
Health-records software pushed opioids to doctors in secret deal with drugmaker - braythwayt
https://www.bloomberg.com/news/articles/2020-01-29/health-records-company-pushed-opioids-to-doctors-in-secret-deal
======
codeulike
_[when opening a patients records] a pop-up would appear, asking about a
patient’s level of pain. Then, a drop-down menu would list treatments ranging
from a referral to a pain specialist to a prescription for an opioid
painkiller.

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

~~~
mtgx
People are going to go to prison for this, right?

Or has all white crime been made legal in America? Because I can't tell
anymore.

~~~
ska

      Or has all white crime been made legal in America?
    

Can you think of a time when it was significantly more likely for something
like this to end up with execs in jail?

~~~
ohithereyou
I can think of a time about 125 years ago that it was significantly more
likely that execs of the company would end up with a bullet in their head or
their loved ones kidnapped and ransomed for such shenanigans. (Note; This is
obviously bad and I'm not advocating for it, but it's more than just "no jail
time and you have to sell your third and fourth house to pay the fine".)

~~~
TeMPOraL
> _" no jail time and you have to sell your third and fourth house to pay the
> fine"_

I might be too cynical, but I half-expect the company to have _insurance_ to
cover it.

~~~
ohithereyou
Most insurance policies exclude willful criminal acts perpetrated by the
policy owner.

------
dfsegoat
A murder trial for an MD who was over-prescribing opioids just started in my
city [1].

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...](https://www.pressdemocrat.com/news/10643995-181/murder-trial-
against-santa-rosa)

~~~
alexandercrohde
I think punishing the engineer would be much less practical than the CEO.
There will always be an engineer (perhaps a remote contractor) who will build
this.

~~~
dfsegoat
> _I think punishing the engineer would be much less practical than the CEO._

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"

~~~
batiudrami
A fundamental part of engineering accreditation in most countries is ethics
and enforcing the fact that you are to blame for the things you build and you
are obligated to raise objection.

------
rayhendricks
“ The San Francisco-based company was founded in 2005 and became known for its
unique model of providing free, ad-supported health-records software to
independent doctors.”

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.

------
r_singh
In retrospect doesn't seem like a very big surprise that they would resort to
something like this as Practice Fusion was initially launched as free for a
long time, and costed only $99 per month later.

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](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.

~~~
swiley
I think you mean free as in free beer and software as in software services.

IMO the medical industry could use more free as in freedom software, and that
may be an alternative way to prevent things like this.

~~~
skwb
The healthcare industry is VERY conservative. Even the thought of moving EHR
hosting to the cloud was a huge effort. Things in this industry are simply
done at a different pace. Even digitization of medical records required
millions of dollars in federal incentives (the carrot), and even more money at
stake for not adopting (the stick).

------
pimmen
I think this creates an interesting discussion on the part of the designers
and programmers. Did they understand that what they were building was going to
increase opioid dependence? Did they ask about it?

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.

~~~
idiot900
I'm a doctor. During medical school and residency, I was taught in good faith
that "only as much as necessary" opioid was OK to give and wouldn't create
dependence - it was only an "excess" of opioid that would cause a problem. So
under the banner of reducing the suffering of our patients, and a mandate to
reduce patient-reported pain scores, opioids flowed relatively freely.

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.

~~~
bpaddock
The problem is things have gone to far the other way now. Those with Chronic
Pain are now committing suicide (as did my wife) when they are let to suffer.

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...](https://www.cdc.gov/media/releases/2019/s0424-advises-
misapplication-guideline-prescribing-opioids.html)

~~~
conanbatt
Incredible that this is another comment of yours that manifests the answer I
gave you in this topic.

Providers are under the microscope for opioids now, so why risk it, it's not
their pain. Medicine is a rough field.

~~~
bpaddock
We posted at the same time, see my comment above yours about the documentary
Pain Warriors.

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.

------
coldcode
Yet all that happens is they pay a small fine and promise not to do it again.
Tell that to all the families who lost people to opioids.

~~~
JshWright
According to the "statement of facts" the US Attorney's office released, this
action resulted in "tens of thousands" of additional prescriptions of highly
addictive extended release opioids. Without a doubt this resulted in lives and
families destroyed.

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.

~~~
toomuchtodo
Civil suits are a possibility. Someone bought a whole lot of liability.

~~~
raverbashing
Class action lawsuits are a money making machine for lawyers but it seems this
is the use case they were designed for

------
dkarras
As a non-American I'm also curious about the mass necessity of opioid
painkillers to begin with. From what I hear, people are prescribed opioids
post surgery etc. which is bonkers to me as a foreigner. I'm a middle aged
person and I have never seen anyone using opioid painkillers anywhere in my
life. They give stuff to you when you are having surgery, and when you are in
hospital's care, but something very extraordinary has to happen here to have
access to those medications outside of a hospital setting. In the USA it seems
to me like most people are prescribed these painkillers at least once in their
life between 1-50 years but here, it is very exceptional and people are doing
just fine.

~~~
nradov
In 2007 an oral surgeon gave me a prescription for opioid painkillers after a
wisdom tooth extraction, just in case I needed it for pain. The pain wasn't
very bad and I never filled the prescription, but in retrospect giving me that
prescription in the first place was just crazy!

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.)

~~~
somurzakov
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](https://en.wikipedia.org/wiki/Alveolar_osteitis)

~~~
nradov
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...](https://med.stanford.edu/news/all-news/2018/12/opioid-
prescriptions-from-dentists-linked-to-youth-addiction-risk.html)

~~~
somurzakov
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.

------
dekhn
My wife used to work on an EMR that basically did the opposite of this - if a
patient came in, and the dr was going to prescribe opiates, it would pop up a
big window saying "Are you sure? There is potential for abuse..." for patients
with a history of abuse (not sure what it did for other patients).

------
MandieD
Story from VTDigger: [https://vtdigger.org/2020/01/27/health-records-firm-
agrees-t...](https://vtdigger.org/2020/01/27/health-records-firm-agrees-
to-145m-fine-the-largest-ever-in-vermont/)

Spoiler alert: "Pharma Co. X" is Purdue. Shocking! /s

------
dirktheman
If I would know that my MD is using a free, cloud based, ad-supported platform
to keep my health records I'd be rather ticked off...

~~~
JshWright
The age old adage... If you're not paying for the product, you are the
product...

~~~
penagwin
I'd think Americans are paying enough for their Healthcare to not be the
product but....

~~~
bcrosby95
For the first time, this year my tax document shows how much my employer is
paying for my health insurance.

34k/year. Yeah, that's a lot.

~~~
MandieD
I hope that also covers your spouse and six kids, with no deductibles and on-
demand housecalls from specialists...

------
sjg007
This was Practice Fusion, which was a startup in SV/SF.

[https://news.ycombinator.com/item?id=22165946&ref=hvper.com&...](https://news.ycombinator.com/item?id=22165946&ref=hvper.com&utm_source=hvper.com&utm_medium=website)

------
KoftaBob
"Practice Fusion admitted to the scheme with an unnamed opioid maker, though
the details of the government case closely match a public research partnership
between Practice Fusion and Purdue Pharma Inc., which makes OxyContin."

Color me surprised that it's probably Purdue. Every asset that the Sackler
family owns should be seized.

~~~
annoyingnoob
We really need to bring back the Stocks/Pillory for the Sacklers.

------
joshpadnick
I remember the shock about 10 years ago when I saw that PracticeFusion
wholesale-copied the website design of Mint.com and then just customized it to
their own business[0]. It struck me as boldly unethical, and 10 years later
this opioid popup scheme rings the same.

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...](https://web.archive.org/web/20100628142953/http://www.mint.com/)

[0b] PracticeFusion in Feb 2010 (though rendering required Flash at the time):
[https://web.archive.org/web/20100228002944/http://www.practi...](https://web.archive.org/web/20100228002944/http://www.practicefusion.com/)

------
Jerry2
I was curious who the people behind Practice Fusion, the company in question,
were so I did some digging:

Executive team:
[https://web.archive.org/web/20131108114711/http://www.practi...](https://web.archive.org/web/20131108114711/http://www.practicefusion.com/pages/executive_team.html)

Board of directors:
[https://web.archive.org/web/20131022222205/http://www.practi...](https://web.archive.org/web/20131022222205/http://www.practicefusion.com/pages/advisory_board.html)

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.

~~~
beaugunderson
That page looks to have been removed after Allscripts bought them. Part of the
deferred prosecution agreement is that PF will have to have information about
the prosecution on their website, so I'm looking forward to that.

------
bitwize
Candy Crush adverts in Windows 10 was bad enough, but this is next-level evil.

Time for the software industry to wake up and realize it's not the advertising
industry.

~~~
m_fayer
Most software is streamlined automated bureaucracy. Not in the pejorative
sense, but in the "basic infrastructure of a human enterprise" sense.

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.

------
kingkawn
Who’d a thought that drug dealing was so lucrative?

~~~
lawn
There's a certain irony on how the U.S. has spent billions on the war on
drugs, yet they still have a gigantic drug dealing problem, right under their
nose.

~~~
mywittyname
Irony is not the word I'd used.

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.

------
zouhair
This is one of the reason some things should never be left to the market or be
driven by profit. Healthcare is a clear example of that.

------
logfromblammo
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
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.

~~~
vharuck
>But even if the developers had ethical concerns, they had no recourse but to
quit, and be replaced by someone else

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.

~~~
mcguire
Whistleblowing is likely worse than quitting.

~~~
jessaustin
Yes, by whistleblowing they would have gone from unemployed developers to
unemployed developers in prison. FBI targets security researchers with no
business connection to health software companies. [0] How much worse would it
be for _ex-employees_?

[0] [https://www.dailydot.com/layer8/justin-shafer-fbi-
raid/](https://www.dailydot.com/layer8/justin-shafer-fbi-raid/)

------
Amarok
I believe opioid addiction is not well understood among general practitioners.
Here in the UK, they accept as common sense that your patient won't get
addicted if they're taking opioids for pain. Similarly for ADHD, when I was
started on meds my psychiatrist reassured there was no risk of addiction
because I had ADHD. In practice, whenever I spend more than 3 days without
them I get terrible headaches.

------
neonate
[http://archive.md/5HYTs](http://archive.md/5HYTs)

------
imvetri
[https://www.reddit.com/r/technology/comments/evt5vz/electron...](https://www.reddit.com/r/technology/comments/evt5vz/electronic_patient_records_systems_used_by)

------
thoughtstheseus
Wow, less than 50 years of internet and already people are designing software
to manipulate doctors into recommending opioids. Just think what might happen
with younger peoples.

------
fkfaduc
I'll definitely put that on my list of arguments against proprietary software
(although I'm aware that's not the primary issue).

------
Barrin92
Enough people have pointed to the problems of for-profit healthcare and drug
markets in the comments but I'd also want to stress that this is also an issue
of privacy. These patient informations should never have made it through so
many hands and there should be no pop-up ads in a doctors record file.

Before anyone complains about burdensome regulations, these are the situations
were respecting people's information prevents deaths an family tragedy.

------
jessaustin
_...free, ad-supported health-records software to independent doctors..._

You're not the customer...

------
Jamwinner
The people defending these types of actions here make me sick. What the hell.

------
say_it_as_it_is
If a doctor is unable to think independently of a pop-up recommendation for a
drug, the doctor should have his/her license taken away. This should be the
next step in the process for real social justice.

------
ptah
doesn't texas still have death penalty? pity it doesn't apply to corporations.
both of them deserve it

~~~
Nasrudith
I don't think the crimes technically qualify as a capital crime despite the
major and obvious ethical and moral lapses. Even with more blatant and callous
examples like "miracle mineral solution" (read: bleach as medicine for
internal use) fraudsters don't reach that level. Nor even "knowingly selling
possibly tainted products". Not a lawyer but I think it essentially would call
for say deliberately adding cyanide to your products to be outright murder.

------
RobLach
What horrid business. Embarrassing.

------
ptah
surely this is jailable fraud?

------
alistairSH
Another slap on the wrist for corporate malfeasance. And the executives who
dream up and sign these deals get away with murder.

------
conanbatt
Designing the tools that providers use to treat patients is exceedingly
difficult and filled with moral hazards.

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.

~~~
Wowfunhappy
> Designing the tools that providers use to treat patients is exceedingly
> difficult and filled with moral hazards.

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.

------
rolltiide
the market will always gravitate towards products that scale, that's all drugs
are. when you become more efficient it is intangible easily replicable things.

I think a quadrant based graph makes this more apparent and can influence
public policy

~~~
jessaustin
Could you flesh this out a bit more? What are the two axes of the quadrant?

~~~
rolltiide
Liquidity, overhead

Maybe a z-axis for margins

------
LatteLazy
Profit motive is great for simple products, ones that have few social
implications, ones where defects or issues appear quickly. Maybe that used to
be the case in medicine. But its not anymore.

------
marriedWpt
Remember when physicians said they should be the only ones to give out
antibiotics for our safety?

Can we totally kill that excuse for their monopoly?

We trusted the physician cartel for decades and they have made healthcare
worse.

~~~
bpaddock
Fluoroquinolone antibiotics such as Levaquin (no longer manufactured, only
generics now [you can not sue the makers of generics in most states]), Cipro
etc. should be removed from the market due to their devastating side effects.

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.

~~~
mikestew
_Someone here will inevitably say "I took Cipro et.al just fine"._

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?"

~~~
bpaddock
If you look into their history you find that they are decedents of failed
chemotherapy drugs.

No, they are not safe.

