desktop or
laptop with a persistent connection. This would break on iPhone because Apple
didn't allow backgrounding.

Kik and similar took over once Apple introduced their push notification
service. This allowed apps to behave closer to text messaging.

------
csours
Does anyone know how NASA modified presentations after the report mentioned in
the article? Only show one single piece of data per safety slide? Mandate
large fonts and color coding on safety slides?

~~~
unexistance
not exactly slide-related

[https://news.ycombinator.com/item?id=11719953](https://news.ycombinator.com/item?id=11719953)

~~~
csours
Excellent reference, thanks.

------
post_break
There is an antifreeze sold in a green pop top can that looks similar to beer.
I wish I could find the photo of it.

~~~
homero
[https://i.redd.it/igpx1sl1ex9x.jpg](https://i.redd.it/igpx1sl1ex9x.jpg)

~~~
TheSpiceIsLife
Is it legal to sell that in the U.S.? It wouldn't be allowed on the shelf in
Australia.

------
WalterBright
The design of pilot controls in aircraft has a great deal of effort going into
making them intuitive, and still serious mistakes are made. It's a very hard
problem, and what's obvious in hindsight escapes nearly everyone in foresight.

------
joebergeron
Wow. I think what baffled me the most is this:
[http://i.imgur.com/AUW0C1P.jpg](http://i.imgur.com/AUW0C1P.jpg)

It just doesn't make sense for -so many- reasons. Besides the obvious that the
cleaner literally looks identical to a neon-colored children's drink, why
would anyone possibly decide to put them on the same aisle? The cleaner even
has similar pricing to the beverages.

Some stupidity I can understand, but this? How does this possibly get past
anyone in the chain of command? Feel like this requires a dedicated, concerted
effort in avoiding any thought whatsoever to occur.

------
ensiferum
If this was open source software the answers would be "Don't use if it you
don't like it" or "It's open, why don't you fix it yourself?"

------
CoconutPilot
Another horrible shifter is Toyota's. Take a look here:
[http://imgur.com/a/9ShAC](http://imgur.com/a/9ShAC)

First gear is all the way down and to the right. Then left for 2nd, up and
left for 3rd, up for 4th, right (!!!) for 5th (aka drive). Now it gets
dangerous, if you go up and right you get reverse.

Is there a method to this madness?

~~~
et-al
Visually, it may seem confusing, but tactilely, it's intuitive:

Move your hand from the bottom-left corner to the top-right. That diagonal
motion is shifting from D-N-R-P, what most people will use.

Now pretend you're driving in the mountains and you're on a long descent.
Instead of riding your brakes, you want to use the transmission to limit your
speed.

You're in 4th gear (D), so just bump your lever down to third (3). It's a
simple vertical motion. Now you're in 3rd gear, but forgot and think you're
still in 4th (D), and attempt to downshift once more. Fortunately, you _won
't_ accidentally drop the car into second gear. To get into second gear, you
need a downward _and_ horizontal motion. It requires intention to move from
3rd to 2nd gear.

And once you're in the rarely used 2nd gear, to switch between second (2) and
first (L) is a horizontal motion.

So it makes sense once a person feels it out and actually _drives_ their car.
Designers with a background limited to just visual aesthetics need to learn
this. Run through your interfaces; interact with them under less-than-ideal
conditions.

    
    
      **tl;dr**
    
      P-R-N-D: diagonal motion
    
      D-3: vertical motion
    
      2-L: horizontal motion

~~~
CoconutPilot
You've somewhat proven how poor this shifter design is because you didn't
realize it is for a 5 speed transmission!

~~~
et-al
You're right, but I've only looked at it and run the design through my head.

If I were sitting in a car, I would would know that 4-D is basically shifting
between fourth and overdrive. And if someone accidentally did shift from
overdrive down to fourth, it won't kill the car in most circumstances. It's
better than the old O/D button that asks your thumb to press it.

Ultimately, my proposal that this shift pattern groups gears by use-cases
still holds true. D-4, 4-3, 2-L. If a person can't understand that, it's
perfectly fine to leave it in D.

~~~
CoconutPilot
Consider this scenario: you're shifting up from 1st gear and forget what gear
you're in. If you're in 3rd gear its safe to shift up and to the right. If
you're in 5th gear its not safe, up and to the right is reverse!

I don't agree with your analysis. Toyota's shifter is unsafe.

~~~
et-al
First off, please explain to me the scenario where you're drag racing someone
and limiting your upshifts in an automatic transmission car. Okay, so you're
in 5th gear (D), which happens to be overdrive. If you know what overdrive is,
then you'd know that the possibility of redlining in that gear is next to
none.

Lastly, with any automatic-transmission car made in the past 20 years, they
won't let you shift into reverse from drive.

See:

[https://www.quora.com/What-will-happen-if-a-person-
suddenly-...](https://www.quora.com/What-will-happen-if-a-person-suddenly-
shifts-from-Drive-to-Reverse-or-Park-while-driving-at-a-fast-speed)

Shift Transmission into Reverse While Driving
([https://youtu.be/GR13mElbqxM](https://youtu.be/GR13mElbqxM))

Anyways, you don't have to agree with my analysis. AFAIK, Toyota hasn't had a
recall for this shift pattern.

------
xlayn
Bad UI can happen to everyone and for a lot of reasons: I think the minimalism
thing can get to stupid levels, the music controls on the ipad mini has the
controls so cramped that I get a friend to prove than less than 50 percent of
the time I can move the sound without pressing the rewind arrow.

------
catpolice
Speaking of bad design, on mobile the text on that page slightly flows off the
right edge in a way that interferes with reading and can't be fixed by
zooming.

------
cel1ne
Must-read in this category: "The design of everyday things" by Don Norman.

