Really the thing folks need most is someone they know knows their world. Someone to pierce the veil and tell you it’s all bullshit, and that if you want help you have to actually want help. This is what addicts are looking for online, and unfortunately it’s all too easy to manipulate people in this state.
Dealers and con men taking advantage of this ease of manipulation is as old as drug addiction.
This happens in NA/AA meetings too, but the sponsors are usually pretty good at spotting them. I don’t trust Facebook to play that role.
Obamacare mandated that all insurance should cover rehab costs. Several rehabilitation companies opened an enormous amount of "clinics" in Florida. "Rehab SEO" companies then offered services to these clinics to funnel patients to them. Clinics could charge upwards of $5,000 per urine test from the insurance companies.
It became so profitable, that rehab companies would pay to fly patients down to Florida, pay $1,500 commissions to the SEO companies, and more.
This system of misaligned incentives resulted in the "rehab" companies to buy drugs for their patients, so that they would fail a drug test. This would allow them to "reset" billing for that patient. There is an anecdote from a patient describing one such clinic directly next to a crackhouse with prostitutes. Apparently many patients spent years rotating through these clinics because they had no other options (except maybe homelessness, due to their addictions).
Florida eventually legislated rules that prevented this behavior, which resulted in many of these "rehab" clinics moving to California.
More reporting on this system:
CMS is moving to outcome-based payments for this reason. Too many relapses coming from your treatment center? You get less per patient until your results improve. That should eventually help reduce this kind of behavior.
No, there isn't. This seems like another pop-culture meme that comes out of drug war hysteria.
In recovery you find people that already have access, trying to stop using.
I can't help but think just how much the internet opens the door to bad actors trying to pillage and plunder. Really makes this line of work feel like a massive mistake.
One of my friends from high school jokingly told me they call that the thirteenth step. So it must be pretty widespread to have a name, which is sad. You go some place for help and your fellow attendees prey upon you instead.
[I spent a few years in the orbit of 12 step programs in my youth]
I'm not saying there aren't predators, mind you, I just don't think that every relationship there stems from one person trying to take advantage of another.
In fact, I've seen three people ever asked to stop coming to a meeting, and all three were for thirteenth-stepping or similar. Being asked to stop coming may not seem serious, but for some perspective: the third tradition of AA is "The only requirement for membership is a desire to stop drinking." People show up disruptively drunk or tripping and don't get kicked out. A large portion of our membership have spent time in jail for violent crimes. Before these things were accepted in society at large, people of color and gays were accepted into meetings. We take the third tradition very seriously--the only way someone is asked to leave is if there's justification from the first tradition ("Our common welfare comes first") so you have to be seriously impacting the welfare of other people in the group before you'll be asked to not come back.
I'll also add that there are resources available to protect people. There are tons of women-only meetings and most areas have LGBT meetings as well. It's also explicitly not against any traditions to involve law enforcement if sexual harassment, stalking, etc. occur--there's a safety card which explicitly announces this and it's read at the beginning of many meetings.
When people get more sober time, dating becomes more accepted--generally after a year. But generally this is done with strong admonishments to put the sobriety of both parties first, and we still look out for each others' safety.
I don't look at AA with rose-tinted glasses. It's a human program and it's imperfect. Certainly as an atheist I wish there was a lot less god nonsense. But the flipside is that I'd probably be dead if I were still drinking, and instead I'm 20 months sober and doing really well. Certainly 13th stepping is a problem, but it's a problem which many groups deal with fairly well, and I wouldn't want anyone to not get help because they are afraid of being 13th stepped.
The only thing that defines whether you are a good or bad person, is what you do at a personal level. Even though I may contribute to horrific consequences on a business level, at the personal level I am still a good man.
I'm all for cutting people slack for systematic issues, environment, zeitgeist etc. But just giving it a free pass because it's business seems very wrong. Most of the bad things in this world are "just business".
Today’s equivalent might be H1B Visas, which many companies in the valley make ample use (and even abuse) of.
Slaves are mistreated by definition of being slaves.
It's true that on some level, we exist within a system that forces us to make bad choices, and in general I think criticising individuals for systemic issues is a waste of time, but you can't just say "it's just business" to dismiss all moral decisions.
If you are working for a company which you know to be causing harm, and you are in the privileged position to be able to leave without becoming destitute, choosing to keep working for them is absolutely an action which can be morally condemned.
There is something uniquely... American about this comment. By that I mean that divorced from the ethics setting up large Facebook groups and using them to funnel patients into your addiction center is a great strategy, and it clearly works. It seems, to me at least, to make good business sense. That's not to say that the practice itself is unique to America, more that it's encouraged by the hyper capitalist 'profit above all else' that America espouses.
After taking a step backwards however then you're just exploiting/taking advantage of vulnerable people looking for help and using that to manipulate them into giving you money.
This describes an uncomfortably large section of our (customer facing) economy. Casinos, tobacco, payday loan sharks, etc are the obvious actors. But if you look more closely, you will see that there are essentially two families of competing in b2c:
* productive: quality, service, price.
* destructive: bait and switch, seduction through marketing (unrelated to the actual product), etc.
All of the destructive forms eventually boil down to: abusing the faults in our human brain. Once you start looking at the world this way, you will see it everywhere. Almost every commercial on tv is destructive. E.g. car commercials never talk about car specs; they just try to seduce your fallible brain. Perfume. Clothing brands. Any food franchising (which are not about food, they are marketing companies who happen to sell food). Etc etc etc. None of these advance society forward.
There is an all-out, 24/7 war on your brain. It is what hippies mean when they talk about “buying shit you don’t need”. The only problem with that statement is it puts the blame with the consumer. But we are only human, and fighting a mental war 24/7 is exhausting. The problem is more insidious than mere gluttony / consumerism.
The example here is egregious and very clear. But make no mistake about it: it exists, in smaller form, everywhere you go.
And the sad part is that a lot of our brightest people work at Google, Facebook and others to win that war for the seducers.
I got a job making new software and learned what a Skinner Box was and changed by plans. I don't need to be part of that.
It seems to me like there's plenty of good people willing to fight the good fight, but their lifestyle comes first and ideals second.
Furthermore, try sitting down with a teen, twenty, thirty, or heck, anyone not technologically inclined and try to explain the causes and ills that "marketing" causes. It is difficult. However, many are aware of and despise it, but have no idea what to do about it.
I'm sorry, but GP is right. Advertising has gone too far. It really is just customer predation at this point. It is no longer about making sure your business is out there if the consumer comes looking, it is about exploiting every heuristic that can be used to short circuit the consumer making a conscious decision to see anyone else but you.
At some point, the intrusion and attention manipulation has to end.
The reason advertising companies collect all this data is to use it for marketing/advertising (among other things). The truth of the matter is that Google et. al. would lose users if they charged them what it actually cost to run and continually improve their services and make a profit (which is their prerogative/duty as for-profit companies).
Consumers may say that they'd be open to paying for services, but I have a strong suspicion this is not true at a large enough scale to be even worth exploring.
People paying for online streaming services versus cable may be a counter to that argument, although then it seems like it takes decades for the ad-fatigue to set in...or the ratio of ads to content has to steadily keep increasing until it reaches the tipping point where people would rather pay (and still throw a fit when Netflix raises their prices).
Pay-TV over cable arrived in the US in 1972. Netflix's streaming service was first available in 2007. The problem wasn't that people took decades to be annoyed by advertising on cable but that for decades Netflix (Hulu, Amazon Prime, HBO Now) did not exist. Once paid commercial-free streaming services arrived, uptake was rapid.
20 years ago, I knew plenty of people who would be willing to pay good money for a TV service without ads.
Today I find almost no one willing to pay enough for, say, Facebook without ads. Most people I asked say $0 or $1/month. To get the same revenue as they currently do, FB would need to charge $20/year to everyone. Since many (most) will not pay that amount, they need to charge even higher.
I don't see how a company like Facebook would make that much profit without ads.
And to be frank, decent enough non-ad supported alternatives exist. I can't get one person in real life to switch to them.
News is another example that mostly hasn't worked without ad money. There are some examples (e.g. government funded), but even those don't have enough reach compared to what the ad supported ones did 20 years ago.
That it worked for TV is not an indicator that the general model can be applied to all ad-supported services out there.
Advertising is "Hey, we're here!"
What they do now is more akin to attempted social engineering/psychological manipulation.
It's disgusting to see, disrespectful to everyone, and if I had to guess, I'd say it is fueling a counterculture that could very possibly put a leash on the current understanding of free 'marketing' speech.
News and the main stream media have the same problem. They focus so much on paperclip maximizing for viewership that the quality of actual useful productive content is being degraded in order to 'lock in' target audiences.
The reason most American consumers prefer advertised-supported products to paid products is simply that can't afford them otherwise.
Unlike people in the top 10% of incomes, like most here on HN, most Americans simply don't have the means to pay an extra $10 or $20 a month here and there for various subscriptions or products. Almost 50% of all Americans have a negative net worth AND struggle to pay their basic bills like water, rent, electricity, and phone/Internet.
Once you understand this, then you'll understand why most Americans can't afford to pay for additional services even if they understood the true cost of advertising-supported services. Unlike the average software developer, they don't have an extra $1000 discretionary income a month to save or spend. They spend their entire income on necessities.
Plus, the cost of ad-supported services are not always evident to the average American, which reinforces their belief that it's not a bad idea to use Facebook and similar services (where they are the product).
stacked against people, this narrative goes. Even being on the wrong end of the structurally inherent information asymmetry between seller and buyer is the buyer's fault, somehow.
Or is it the golden rule at play? He who has the gold makes the rules
The issue at stake here in the US is that money is the final arbiter (with a few exceptions that prove the rule). There is no higher authority (despite the religious types claiming otherwise - many of their clergy are also soaking in the lucre). So our bright, not-foolish engineers should not be solely blamed for the rules in place.
Marketers in this industry are bad and would find a way to do it without Facebook and Google, but you’ve got to admit the engineering/UX/product teams are indirectly enablers in the system as well.
Buying ads and ad services for one. Not sure how I feel about 'market research'.
I'm no fan of advertising (canceled cable decades ago, happily use Ad Blocker, etc). But these sweeping statements do not sit well with me.
Any time I try to persuade someone to do something, I am engaged in brain manipulation. As someone who in the last few years decided to take up subjects like negotiation and communications, most effective communication is brain manipulation - and not in a way that is significantly different from advertising. As the GP said - once you learn these topics, you begin to see it everywhere - in all the ways people talk.
For most of my life, I tried to convince people with purely objective means, and for the most part, it was a failure. If you want to achieve good for most people, brain manipulation is not just a nice-to-have - it is a must.
So declaring it to be brain manipulation is not, in my mind, a negative. It is unfortunate, but not unreservedly evil. Certain applications of it are evil. But banning advertising wholesale is just a lazy way of not dealing with the problem.
Unless you somehow think that having a "society" or "economy" is predicated on that kind of manipulation. I actively repudiate that notion, personally.
>The fact of manipulation is, itself, morally neutral.
I don't disagree. The person I was responding to, however, seems to.
One could argue that we've been influenced by ads for centuries, and the concept of targeting isn't new. But this is one of the cases where a change in amount (how detailed targeting gets) becomes a change in kind. Yes, it looks like the same thing as before just with more data, but it's actually a fundamentally different kind of thing.
Every time we make a discovery or invent a new tool we play around with it for a while, exploring its uses and implications, and find its boundaries. Atomic energy for example. Before we knew exactly what radioactivity was Marie Curie carried around bottles of highly radioactive stuff in her pockets, she was so nonchalant about it that now her notebook has to be kept in a lead box, 100 years later. Since then we've created power sources and weapons and had disasters. Now everything highly radioactive is regulated and tracked.
We're in the "Marie Curie" stage with our advertising tools. We will need to dial back how nonchalant we are about employing these tools against others eventually. Either it comes from within the industry, or it comes from regulation, or we devolve into a dystopia where companies more and more literally own your mind.
This movie also contains one of the best action hero bravado lines ever. I won't quote it here, as I think it's worth discovering in context, but I promise you'll be saying it after.
in my mind, a sequel to They Live would pick up ~30 years after the events of the first film, where it becomes obvious that everyone saw the ghouls in their midst and responded by essentially shrugging. it seems to me that's pretty much what happened irl.
 - https://www.youtube.com/watch?v=eJ3RzGoQC4s
the book is called phishing for phools: https://press.princeton.edu/titles/10534.html
especially on products we're not knowledgeable about, we're vulnerable to get phished.
That is, if you are in the business of giving people a legitimate reason to feel good about themselves, you're either not 'in business' or soon won't be.
And so alarmingly many of the "trust the market" crowd with whom I've spoken simultaneously hold the position that if you've been taken advantage of by marketers who are leveraging the flaws in your brain against you, that's your fault.
I'm just, "Buh?"
My libertarian coworker used to say to me, "well, you don't have to buy the product". He didn't buy my explanation, which was this isn't people just asking you to buy their product in an annoying manner. Its straight up psy-ops (psychological warfare) at this point.
This discourages me from wanting to go into long thought train about what I would like to outlaw. What I feel more confident about is adding lots of friction to the system.
There's nothing wrong with that. You have to. It's where the change will most immediately happen. Grandstanding about how society is at fault etc etc won't change anything in the near-term. Corporations don't give a shit about the ethics of the situation. A more informed citizenry is the only way anything will realistically change.
Edit: Thinking about it more, it's 100% the fault of citizens. If everyone decided "you know what, fuck McDonald's" and stopped going to them the following day, the company would be sent into a death spiral that would have rippling effects of various degrees across the entire global economy.
The bulk of their customers have kitchens and could make better meals choices.
That's always had resonance for me, especially here in startup culture, where the line between the two is at best hazy, and is often willfully erased. Just today in Jean-Louis Gassée's article on Theranos, he quotes an old Silicon Valley joke about a pitch that shows both kinds of hustle: "It’ll work because it’d be cool if it did." https://mondaynote.com/theranos-could-have-been-stopped-9670...
If you meant that this is a capitalism/free-market problem and the US is the poster child for those values, then I agree with the sentiment, if not the phrasing.
Yeah, that's what I was trying to say. I've edited it a bit to make that more clear.
I would argue that it does seem uniquely bad in the US, and that could be for a number of reasons like significant differences in drug use compared to other developed nations.
For all the bad rap it gets about being inefficient, some things really ought to be run by the government, especially when public money is involved. I find it hard to believe that a government run system could be less efficient than one that has to pay off insurance companies, recruiters, and mass marketers, all with what seems like little oversight.
...and lawyers. Apparently many software, hardware and medical drug research companies spend more on legal fees than research (!!!).
Plutocracy, kleptocracy, laissez faire and such may be more efficient, but they’re intrinsically unfair.
What makes you think that the government wouldn't also have to work through those hurdles?
Government is notoriously inefficient, especially at scale. If government demands a process be done in the public sector, then there is zero competition and little innovation in the process.
Fewer conflicting incentives, for one.
I'd say that government is more legendarily inefficient, in the sense that it's something people just say without much data to back it. I've done chunks of consulting for both governments and very large companies. I don't think one is particularly more efficient than the other. The problem is more large organizations than their revenue model.
One real advantage government has is a sense of mission. I've met plenty of people in public service who really do view it as service to the public. At a large company if you want a bunch of people to row in the same direction you often have to make it personally valuable to them in the sense of explaining why it's better for their careers or their wallets. In government, I've had plenty of luck appealing to a sense of purpose, of doing good for the citizenry and the people being served.
If anybody would like to see for themselves, I recommend Code for America's annual conference, which is coming up at the end of the month in Oakland: http://www.cvent.com/events/code-for-america-summit-2018/eve...
The one time I went I met a lot of people who were excited about the way modern technology let them be radically more user-focused than old bureaucratic and/or computerized solutions allowed.
I have looked at the various Code for America endeavors and you're right: it does appear that people who are part of it feel very motivated by mission, so things like that are probably a very strong net good.
It also leads to organisations spending money on things like advertising, which serve little purpose for the consumer, and exist only to improve their position relative to their competitor.
Competition can be better in some cases, but I'm increasingly sceptical of the assumption that it's always better, since it has these downsides.
And I don't think there's any inherent reason why a government organisation can't innovate, they usually just don't have the resources to risk doing anything they can't be sure will work. I suspect there are plenty of people in most government agencies who have ideas about how to make things more efficient, if only they had a bit of flexibility in their budget to try them. This is largely a political issue, not an organisational one.
How does anyone know how inefficient or efficient any large organization is since they are all complex and different? Without transparency and proper methodology identifying areas of inefficiency, drawing sweeping conclusions either way is more an ideological position.
Banks have just been bailed out with trillions of dollars, where is the efficiency. The pharma and telecom industry is routinely exposed for price gouging. And the corruption investigations against private educational institutes has recently been dropped by the current administration. These inefficiencies are simply transferred to the public in higher costs.
This is simply not true. It’s true for many branches of American government, partly due to the efforts of anti-tax advocates, but there are many highly effective governments worldwide.
It's not implemented 100% and there are exceptions but most parts of the public sector are required to find ways to do more for less every year. Obviously the idea is to use technology or better procedures.
This doesn't mean that the public sector doesn't grow just that it has to be more effective with it's money.
No more than any other similarly sized organization.
If your business model starts to look like a copy of Scientology you should probably question your ethics.
And not doing that would be a case of "leaving money on the table" - a cardinal sin.
The reason we invented commerce and later corporations is that we can create more value for each other than we can create for ourselves on our own. Systemically, businesses exist to create more value for their customers than the business extracts in cash. Profit is a side-effect of serving customers, not the purpose. In practice, almost anybody hauling out the "increase shareholder value" line is justifying some sort of short-term thinking that increases cash returns at the expense of long-term assets like loyal customers and happy, highly-trained workers.
It's a dumb idea. And don't take it from me; the article has many famous capitalists saying so. Further searches will lead to many others saying why, including many business school professors.
* The conquistador and later Portuguese ans Spanish empires "strip mining" the Americas
* Both East India companies (Dutch and British) "strip mining" India and south east Asia
* The slave trade and various industries it enabled (e.g. cotton and sugar)
* Colonial financial interests of the US in the Americas
Closer to our times checkout the "Friedman Doctrine": "There is one and only one social responsibility of business – to use its resources and engage in activities designed to increase its profits so long as it stays within the rules of the game, which is to say, engages in open and free competition without deception or fraud."
As to the "many famous capitalists" you mentioned, it doesn't really matter what they say but rather what the businesses they manage do.
One organization literally refers to patients as "rescues". and this is one of the better actors in the space.
OTOH, these efforts help "raise awareness" and "save lives", more lives than if nothing had been done. It's extremely cost inefficient, but a self-interested naive outlook allows a straightforward rationalization process.
All watched over by machines of loving grace (Essential viewing for hackernews readers, I think this is his best work)
However they are thought provoking and extremely well made.
Honestly I have no way of knowing. Sending me for all sorts of tests would indeed maximize shareholder value, though, which is all anyone in the US cares about anymore.
On top of that, they don't provide anything even approaching evidence based care.
It's more about working with human nature instead of against it. Doubting virtuous intent seems important too, but maybe that's just me (and not you credulous folks).
They learned it from the best. The Dutch East India Company, the British South Africa Company, and a couple of dozen others.
People in stone houses shouldn't throw glasses.
This has been one of the most insidiously destructive forces in the modern world. Luckily the millennial generation (even in America) is largely rejecting this conception of the purpose of business.
You can read Friedman's Op-ed in the NYTimes espousing this here: https://www.colorado.edu/studentgroups/libertarians/issues/f...
I think Friedman's point was more that 'businesses' don't make decisions, people make decisions, and there are two classes of people involved - the people who own the business(principals), and the people who run the business on their behalf (agents). His article argues that the agents should carry out the principal's wishes (which does can include ethical concerns), not their own.
"Of course, the corporate executive is also a person in his own right. As a person, he may have many other responsibilities that he recognizes or assumes voluntarily–to his family, his conscience, his feelings of charity, his church, his clubs, his city, his country. He may feel impelled by these responsibilities to devote part of his income to causes he regards as worthy, to refuse to work for particular corporations, even to leave his job, for example, to join his country's armed forces. If we wish, we may refer to some of these responsibilities as "social responsibilities." But in these respects he is acting as a principal, not an agent; he is spending his own money or time or energy, not the money of his employers or the time or energy he has contracted to devote to their purposes. If these are "social responsibilities," they are the social responsibilities of individuals, not of business.
Much of the best writing I have seen regarding the relationship between individual 'virtues' and economic growth is Deirdre McCloskey's "Bourgeois Virtues: Ethics for an Age of Commerce"
I've had exactly that said to me in a discussion of pollution: I.e. someone actually said that corporations should pollute to make more profit to the legally allowed extent of the law, to maximize shareholder value, and then they can pass laws to reduce the legally allowed pollution levels, rather than just instructing management to not pollute.
(My reply involved VW emissions scandal FWIW.)
If Corp A is reaping the profit while the cost is diffused then Corp A is in a far better place to influence future laws than those they are harming.
And by the same guiding principals, Corp A should influence the law to the extent allowable by law, including changes which allow them more legal influence, and remove the influence of others.
The purity and simplicity of the "Friedman position" is seductive. But I just don't think it is fundamentally valid to e.g. pollute to make money just because you're acting on behalf of someone else.
Someone should inform the members of "Affected by Addiction Support Group".
Civilized societies see a healthy and educated population and infrastructure as the beginning of building a progress oriented society, market fundamentalists like Friedman see it as an end, a process from which they can extract profits. This is an impoverished self-limiting vision.
(Willie Sutton was a notorious bank robber, who allegedly upon being asked why he robbed banks, replied «Because that’s where the money is!»)
While distinctly in poor taste, it can hardly be a surprise that these groups are preyed upon by marketers.
What makes such problems difficult is that they precisely cannot be solved by throwing more money at the problem which in many cases can exacerbate them.
Man, what's with this fascination with "reaching out"? Here we a sales person targeting victims of addiction for a sales pitch terming it "reaching out", setting up some pretty negative associations of that phrase. Yet the journalist is so conditioned they use the very same words for the process of requesting a comment from one of villains of the story!
I guess it's just poor editing, but the blindness is still remarkable!
To me, where it becomes a scam is if/when they proffer completely ineffective treatments. If this place happens to make a buck while saving someone's life, more power to them.
No, you really can't.
Look at how aggressively advertisers bid for ad spots on [credit counseling services]