
Lawyers Send Mobile Ads To Phones In ER Waiting Rooms - okket
https://www.npr.org/sections/health-shots/2018/05/25/613127311/digital-ambulance-chasers-law-firms-send-ads-to-patients-phones-inside-ers
======
edwhitesell
Could be worse. I recently called my doctor for a refill on a prescription,
left a message for the nurse. Before I received a call back, I got a text
message from GoodRX with a link about the medication, following the link (I
anonymized it) took me to a page about the medication and advertising about
where I could get it for the best price.

Of course, this made no sense to me, as I deny sharing of my medical
information with anyone. So I contacted the office, went through a couple of
phone trees and spoke with a few different people. None of them could see the
issue with what happened. Then I explained a phone number is PII, and tying it
to a medication seemed like a significant HIPPA issue.

Then things changed, it took a few hours to hear the whole story where a
pharmaceutical rep had apparently told the nurses/office staff about this
great way to get prescription drug information to patents by simply entering
the medication and the patient's phone number in an App...

I’ve been told this is rectified, but the reality is I wish there was more I
could do. I can’t imagine how many patients have been affected by this and
thought nothing of it.

~~~
unclebucknasty
I feared this story would end with some version of "no one could tell me how I
received this message". So, I suppose it's heartening to hear that you were
able to resolve it, and relatively quickly.

But, I do think that's where we're headed fast: with so many interconnections,
"affiliate" side-deals, opt-out limitations, etc., we'll soon not be able to
manage the byzantine trail of entities that have access to our data in a given
scenario. Our efforts to even understand who has our data and how, let alone
control access, will be near-useless.

------
soared
1\. Geofencing is not very accurate. The range I’ve seen is ~100 yard
accuracy. This is potentially a colossal waste of ad spend for lawyers because
they get some people in the waiting room, but they also get every single
device in the building, parking, and surrounding area.

2\. They’re called device ids not phone ids. Proof right there the author
didn’t research effectively.

3\. The doctors/etc who have to abide by hiipa are explicitly requires to have
their vendors (ex marketers) follow the same laws as them. This goes for any
industry, but is written in the law for health.

Geofences are awesome for things like sports arenas, neighborhoods, malls,
etc. but ineffective for anything smaller.

Edit: For #1 here are two sources. This is coming from a vendor that only
sells location data, so their accuracy number of 93 feet is definitely not
100% truthful.

[https://www.placeiq.com/2016/05/study-smartphone-location-
on...](https://www.placeiq.com/2016/05/study-smartphone-location-only-
accurate-to-within-93-feet/)

[https://www.placeiq.com/2016/10/location-data-accuracy-
the-f...](https://www.placeiq.com/2016/10/location-data-accuracy-the-fast-
factors/)

~~~
rconti
I'm not sure I've ever been to a hospital with anything non-hospital related
within a 100 yard radius. And you can always adjust the center of your
geotargeted area to make it more effective.

In an urban setting, sure, but most hospitals I've been to are MASSIVE,
sprawling facilities.

Seems like the parking lot is close enough to being in the ER anyway.

Regardless, the 'waste' will be more from targeting health care workers,
janitors, visitors, etc, but the targeting will still be more effective than
not doing it at all.

~~~
sologoub
To expand on that, say you want to market to only people within the ER room
itself because you are an attorney for personal injury.

You will most likely get everyone who’s phone was within the overall geofence
+100yards or so (sometimes better sometimes worse, really depends on what and
how you are measuring).

That will include everyone above and below you with good enough signal to get
through. Hospitals are usually tall in urban centers, so 5-10 stories of
people?

Now you have your potential list. However, the real segment you just made are
hospital visitors + employees/vendors.

Maybe you can exclude those that you see a lot or on a regular cycle as
staff/vendors.

You are still not very close to just “personal injury” data.

Usually, you’ll need to combine this with something more to make better
segment overall and go from there.

Unfortunately, data vendors will often market the above without much cleaning
as “ER visitors” or “people with health problem X”.

There are numerous threads on HN about how bad some of these segments are -
people tagged with mutually exclusive segments, wrong info, etc. That’s why FB
and Google, and to a lesser extent for now Amazon, are sitting on some really
valuable data - we tend to tell them explicitly and/or they have fine-grained
location on us.

And let’s not forget that stuff like this has spurred responses like GDPR.

~~~
bigiain
The list doesn't need to be perfect - hell, it doesn't even need to be very
good at all. It just needs to convert better than not using the list.

(I'm equal parts horrified and impressed that someone's actually doing this...
This is why, as much as it's annoying at work, I really like the GDPR...)

~~~
sologoub
True, but then again Google/FB/etc offer better access to a more targetted
audience at a reasonable price.

I’d consider using something like this if I had already deployed marketing
capital elsewhere and hit diminishing returns. These are more akin to gambling
in my book.

Not to say that polygon-based geofencing doesn’t work. It does, but with
larger, less dense locations where the lower fidelity is good enough.

~~~
bigiain
> True, but then again Google/FB/etc offer better access to a more targetted
> audience at a reasonable price.

I'm not so sure in this specific case. If I were a (cue pejorative stereotype
for emphasis) scumbag ambulance chasing lawyer - I doubt there's anything in
Facebook or Google's ad targeting demographics that'd give me quite the same
opportunities as a rough-and-ready demographic of "people at or close to
hospital emergency departments" to try selling to...

I hope (but am prepared to be shown otherwise) than neither Facebook nor
Google have an easy way to target ads to people who've just posted "Faaark!
Just been in a car accident! #YOLO #GladIBoughtAVolvo
#ShouldntHaveBeenTexting"

(Evil-idea: I wonder if anyone's using siome combinations of accelerometer and
GPS data to detect potentially traumatic events and selling that data on?)

~~~
BMFX
Tie into insurance safe driver programs that in your car... Hell tie into the
car its self soon... With all the car brand API's coming out. I know it could
be done with Tesla, and Mercedes....

------
whoopdedo
Keep in mind that this type of correlation is baked into the system. Lawyer
hires an ad agency to get the word out. Agency does SEO on inbound clicks.
Finds that there are geographical clusters where a lot of searches originate
from. Agency responsibly increases bids on ads for devices in those places.
The agency could take the next step and identify what those places are and why
they're popular with people looking for lawyers, but what would be the point?
All they're interested in is maximizing the value of every dollar they spend
on advertising and if the data says do it that's what you do.

~~~
medecau
The book "Weapons of Math Destruction" goes into some detail on how these
models are being used to exploit people when in some cases they could be used
to help them.

[https://en.wikipedia.org/wiki/Weapons_of_Math_Destruction](https://en.wikipedia.org/wiki/Weapons_of_Math_Destruction)

------
sanbor
Here in Argentina my mother had a car accident. I received a call from the
hospital. I went to the hospital and talked with the guy that called me. He
was dressed like a nurse. He gave me the news about her accident and that her
friend died in the accident. Then he gave me his card. He was a lawer.

~~~
inteleng
That's horrifying. Did you report him to the staff?

~~~
sanbor
No. I was overwhelmed by the whole situation and public hospitals here are
kind of crazy. On the positive side they're public and if anyone (citizen or
not) needs medical aid it's free up to a certain point (they're not going to
give you a peacemaker for free but the surgery is free).

------
awat
This is the type of digestible quip that will get non-tech people to vote for
more regulation.

*I’m not advocating for this usage just illustrating a point

~~~
pavel_lishin
I don't see "more regulation" as an inherently negative thing.

~~~
craftyguy
The problem is that folks want either 'no regulation' or 'more regulation'.
Neither is the solution.

We need regulation that targets specific problems, nothing more and nothing
less. Instead we get regulation that may loosely address the problem it was
originally drafted to address, but has since grown into a mess of compromises
added at the request of lawyers, lobbyists, and uninformed politicians.

I'll start:

"You cannot send advertising to people when you suspect (e.g. by geofence)
they are suffering from a medical emergency."

~~~
TheGrumpyBrit
That doesn't seem to help anything. Wouldn't this be better:

> Personal data held by a hospital about their patients may not be used for
> any non-medical purpose, and may not be shared with any third parties unless
> directly necessary for a medical purpose.

~~~
pavel_lishin
A user's location, as reported by a phone app, isn't "personal data held by a
hospital".

------
parvenu74
Correct me if I'm wrong, but there's got to be at least one app on the
person's phone that's reporting GPS info that is feeding information to the
marketing company. Is the name of the app(s) mentioned?

~~~
massel
Usually this is done in cahoots with the carrier - you’re typically buying the
advertising from them. At least, that’s how it is here in Canada.

~~~
gruez
i doubt it. do carriers really sell advertising directly to their clients? ie.
does the company have a advertising division where you can spam SMS to their
clients within a certain radius?

~~~
massel
Actually, yes. I was pitched by ad reps from the largest carrier - they
claimed to be able to send an SMS when one of their customers enters a
geofenced area.

------
lopmotr
In America, don't victims of injury caused by other people have to sue to get
compensation for their medical bills if they're under-insured? That would mean
it's quite helpful to have lawyers offering their services right when you need
it. In my country, hospitals will pressure you into taking money from the
state accident compensation service when you're injured. So what's the
difference? Patients are being informed of the assistance that's available to
them.

It's weird that targeted advertising is so widely criticized now, but when it
was made popular by Google a couple of decades ago (we'll read your email and
offer you things that you'll like!), it was hailed as an improvement over the
blanket ads that were polluting the internet and of no use to just about
anybody. I still think targeted ads are fantastic. Advertisers are doing the
leg-work of informing people about how to buy what they want, instead of just
cars, shoes, and travel which is what we used to see.

~~~
ams6110
If it were only compensation for their medical bills that would probably be
OK. But the way it really works is that the the typical personal injury lawyer
takes 30%-50% of the award as a fee, so they are highly incentivized to
inflate the damages, often with "pain and suffering" claims that money really
doesn't compensate for and are hard to disprove.

~~~
lopmotr
Surely the solution to that is not having fewer victims sue the people
responsible? Sure, that would reduce the total pain and suffering payments,
but in an unfair way by giving it all to a few who get lawyers while the
others get nothing, not even the cost of medical bills.

------
bhartzer
If the lawyers were smart, they wouldn't use geo fencing--they'd use IP
Targeting instead. IP Targeting allows you to target an IP address that's been
matched to a physical street address. All they have to do is set up IP
Targeting and target the hospital's network. Anyone who uses the hospital wifi
would see the lawyer's ads.

~~~
eli
Which ad networks let you target by IP?

~~~
soared
Most exchanges/dsps let you target, the tougher thing is finding a good
company to match an address or pii to an ip. (liveramp does it I know)

~~~
bhartzer
El Toro is the best at matching IP with physical address.

------
canada_dry
It doesn't take much imagination to use geofencing for lots of sleezy
advertising. Like lottery, gambling and loan shark ads around pawn shops and
food banks.

Also, I imagine that televangelists who want a shiny new airplane probably
target low-income neighborhoods with their free enchanted water 'guaranteed to
bring wealth and prosperity'.

------
Johnny555
The article doesn't say where the advertisers get the geolocation data -- is
that from the data that the carrier is selling, or is it coming from some
app(s) installed on the phone?

~~~
jacquesm
> is that from the data that the carrier is selling, or is it coming from some
> app(s) installed on the phone?

Could be both, could be some website you viewed, could be google maps,
anything that shares your location. Location data is pretty valuable to
advertisers, OpenRTB supports it explicitly during the real time bidding
process.

All manner of cleaning is applied to the data to ensure that it isn't faked or
useless before the bidding starts.

------
DoreenMichele
Probably the real value here is that if you can hook them in the ER right
after something terrible happened, they will have a very hard time being
rational and walking away later. If you get to them at any other time, they
will be vastly more rational. But planting this idea in their head at this
critical time will serve to essentially make many people a captive audience
who cannot escape later when it seems they would be more able to think
rationally.

------
bawana
The first step towards AD supported healthcare. Watch ads in the ER - accrue $
towards your bill (which is silently and automatically padded to make sure
that any 'money' you make is sucked right back out). Or maybe Pfizer will buy
ad - space on the hospital guest LAN allowing more dollars to flow into the
hospital execs pockets - essentially allowing to profit over the patient's
illness and misery.

------
jacquesm
This is really adding insult to injury.

In quite a few hospitals that I've been to mobile phones are forbidden in the
ER, why is it different with these hospitals?

~~~
wjn0
Interesting, at one point it seems like there may have been technical reasons
for that [1], but not any longer. I've had to wait in hospital waiting rooms
for hours, and not being able to use a phone/laptop _at all_ would kind of
suck.

[1]: [https://health.stackexchange.com/questions/10880/are-cell-
ph...](https://health.stackexchange.com/questions/10880/are-cell-phones-still-
prohibited-from-the-er-or-other-medical-facilities-why-or)

------
s73v3r_
This is why we need GDPR worldwide.

------
dang
Url changed from [https://arstechnica.com/tech-policy/2018/05/injury-
lawyers-p...](https://arstechnica.com/tech-policy/2018/05/injury-lawyers-push-
ads-to-patients-phones-when-they-go-to-geofenced-ers/), which points to this.

------
sudouser
as intrusive as those minority report ads...

surprised and disappointed HN comments are about tech...

------
sandworm101
It isn't all about personal injury. Hospitals are where life-changing things
happen. They are where many people are born and die. People coming in and out
of hospitals, be them patients or family members, may need all sorts of legal
services, wills and estate planning being top of the list. Not every lawyer
advertising near hospitals is an ambulance-chasing leach.

~~~
stordoff
I'm not sure that makes it any better - targeting the bereaved or dying (for
wills and estate planning), whilst they are still at the hospital, feels
potentially more tasteless than targeting people for personal injury claims.

~~~
sandworm101
>> targeting the bereaved or dying (for wills and estate planning)

Or the young parents who want to add their new kid to their will? Or the very
ill person who realizes that their will/life insurance leaves everything to
their ex-wife, not their current family? Getting that changed asap will
certainly be a relief to them. Or the parents who's kid was just brought to
the hospital by the cops and need someone to talk to about it?

There are times and places where lawyers do good things, they just aren't as
sexy as the evil things.

