
Apple Autocorrects Names of Some Medications to Names of Different Medications - Houshalter
https://twitter.com/slatestarcodex/status/944739157988974592
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carussell
This is reminiscent (in scope for errors, not mechanism) as the problem from a
few years back with the Xerox machines that would alter the text of copies:

[http://www.dkriesel.com/en/blog/2013/0802_xerox-
workcentres_...](http://www.dkriesel.com/en/blog/2013/0802_xerox-
workcentres_are_switching_written_numbers_when_scanning)

[https://arstechnica.com/information-
technology/2013/08/confu...](https://arstechnica.com/information-
technology/2013/08/confused-photocopiers-randomly-rewriting-scanned-
documents/)

~~~
xigency
That is an amazingly bad design.

~~~
katastic
That was an incredible read. I had no idea about it. Hilariously dangerous.

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beardyw
I am baffled by some of the twitter responses. If a real person were crossing
out one drug and writing in another would people be rushing to their defence?
Here is a good rule:

It is never right that a computer should do the wrong thing.

It may be explicable, it may be avoidable, it may be correctable but if it is
wrong it is wrong. We will be living in a world where computers are
increasingly autonomous in their actions. Defending their behaviour now sets a
dangerous precedent. Will the same people be blaming victims of self driving
cars?

So whoever added drugs to the spell checker didn't think it through properly.
They need to be told to take them out or put them all in and keep them
updated. If we work around things it is us who will become the servants.

~~~
post_break
Dealing with any issue in the Apple community is mostly baffling. The mindset
of it works for me just pisses me off so much. Got a weird apple bug? 20
comments of how it works for them and YOU must be the problem. Watching people
do mental gymnastics to apologize for the battery slowdown issues on iPhone
recently makes me throw my hands up in the air and land of my face.

~~~
astura
I recall when the first iPhone came out. People would criticized the missing
features, which were inability to copy and paste and no MMS support and Apple
apologists would reply with "why would you want that?"

It was pretty surreal.

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antoineMoPa
Autocorrection in general is bad. Underlining errors and proposing corrections
is OK. As a keyboard user, I expect what I type to show as-is on the screen. I
can always correct later.

Also, autocorrection does not provide proper feedback to learn from mistakes.
Underlining errors does.

~~~
niftich
I've seen people argue that autocorrect is part of the input mechanism of on-
screen smartphone keyboards. The rationale goes, with a physical keyboard of
respectable size, you make much fewer typing mistakes than with a virtual
keyboard on flat glass where the touch targets are tiny. To compensate for the
inferior precision, autocorrect comes in to figure out what you meant.

As a thought experiment, consider voice input. Voice input is often used when
a screen isn't even available for feedback, so the computer has to figure out
if it thinks it transcribed you correctly. To make the usability bearable (and
to keep the computational difficulty down), contemporary systems don't ask you
for clarification; they just try to transcribe your sentence against a
dictionary. For the voice-controlled systems of today, "autocorrect" is
definitely part of the input mechanism.

~~~
dragonwriter
> I've seen people argue that autocorrect is part of the input mechanism of
> on-screen smartphone keyboards. The rationale goes, with a physical keyboard
> of respectable size, you make much fewer typing mistakes than with a virtual
> keyboard on flat glass where the touch targets are tiny. To compensate for
> the inferior precision, autocorrect comes in to figure out what you meant.

That's a nice theory; the problem is that autocorrect is often stunningly bad
at that, and turns slight typos into radically different words. Humans are
_very good_ at getting the correct sense from text with typos, but not so much
with arbitrary replacements.

Voice control is, obviously, a whole different kettle of fish since you don't
have a text input stream to start with.

~~~
JoshTriplett
> Humans are very good at getting the correct sense from text with typos, but
> not so much with arbitrary replacements.

That assumes that you leave the typos in place rather than fixing them. If
your goal is to type error-free text, then which one leads to the correct text
faster? Autocorrect and then fixing the occasional word it gets wrong, or
trying to edit away typos on a tiny screen?

~~~
stordoff
A correctable error (e.g. a typo, as most will still be understood) is better
than an uncorrectable error (e.g. a change to a word that may still made sense
in the context). Offering to correct a word, rather than silently doing it,
will like lead to correct text, rather than text that _appears_ correct faster
- I can very quickly scan for a UI prompt suggesting there is a typo, but I
might never notice when a word is silently changed for me.

I've noticed this on Windows Phone - on WP8, the background colour of the
suggested word briefly changes on an automatic correction, so it's easy to
notice and double-check it's done the right thing. On WP10, it only gets
slightly bolded and only until you hit space. I've had multiple emails where
I've not noticed a erroneous correction until I'm later re-reading it for
whatever reason.

~~~
JoshTriplett
> Offering to correct a word, rather than silently doing it, will like lead to
> correct text, rather than text that _appears_ correct faster

Android's approach is to take confidence in the correction into account: if
it's _extremely_ sure it'll auto-correct, if it's less sure it'll just offer.
And either way, the UI makes it clear when either of those things has
happened.

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gumby
I heard this problem discussed in a talk about electronic medical records 20
years ago. One of the many drivers was to remove the "burden" of the
pharmacist. The speaker (who had an EMR company, and was pro EMR) said that
actually the pharmacist was a crucial preventer of error as they would notice
a strangely chosen medication (usually a pull-down-list mis-click back in the
late 90s) and call the doctor for clarification.

Ironically this would often piss off the patient who was waiting for the
prescription!

~~~
bonzini
This happened to me eight years ago, though the prescription was for my wife.

The pharmacist just ignored the prescription because it made no sense for the
symptoms, and the dose was correct for the other medication. So it was obvious
to him what she had to take.

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eitland
I'd say that would also be scary..!

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pavel_lishin
Which part? The pharmacist deciding which medication to give you? It makes
sense to me - they're looking at inputs, and using their professional training
and experience to make the right choice.

It's no scarier (or, alternatively, as scary as) a doctor listening to your
heartbeat and measure your blood pressure and choosing which medication to
prescribe.

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leereeves
How did the pharmacist have access to the information - symptoms, test
results, medical history - they needed to make the right choice?

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kurthr
Prescriptions include the drug name, (route- oral/rectal) the amount (and
exiration), the schedule (and refills), and the symptom being treated along
with the name of the doctor and their prescribing organization. Some
combinations of them are so common/nonsensical that they could be corrected
from context.

I'd argue that changing the drug without calling the doctor (to at least let
them know there was a mistake e.g. pull-down error by the nurse assistant)
isn't a good idea, but it's VERY common to have them fill with an
alternative/generic when the prescribed one isn't in stock. Usually, they'll
mention it.

Honestly, there's a reason that pharmacists have such strict education and
licensing. They regularly have to decide exactly these things based on this
limited information. It's their job (often along with mixing/compounding
drugs).

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astura
I don't know where you live but I'm sickly, I've filled hundreds of
prescriptions in my life written by 20+ (at least) prescribers in three
different states. Never once did any contain any symptoms. Even the ones that
are prn (as needed).

Not only that but many medications are not for treating symptoms but are
prophylactic. Especially post surgical ones.

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kurthr
Examples: Take as needed for anxiety, pain, etc. I've never seen a difference
with post surgical prescriptions in CA or TX other than the type and quantity.

~~~
astura
Just no... No...

I believe that short term prn medicine may contain some language like that.

For anyone else,

The _VAST_ majority of prescription medication does not contain such language.
Post surgical medication are like this: "take once a day" not something like
"take this antiepileptic drug once a day to prevent seizures after brain
surgery." Which is the actual purpose of the medication.

I talk from experience.

Any type of ongoing maintenance drug is going to omit any sort of symptoms,
assuming any are present in the first place.

Again, experience.

Sure, this may be your experience with filling 5 or less prn prescriptions but
this isn't how the majority of scripts work.

Even if the pharmacist had your FULL medical history it seems very unusual
they'd be able to catch this sort of error.

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panic
I've never understood why autocorrect is enabled by default on Macs, which
have precise, physical keyboards.

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brianpan
The answer is imprecise, erroneous humans.

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pishpash
Noted. Precise humans will choose another brand.

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Spivak
Precise humans will turn it off and post elitist comments on internet forums.

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nykolasz
I found this happening with many other domain specific keywords. However, this
can be deadly with medications.. Scary.

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crooked-v
I wonder how many people have already received the wrong drugs because of
this.

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0x0
This is a disaster waiting to happen. Scary.

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csydas
Well, yes, but I think the issue is slightly blown out of proportion.

On my 10.10.5 Macbook Air I tested quick and the issue is simply that
duloxetine is not part of the dictionary and fluoxetine is. Even as I write
this post I have the red line under duloxetine.

I'm not sure how the association was made on their particular computer, but it
raises a good point about how the annoyances of AutoCorrect can cause some
difficulty. My last name, for example, is mostly unique, but is one letter off
from a type of fabric. It was mildly irksome until I had the dictionary learn
my name. (At least one goof up at an airport after buying auto-corrected
tickets)

In this case, there is of course a simple fix, which the author should apply,
and if being deployed in a work environment where the change is important,
there are steps that probably should be taken to resolve such issues, and
better visible custom dictionary files. (looking on various *.exchange site
when searching for "bulk add words to macOS dictionary provides many
solutions)

So I agree, that it's a problem, but it's not intentional malice here on
Apple, workarounds are available, and it's a really good feature request that
ought be a pretty low hanging fruit.

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crazygringo
I would assume there are medical regulations that x-ray images, for example,
can't be stored as blocky JPEG's.

It seems like there should also be a medical regulation that input devices
used in a medical setting should have autocorrect turned off. It's useful for
e-mailing your mother, but obviously not in medicine.

There are all sorts of regulations licensed medical practices need to follow,
or which medical devices have to follow, which the rest of us don't have to.
(Similar to aviation, for example.) Sounds like this is a good candidate for
another, no?

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raverbashing
Oh, in a desktop computer that's even worse

It could autocorrect minor mistakes but not whole words

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daveFNbuck
fluoxetine -> duloxetine is a minor mistake. It's just swapping lu to ul and
typing d instead of f. These are very common typos.

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Asmod4n
Autocorrect gets it data from all iOS/macOS users, so "just" a few million ppl
have to correct it back so it changes for everybody :/

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shiven
Why isn’t some abulance chaser on it already?

Seriously, _proving_ loss due to something like this should be not too
difficult. There is money to be made here - with the ancillary end result
being Apple loses, what little position it has, in the point-of-care market.

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Aloha
No spellchecker can be infinite - its always up to the user to ensure they are
actually saying what they mean.

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nixpulvis
Spell checking is something that doesn't happen automatically when you hit
spacebar or send though...

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Aloha
it does and can - its app specific behavior - mac apps can be setup to
automatic spellecheking, or just flag the word as suspect.

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DecoPerson
I’d say that’s “autocorrect” rather than “spell check”

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Aloha
Semantics for this discussion - the library used is for both spellchecking and
autocorrection.

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stan_rogers
No, "semantics" suggests that the behaviour is approximately the same.
Spellcheck highlights possible errors and awaits user action, while
autocorrect silently changes things. They may use the same dictionaries, but
they are only distantly related otherwise.

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dboreham
Autocorrect is one reason why I am certain we won’t have working self driving
cars any time soon.

Once I see typing correction that’s better than useless, then I’ll know to
look out for driverless cars outside of the Bay Area..

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emerged
That feels true until you imagine plucking a random real life human driver off
the street and paying them to act as your own personal auto correcter. Same or
worse results and yet they make it to work without a wreck on most days.

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AlotOfReading
This is literally what a publishing editor does. They're a lot better than
autocorrect if my experience is anything to go by.

~~~
astura
You're totally missing the comparison. The majority of humans drive, hence
"random person off the street." Youre talking about a trained professional,
the majority of randos aren't randomly spell checking and copy editing
documents. The majority of randos are driving, not just highly trained NASCAR
drivers.

A very large percentage of driver have no business driving, they will give a
driver's license to anyone with a pulse and even people who have no driver's
licenses are all over the road. They don't care, drive drunk, tired, half
blind, with medical conditions, or otherwise seriously impaired. People would
routinely come through my drive thru drunk and stoned, slurring, and barely
comprehensible when I worked at BK. You haven't seen dangerous until you've
seen someone with bipolar disorder drive while manic.

Youre talking about a trained professional, the majority of randos aren't
randomly spell checking documents.

So self driving cars have to be better than your average driver not a
professional driver. Which, frankly, is a pretty low bar.

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BenjiWiebe
Well, if medications had more unique names wouldn't hurt either. Two separate
antidepressants: Escitalopram and Citalopram. And pronounced, they sound
almost the same as well.

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chimeracoder
> Well, if medications had more unique names wouldn't hurt either. Two
> separate antidepressants: Escitalopram and Citalopram. And pronounced, they
> sound almost the same as well.

The names only sound confusingly similar to people unfamiliar with them - for
physicians and pharmacists, it's rare to confuse them.

The similarity in the names is actually intentional and a feature. For
example, erythromycin and azithromycin have the same suffix _and_ similar
prefixes, which is an indicator that, not only do they belong to the same
class, but one is a derivative of the other.

It's been a while since I studied this, but based on the names alone, I would
be willing to bet that Escitalopram is an S-enantiomer of Citalopram - ie, a
mirror image of the drug (or an isolation of one of the two mirror images
present in the latter). If you say it out loud, it's almost a mnemonic pun.

I could also guess that's an SSRI based on the "pram" suffix, though
admittedly you made that easier by mentioning it was an antidepressant in the
first place.

INN names (like citalopram) are actually _incredibly_ well-designed for the
intended user (a pharmacist or physician, not a patient). I wish engineering
terms had the same level of consistency.

 _Edit_ : Turns out I was right. Both are SSRIs, and the former is the
S-enantiomer of the latter.

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pygy_
BTW, the enantiomer thing is a common trick used by the pharma industry to
double the life of a patent. They first release the racemic mix, then the
purified, active enantiomer once the original patent expires.

The racemic mix usually has a slightly higher level of side effects.

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dmurray
I have heard this before and believe it, but I don't understand why it's not
vulnerable to a competitor (perhaps a manufacturer specialising in generic
drugs) releasing the version with only the active enantiomer. After all, it's
not protected by patent.

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pygy_
That's a very good point and I don't know either.

Possibly: the process to manufacture the molecules is also patented, and you
must make the racemic mix to extract the active enantiomer. Not sure though.

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jmm5
Trivial for Apple to compile a list of all medications and fix this.

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nixpulvis
You're joking right?

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function_seven
Isn't there a database of medications? Parse that and include it in the
dictionary.

[https://druginfo.nlm.nih.gov/drugportal/](https://druginfo.nlm.nih.gov/drugportal/),
for example.

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sk5t
Like most things, it only seems simple from a distance. Between branded,
generic, ingredient, and chemical names, there is diversity and ambiguity in
drug naming.

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drewmol
It seems you both are correct... And that's where the problem originates

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INTPenis
Wow this debate is funny. Imho the blame is solely with the user.

To rely on your phone for autocorrecting difficult medication brands and then
blame the phone manufacturer when it doesn't work is really a 1st world
problem.

I'm not saying that Apple is unable to remedy this situation. I'm just saying
the users are unrealistic in belieiving that Apple has thought of this
situation beforehand and made any changes to aide in the autocorrecting of
medicine brands.

Because they are brand names. And there are thousands of them.

~~~
TheRealPomax
Why?

Apple has been in the business of automating daily tasks on the iphone for a
decade now, holding them to account when it comes to when autocorrect _could_
lead to a person's death, and when it is trivially innocent, is at this point
perfectly fair.

There are thousands of brands, so having a cherry-picked list of just a few of
them preinstalled in the dictionary is something anyone who specialises in
autocorrect (say: someone who's worked on it for 10 years and has run into
virtually every edge case loads of times by now) knows you should not be
doing.

Instead of having autocorrect kick in at all, it should simply go "I do not
know this word", so that the blame _does_ lie with the user when they tell the
phone to add their medication to the dictionary.

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ztjio
Tired of people blaming machines for working as designed when they have full
control over the behaviors they are complaining about. It's a single checkbox
in the system prefs to disable this system wide by default. These are
supposedly professionals. They should be professional with all their tools or
hire professionals that can proxy that liability for them.

In other words, this is 100% a fault in the hands of the users in the supposed
problem case.

Now, all that said, I'd not be sad at all if this resulted in Apple disabling
this feature by default. I always have to disable it on every mac as it drives
me nuts. I type quickly so I never see the autocorrection popup.

~~~
jmiserez
In the end it’s a failure of education. If people could write properly they
wouldn’t need autocorrect. Red squiggly lines are useful, but the actual
correction should always be done manually by the user himself. Otherwise
there’s no learning effect.

I always disable autocorrect on all my devices.

~~~
Operyl
I disagree, there’s times where I fat finger. There’s times where I just have
complete brain farts, or have trouble with dyslexia. Auto correct is a savior,
and I don’t believe any of these things I listed are a result of this “failure
of education.”

